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PubMed2003

Intravenous immune globulin use in Canada.

OBJECTIVES: To determine the amount of intravenous immune globulin (IVIG) used across indications in Canada and which Canadian medical specialties prescribe IVIG. To assess the proportion of IVIG that was used in appropriate off-label and labelled indications versus those deemed to be inappropriate off-label indications. METHODS: In Canada, all IVIG is distributed by the Canadian Blood System to Canadian blood banks within the hospital setting. Hospital blood banks then dispense IVIG to individual patients as it is prescribed and, as such, many institutions maintain a comprehensive database inventory on IVIG use. This study is a retrospective review of IVIG use as obtained from 10 teaching and community hospital blood bank databases in Ontario, Quebec, Alberta and British Columbia. Two of these 10 institutions were pediatric teaching hospitals whereas the remaining eight centres were adult care sites. Product usage was assessed between 1997 and 1999 in adult care sites, and 1997 and 1998 in the pediatric hospitals. The information collected included the number of grams of IVIG dispensed, the indications, the prescribing physician's specialty and the number of patients treated for a given indication, all assessed on an annual basis. A separate analysis was performed to determine the appropriateness of IVIG use where appropriateness was based on the published 1997 and 1999 Canadian Consensus Guidelines for IVIG use. RESULTS: IVIG was prescribed for 90 different indications, six of which are licensed in Canada. When considered as separate populations, adult and pediatric use accounted for 61 and 65 different indications, respectively. Licensed use for all known indications represented approximately 47% and 62% in adult and pediatric settings, respectively. Twenty-nine per cent of IVIG use in adult and 17% in pediatric settings was not reported and is therefore unknown. Although off-label use by definition is approximately 53% in adults and 38% in pediatrics, the majority of overall IVIG use (89% in both populations) is considered appropriate by guideline definition. Hematologists and neurologists were the most prevalent prescribers of IVIG. CONCLUSIONS: Based on guideline definition, appropriate off-label use of IVIG is very high in Canada.

Adolescent↗
PubMed1996

Shift in power to hospital accountants.

With the introduction of the Prospective Payment System, hospital accountants' role changed from reimbursement maximizers to an important role in decision making. Faced with increased competition, many hospitals are installing financial controls. Many hospitals are engaging in promotion and health awareness campaigns and expanding their services to stabilize income and reduce the effects of a changing environment. Thus, hospitals operate in a more competitive environment with much uncertainty. When faced with uncertainty, organizations often believe that they must convince society that their existence is legitimate. Increasing specialization and organizational complexity in healthcare professions have made the expert important. Experts, such as the role assumed by hospital accountants, maintain power because the organization depends on them for their special skills and information. Scarce resources coupled with uncertainty move hospital accountants as experts into the power equation in the changing control of the U.S. healthcare system. Since accountants often serve as monitors of scarce resources, information about the resource allocation directly affects the distribution of power. This places hospital accountants in a critical role of assisting their institutions in adapting to a new environment.

Accounting↗
PubMed1992

Constant incidence rates of needle-stick injury paradoxically suggest modest preventive effect of sharps disposal system.

Does placement of impenetrable sharps disposal systems in hospitals reduce needle-stick injury? To study this question, annual health questionnaires were distributed on a quarterly basis to all 8000 employees in an academic medical center in a large eastern US metropolitan city asking each employee whether he or she had experienced a needle-stick injury since the last questionnaire. Questionnaires from active floor nurses were separated and hand tallied in 1987, 1989, and 1990, the latter 2 years being after impenetrable sharps disposal systems had been placed at nursing stations and in individual patients rooms. Total needle sticks in staff nurses reported during the 3 years (20.5%, 23.2%, 21.8%, not significant) did not decrease in the last 2 years. Simultaneously, hospital purchases of needle-containing devices increased 13.5%. Thus a constant reported needle-stick incidence rate may paradoxically represent a modest preventive effect of a hospital sharps-disposal system.

Equipment Safety↗
PubMed1995

RDA: a standard for client server communication in a hospital information system.

The University of Erlangen-Nürnberg contains a large medical faculty with many hospitals, laboratories, and other departments distributed in the town of Erlangen, and it is necessary to exchange medical data between them. For example the basic patient data which are held on central computers, must be distributed to various stations and departments. In addition medical reports which are prepared on or generated by computers in central departments must be transmitted to various points in the hospitals [1]. When the network, based on ethernet cabling within the hospitals and a glass fiber backbone, has been completed, the Erlangen hospital communication system will support an electronic exchange of medical information. Two separate communication methods are used: data exchange via electronic mail according to the international standard X.400 and remote access to central databases using the software product NET-WORK.

Computer Communication Networks↗
PubMed1985

A computer-aided system for planning acute care bed need in Michigan.

As part of an effort within Michigan to promote cost containment and equitably distribute hospital resources, the Acute Care Bed Need Methodology (ACBNM), a model for determining bed need based on normative use rates, was created. We describe herein the ACBNM, the associated interactive computer system, and the data base requirements, and make suggestions for improving the methodology. We also discuss the functions the ACBNM has served in Michigan and the role it could serve in future health planning efforts.

Age Factors↗
PubMed1995

Distributing full-risk capitation revenues among providers.

What are the predominant types of vertical-integration models used to form health systems? The author describes these and the most common approaches employed by health systems to distribute full-risk capitation revenues between their primary care physicians, specialists, and hospitals.

Capitation Fee↗
PubMed2000

Inadequate stocking of antidotes in Taiwan: is it a serious problem?

OBJECTIVE: Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. MATERIALS AND METHODS: A questionnaire was mailed to 834 hospitals to gather information on the availability, anticipated need, and preferred purchase policy of 20 selected antidotes. A survey on the availability of cyanide antidote in 523 cyanide-handling facilities and their neighboring hospitals was also conducted. RESULTS: Hospitals of different size and service levels had a statistically significant difference in response rates. Except for pyridoxine, the availability and anticipated need for antidotes also varied significantly among different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and botulism antitoxin were not available in most (>90%) hospitals. Interestingly, these antidotes are also among the most needed antidotes. Most hospitals preferred a government-ordered purchase of antidotes. In the survey of cyanide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and continued handling cyanide products had stocked cyanide antidote. It is noteworthy that cyanide antidote was also frequently lacking in the neighboring hospitals. CONCLUSIONS: The appropriate storage of antidotes in hospitals or workplaces in rural areas is instrumental in the timely treatment of certain poisonings, while nationwide unavailability is the critical problem. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.

Antidotes↗
PubMed1981

Mental health care delivery system in Greece: a critical overview.

The organizational profile of the mental health care delivery system in Greece is mainly characterized by centralization which is reflected in various functional parts of the system (uneven distribution of psychiatric beds and manpower, absence of psychiatric units in general hospitals serving a certain catchment area, lack of community-based psychiatric services, etc.) As a result of this centralized structure there is a centrifugal flow of the mentally ill patients toward Athens and Thessaloniki and consequently the existing possibilities for community-based care as an alternative to inpatient treatment are rather limited. Future immediate objectives of the national social policy planning should be based on decentralization and reorganization of the psychiatric services in order for the mental health delivery system to respond more effectively to the mental health needs of the Greek population.

Delivery of Health Care↗
PubMed2006

Community wide electronic distribution of summary health care utilization data.

BACKGROUND: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data. METHODS: The development of the community wide data system focused on the following objectives: ongoing monitoring of the health care system, evaluation of community wide individual provider initiatives, identification and development of new initiatives. The system focused on the sharing of data related to hospital acute care, emergency medical services, long term care, and mental health. It was based on the daily distribution of reports among all health care providers related to these services. RESULTS: The development of the summary reports concerning health care utilization produced a system wide view of health care in Syracuse, New York on a daily basis. It was not possible to isolate the results of these reports because of the impact of specific projects and other factors. At the same time, the reports were associated with reduction of hospital inpatient stays, improvement of access to hospital emergency departments, reductions in stays for patients discharged to nursing homes, and increased access of mental health patients to hospital inpatient units. CONCLUSION: The implementation of the system demonstrated that summary electronic utilization data could provide daily information that would support the improvement of health care outcomes and efficiency. This approach could be implemented in a simple, direct manner with minimal expenses.

Catchment Area, Health↗
PubMedDate not supplied

Disseminated and disfiguring molluscum contagiosum in a child.

We report widely disseminated and disfiguring lesions of molluscum contagiosum occurring in a 4-year-old girl secondary to a primary immunodeficiency disorder. The child, born of consanguineous parents, had multiple, asymptomatic, raised, skin-colored and whitish lesions since 2 years of age. On physical examination she had growth retardation features with grade II protein energy malnutrition. Cutaneous examination revealed numerous, widespread, skin-colored to translucent, firm, umbilicated papules of varying sizes (pinpoint to larger than 10 mm). They were distributed bilaterally over all four limbs, including the dorsum of the hands and feet, trunk, face (including lips), eyelids, auriculae, and perineal and gluteal areas. In places, they were linearly disposed and had coalesced to form plaques. A biopsy specimen from a representative skin lesion (arm) demonstrated lobulated epidermal growth consisting of keratinocytes with large intracytoplasmic eosinophilic inclusion bodies and a central crater. These findings were consistent with the diagnosis of molluscum contagiosum. Topical therapies with phenol and trichloroacetic acid were ineffective The child succumbed to a fulminant systemic infection at home, 2 months after discharge from the hospital. The extent and distribution of molluscum contagiosum in our patient was remarkably vivid and has been hitherto reported only rarely.

Child, Preschool↗
PubMed1997

Non-fatal asphyxiation and foreign body ingestion in children 0-14 years.

OBJECTIVES: To examine the frequency and nature of non-fatal asphyxiation and foreign body ingestion injuries among children in the state of Victoria, Australia, and to identify possible areas for prevention. METHODS: For children under 15 years, all Victorian public hospital admissions, July 1987 to June 1995, due to asphyxiation or 'foreign body entering through other orifice' (which includes ingestions), were reviewed. Emergency department presentations due to asphyxiation and foreign body ingestion provided information on circumstances of, and the type of foreign bodies involved in the injuries. RESULTS: The childhood average annual admission rate for asphyxiation was 15.1 per 100,000. Food related asphyxiation peaked in infants under 1 year, and declined to low levels by 3 years. The main foods involved were nuts, carrot, apple, and candy. The rate of non-food related asphyxiation was relatively constant to 3 years of age and then declined by 6 years. Mechanical suffocation was less common. The annual admission rate for 'foreign body entering through other orifice' was 31.7 per 100,000. These injuries peaked in 2-3 year olds then gradually declined. About 80% of these foreign body admissions were ingestions, with coins being the major object ingested. Admission rates for these causes remained constant over the eight years. Asphyxiation resulted in a higher proportion admitted and longer hospital stays. CONCLUSIONS: Prevention of suffocation and strangulation needs to focus on a safe sleeping environment and avoidance of ropes and cords, while foreign body asphyxiation and ingestion needs a focus on education of parents and child carers regarding age, appropriate food, risk of play with coins, and other small items. Legislation for toy small parts could be extended to those used by children up to the age of 5 years, and to other products marketed for children. Design changes and warning labels also have a place in prevention.

Adolescent↗
PubMed2004

Compliance with advice and appropriateness of emergency presentation following contact with the HealthDirect telephone triage service.

OBJECTIVE: Evaluation of compliance with advice and appropriateness of emergency presentation following contact with a telephone triage service (HealthDirect). METHODS: Compliance rates, triage distributions and admission rates were determined using linked HealthDirect and ED records for patients living within 2 km of an ED that presented during 2000. RESULTS: Of 13 019 presentations, 842 (6.5%) were HealthDirect contacts. In the HealthDirect group there were a greater proportion of patients under the age of 15 (290, 34% vs 1598, 13.1%) and women (481, 57% vs 5610, 46%). The triage distributions and admission rates for HealthDirect contacts and other patients were similar (HealthDirect 37.6% admitted, 95% CI 34-41, others 38.4% admitted, 95% CI 38-39, Pchi2 = 0.67). Of 3996 callers to HealthDirect, 3167 (79%) complied with advice with 963 (61%) complying with advice to present and 212 (9%, 95% CI 8-10%) presenting despite advice to defer presentation. Triage distributions and admission rates for compliers and non-compliers were similar (compliers 38% admitted, 95% CI 34-41, non-compliers, 37% admitted, 95% CI 30-44, Pchi2 = 0.89). CONCLUSIONS: HealthDirect contacts were of similar appropriateness to non-HealthDirect presenters and appear to attend the ED independent of HealthDirect advice. HealthDirect has a limited capacity to influence ED utilization or workload.

Adolescent↗
PubMed2005

[Hospital drug safety: medication errors and adverse drug reactions].

BACKGROUND: Drug related problems (medication errors and adverse drug reactions) are frequent and cause increased costs. AIMS: Evaluation of the original articles published between 1991-2001 reporting frequencies of medication errors and/or METHODS: Medline search with the expressions "medication error", "adverse drug reaction", "adverse drug event", "hospital" and completion of the retrieved articles by evaluating the references and by checking review articles about this subject. RESULTS: Medication errors occur with a frequency of 5-10% of all applications, studies retrieved. This variability can be explained by the way the frequencies are expressed (per application, per patient days or per hospitalization), the reporting system (systematic acquisition vs. spontaneous reports) and the wards investigated, but not by the distribution system. Application errors are more frequent than prescription errors. Risk factors are insufficient education in pharmacology, overworked nursing personnel, non-computerized transmission of the prescriptions and lacking pharmaceutical support on the wards. Adverse drug reactions appear in about 8% of the hospitalized patients, also with a high variability among the 20 studies retrieved. This variability can be explained by differences between the wards studied and by the detection systems used. Risk factors are medication errors, female sex, age > 65 years, polypharmacy, impaired drug elimination and deviance of risk factors (e.g. previous allergic reactions). CONCLUSIONS: Computerizing the whole medication process and improving the pharmacological education of physicians and nurses could help to reduce medication errors. In addition, the adoption of clinical pharmacists on critical wards could also lower the medication error rate. For lowering the frequency of adverse drug reactions, medication errors should be avoided and the dosage of the drugs should be adapted strictly to the function of the eliminating organs. Risk factors such as drug allergies and familiar diseases should be screened for and drug therapies adapted accordingly. Severe and/or novel adverse drug reactions have to be reported to the regional pharmacovigilance centers.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Work-related injuries in a rural emergency department population.

OBJECTIVE: To describe the spectrum of work-related injury evaluated in a rural ED population. METHODS: An ED-based injury surveillance system (EDBISS) was used to collect injury data for all ED patients seen over a 1-year period. A patient was classified as injured if his or her record contained an ED log injury code, an ICD-9 N-code between 800 and 995 in any diagnostic field, an E-code, or an entry in the trauma registry. An injury was considered work-related if the patient reported that the injury had occurred while at work. RESULTS: Work-related injuries accounted for 1,539/12,321 (12.5%) of all injuries. The mean age of patients injured on the job was 33.8 years (range, 16-77 years), compared with a mean age of 27.7 years for all the injured patients. Males accounted for 1,026/1,537 (67%) of the work-related injury visits, compared with 57% of all the injury visits. The most common mechanisms of work-related injuries were: overexertion (313; 20%); cut or pierced by sharp implements (248; 16%); falls (250; 16%); struck by object (202; 13%); and transportation-related injuries (71; 5%). Sprains and strains were the most common type of injury sustained (415; 27%), followed by wounds to upper limbs (283; 18%), contusions (182; 12%), and fractures (151; 10%). Of the 1,539 patients presenting with occupational injuries, 178 (12%) presented to the ED via ambulance. Most (1,401; 91%) were treated and released from the ED, with the remainder (136; 9%) hospitalized. The mechanisms of injury that most commonly resulted in hospitalization included struck by an object (28; 21%), transportation (26; 19%), falls (27; 20%), crushing mechanism (13; 10%), and machinery (20; 15%). Of those requiring hospitalization, 132/136 (97)% were male, and the average length of stay was 4.4 days. Four of the hospitalized persons died of their work-related injuries. Known medical charges incurred by patients injured at work were as high as $62,622. The average charge for those treated and released was $273; the average charge for those who required hospitalization was $10,910. CONCLUSIONS: Occupational injuries contribute significantly to the overall incidence of injuries seen in this ED and are responsible for significant medical charges each year.

Accidents, Occupational↗
PubMed1993

Capability of hospital computer systems in performing drug-use evaluations and adverse drug event monitoring.

A survey to determine the extent of computerization in key areas of hospitals, the information being collected in the databases, and the capabilities of the computer systems for performing adverse drug event monitoring and drug-use evaluations was conducted. The questionnaire was distributed to clinical pharmacists in the 500 hospitals composing the Drug Surveillance Network. In the majority of the 166 responding hospitals (> 85%), the pharmacy department, clinical chemistry and hematology laboratories, patient admissions, and microbiology laboratory were computerized for data acquisition and management. The medical records and purchasing departments were computerized in a smaller proportion of hospitals (75% and 74%, respectively). In the majority of hospitals with a computerized pharmacy department (> 78%), there was ready access to computer databases in other departments, but simultaneous querying of multiple databases was possible in only 30%. Patients could be identified according to diagnosis in 82% of the hospitals and according to medication received in 83%. More than 85% of responding hospitals had implemented spontaneous reporting systems for the identification of adverse drug events. Computers are widely used in hospitals participating in the Drug Surveillance Network, but a substantial effort is necessary to make these resources more useful and to standardize processes so that data may be pooled across institutions to deal with important public health concerns.

Adverse Drug Reaction Reporting Systems↗