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PubMed1984

Users' perspectives of hospital pharmacy computer systems.

A survey was conducted to determine if user characteristics affected respondents' expectations of computer systems and to identify the most and least desirable features hospital pharmacists want in computer systems. A questionnaire was mailed to 200 hospital pharmacists selected randomly. The survey was designed to gather demographic data, general systems information, and information on system features in 10 major categories. A total of 111 surveys were returned. Of the respondents, 55% had some type of computer system. The leading type of system used by the respondents was a mainframe-shared system. The majority of respondents (87.4%) indicated that they had a "moderate" amount of experience with computer systems. The most commonly preferred hardware was the minicomputer. It appeared that user characteristics did not influence the pharmacists' expectations of computer systems. In ranking the categories, the hospital pharmacists indicated that the i.v. admixture area, inpatient drug distribution, and clinical functions were the most important for computer applications.

Attitude of Health Personnel↗
PubMed1984

How to organize and manage a hospital's information system.

Healthcare organizations are currently faced with a variety of decisions regarding computer systems and information. Of these, the ability of healthcare organizations to make correct decisions regarding developing information systems professionals, managing distributed resources, and enhancing the corporate structure will affect not only the worth of the information systems, but also the ongoing success of the organization.

Centralized Hospital Services↗
PubMed1999

Physics of rotating gamma systems for stereotactic radiosurgery.

PURPOSE: The purpose of this study was to evaluate the characteristics of a new rotating gamma system for stereotactic radiosurgery by comparison with a well accepted system. METHODS AND MATERIALS: A novel gamma unit for stereotactic radiosurgery has been developed and distributed to 15 hospitals in China. The unit contains 30 cobalt-60 gamma radiation sources with initial activity of 200 Ci (7.4 x 10(12) Bq) each. The sources are positioned along 30 arcs, and rotate continuously as a group in an axis orthogonal to the patient's body. Measurements have been made on a representative unit installed in the Auhai Radiosurgery Center at the Beijing Navy General Hospital in the People's Republic of China. Ionization chambers calibrated by an American accredited dosimetry calibration laboratory were used for these measurements, as well as radiochromic film and thermoluminescent dosimeters. The unit tested utilizes collimators of nominal diameters of 4, 8, 14, and 18 mm. Radiochromic film samples from a Leksell Model U Gamma Knife were evaluated by the same laboratory and are presented for comparison. The treatment planning system was not evaluated. RESULTS: Radiation-absorbed dose rates and profiles measured for this unit are comparable to those previously measured with the same techniques for the Leksell Model U Gamma Knife units in San Diego and Atlanta. CONCLUSION: This unit is capable of producing well collimated beams of high energy photons, suitable for stereotactic radiosurgery. It has similar physical characteristics to those previously reported for the Leksell Model U Gamma Knife unit.

Cobalt Radioisotopes↗
PubMed1984

Progressive pharmaceutical services in a small community hospital.

The pharmaceutical services in an 86-bed community hospital in rural Maine are described. With a staff of two full-time pharmacists, one hospital pharmacy resident, and 2.6 full-time equivalent technicians, the pharmacy department operates a 24-hour unit dose drug distribution system with complete i.v. admixture services. In addition, the department supervises nurses on medication administration and i.v. therapy teams. Clinical pharmacy services include patient-education programs, protocols giving pharmacists responsibility for initiating and monitoring specific drug therapies when authorized by a physician, and concurrent antibiotic review. The department publishes a bimonthly newsletter for physicians and nurses and a quarterly newsletter for hospital employees and patients; it also conducts continuing-education programs for nurses. By maintaining a delicate balance between creativity and practicality, pharmacists in small hospitals can develop progressive services.

Anti-Bacterial Agents↗
PubMedDate not supplied

Cost control through computerized materials management.

Material management is a chain that links every element of the supply function: requisitioning, purchasing, receiving storage and the user departments. This article presents three (3) major areas where an effective computerized materials management system can produce substantial savings. Central inventories, supply distribution, and purchases can all be positively improved.

Computers↗
PubMedDate not supplied

Little packages with big power. A micro-network to meet nursing information needs.

Installation and use of microcomputer LANs is on the rise in health care facilities. The microprocessor is becoming more powerful each day. The microcomputer is quite adept at handling textual and graphic information, which is a major requirement of any nursing patient information system. Microcomputer technology has now advanced to a level where a handful of hospitals have installed, and many hospitals actively plan to install, a complete nursing system based entirely upon a network of microcomputers. This paper discusses components of an order entry/results reporting/care management system based on a distributed, micro network architecture; the benefits of such a design; and the future technology to aid in system use and growth.

Computer Communication Networks↗
PubMed2004

Medicare intensive care unit use: analysis of incidence, cost, and payment.

OBJECTIVE: To determine the incidence, cost, and payment for intensive care unit services among Medicare beneficiaries. DESIGN: Retrospective observational database cohort study. SETTING: All nonfederal hospitals with intensive care unit beds (n = 5003) paid through the inpatient prospective payment system (IPPS). PATIENTS: We used all fiscal year 2000 Medicare IPPS hospitalizations with consistent payment information (n = 10,657,587). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined the distribution of cost and payments overall, by hospital type, and by diagnosis related group. Intensive care was used in 2,353,208 cases (21.1%). The overall incidence was 59.8 cases per thousand beneficiaries in the aged (65+) population, increasing with age from 36.2 (65-69) to 91.6 (85+). Intensive care unit patients cost nearly three times floor patients (4,135 dollars vs. 5,571 dollars), with two thirds of costs associated with the intensive care unit portion of the stay, 2,278 dollars per intensive care unit day. However, intensive care unit cases were paid at a rate only twice floor cases (11,704 dollars vs. 5,835 dollars). Only 83% of costs were paid for intensive care unit patients, compared with 105% for floor patients, generating a 5.8 billion dollars loss to hospitals when intensive care unit care is required. There was a linear association between the percent intensive care unit in a diagnosis related group and the percent paid, with payment >90% of cost only in diagnosis related groups with >/=60% intensive care unit cases. We found that teaching hospitals were better paid than nonteaching hospitals (87% vs. 78% of costs, respectively), but this was only due to indirect medical education payments. CONCLUSIONS: Intensive care is common, expensive, and poorly paid in the Medicare population. Few diagnosis related groups have a large enough intensive care unit population to ensure adequate payment. Additional diagnosis related groups for conditions common to the intensive care unit would improve payment and enable incentives for efficiency.

Adult↗
PubMedDate not supplied

Advances in computer-based pharmacy systems.

This paper summarizes recent advances in computer-based pharmacy information systems for both hospitalized and ambulatory patients. It discusses the clinical pharmacy applications of: pharmacokinetic modeling (which allows for the optimization of patient-specific dosage regimens); drug interaction and adverse drug therapy monitoring (to decrease therapeutic problems); intravenous additive and hyperalimentation programs (to aid in formulating complex solutions); drug usage review (to develop and utilize guidelines for appropriate prescribing); drug information services; and drug distribution systems. Administrative and management control systems are briefly described. Automated label preparation and identification of patient noncompliance with physician-directed therapy are also described. The advantages of a computerized integrated hospital information system are also discussed.

Ambulatory Care↗
PubMed1995

[Prevalence of the use of urinary drainage systems in Spanish hospitals].

BACKGROUND: Urinary catheterization constitutes the main risk factor in urinary infections or nosocomial origin. The use of closed urinary drainage systems is fundamental to decrease this risk. The prevalence of the use of a urethral catheter as well as the proportion of closed type drainage systems in the Spanish medium was studied with the aim of improving the degree of the adoption of control measures for this type of infections. METHODS: The prevalence of patients submitted to urinary catheterization (distinguishing between open and closed systems) in an important sample of Spanish hospitals was determined from the data provided by the EPINE project (1990-1993). The evolution over 4 years in addition to distribution by hospitalization areas were studied. Likewise, the results corresponding to an intervention program carried out in the authors' hospital are presented. RESULTS: The global prevalence of urinary catheterization ranges from 13.1% to 14.6%. The proportion of closed systems did not surpass 56.4% of the total with this system being completely implemented only in one fourth of the hospitals studied. A significant variation was not observed in this phenomenon during the study period. In the authors' hospital, the increase observed in the prevalence of closed urinary catheterization was associated to a marked decrease in the prevalence of urinary infection with values ranging from 4.3% to 0.8%. CONCLUSIONS: The prevalence of the use of open type urinary catheterization in Spanish hospitals remains high. The efficacy of the implementation of control measures of the urinary drainage systems is clearly proved.

Cross Infection↗
PubMedDate not supplied

An economical, personal computer-based picture archiving and communication system.

Taichung Veterans General Hospital has been developing a hospital-wide picture archiving and communication system (PACS) since 1993. A personal computer-based environment was implemented to reduce costs (only $2,500 for each view station) and take advantage of distributed system techniques. Other features of the PACS are automatic image acquisition, hierarchic storage management, efficient image transmission, robust fault tolerance, and user-friendly image manipulation. The system is integrated with the hospital information system so that Chinese-language patient data can be automatically transferred. A four-tier storage hierarchy and a multipath search strategy are used to improve reliability and efficiency. Image compression and efficient image transmission techniques (autorouting and prefetching) are used to reduce the response time. Robust fault tolerance is achieved with fault-tolerant hardware, image replication, and a system watchdog. User-friendly image manipulation features include easy adjustment of the brightness, contrast, or quality of the displayed image; several windows for image display; and image measurement capability. The PACS currently supports computed tomography, ultrasound, magnetic resonance imaging, computed radiography, and digital fluoroscopy; almost all appropriate personal computers in the hospital can be used as view stations. Users are satisfied with the quality, reliability, and performance of the system.

Humans↗
PubMedDate not supplied

An efficient fault-tolerant out-patient order entry system based on special distributed client/server architecture.

An automatic order entry system is very important for processing out-patient information. This system not only helps physicians to enter their orders directly, but can also reduce order communication error and thus improve medical quality. Therefore, many hospitals have high aspirations to generate and implement direct order entry systems, but they are also concerned about the setbacks of system failure. In this paper, we present an effective and efficient fault-tolerant order entry system based on special distribution client/server architecture that satisfies the requirements of out-patient order entry very well. From the experimental results carried out on a prototype, we found that this system can improve the system response time of order entry and can also generate an operational method having a user friendly interface. The physicians can enter their orders easily, accurately, directly, flexibly and at a faster rate by making choices from standardized and personalized menus in this system.

Ambulatory Care Information Systems↗
PubMed1990

Expanding clinical pharmacy services in a VA hospital.

The pharmacy staff at the VA Medical Center, Biloxi, Mississippi, has increased direct patient care activities for the Medical Center's inpatients by converting 139 beds from a manual system of unit dose to a computerized unit dose distribution system. Expanded clinical programs were primarily developed, implemented, and operated by staff pharmacists.

Drug Therapy, Computer-Assisted↗
PubMed2003

[Electronic distribution of patient records and images through PACS: implementation of data protection at the University Hospital in Freiburg].

In large installations of a Picture Archiving and Communication System (PACS), data protection becomes an issue. Above all, not every employee should have access to all data stored in the system. At the Freiburg University Hospital, we developed a concept of dynamic assignment of authorization, assuring that every physician is authorized to the data of all patients under his care. We describe the technical implementation of data protection developed for the integration of PACS and electronic patient records in Freiburg. The system was installed in January 2001 and the experience of its two years in operation is reported.

Computer Security↗
PubMed2000

Assessing the relationship between inpatient and outpatient activity: a clinical specialty analysis.

General and specialist services in public acute hospital outpatient departments play a key role in the health care system and represent a vital interface between inpatient and community care. Typically outpatient services involve millions of patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions of service are provided each year. Drawing on the first full year of data from the Victorian Ambulatory Classification System (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatient encounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatient activity at the clinical specialty level.

Ambulatory Care↗
PubMed1985

A retrospective-prospective study of medication errors: basis for an ongoing monitoring program.

Medication error surveillance is an important component of the quality assurance program of any hospital. The present study was undertaken in an attempt to determine the reliability of data collected retrospectively on medication error forms, as compared to data obtained from a prospective observational study within the same hospital. The results indicate that for many parameters reasonably reliable information can be obtained from voluntarily submitted error reports. Other observations made during the study were also useful to both the nursing and pharmacy departments in their efforts to minimize the occurrence of errors. Based on the information provided by this study, a more formalized medication error surveillance program has been established and a number of changes in the drug distribution and administration systems have been proposed.

Hospital Bed Capacity, 500 and over↗
PubMed1995

A decision support database for nurse care planning as part of a hospital information system.

This paper, based on a doctoral thesis, describes the development and evaluation of a computerized care planning database at the Royal Hampshire County Hospital. It is part of an integrated Hospital Information System, the first to be installed in an United Kingdom. The research examines nurses' attitudes to the Nursing Process to the new care planning system before, three months after, and one year after its implementation. The quality of manual vs. computer care planning is compared in the same time periods using an existing quality assurance instrument and an audit tool, developed during the research. All data was analyzed in each time period in a framework of personal and organizational change theories. The proactive nature of the research allowed findings to be used as a basis for modifications during the process, which culminated in a further project to provide a database of standard based care plans. Results showed that an understanding of the Nursing Process was inadequate and that most nurses were ambivalent about paper care planning and the proposed computer care plans. Three months after implementation, attitudes became more unfavorable; however, after a year, attitudes showed a significant shift towards the positive pole. Conversely, the overall quality-of-care planning improved significantly.

Attitude to Computers↗