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PubMed1985

Analysis of the online order entry process in an integrated hospital information system.

In Kochi Medical School Hospital, many online order systems have been developed as a part of the integrated hospital information system named IMIS KOCHI. The prescription, laboratory and radiology orders are used frequently and entered into the system by physicians. The distribution of entry duration of these orders by physicians was analyzed and it was found that the order entry is a completely random event and the entry process consists of the two Poisson processes; the quick process and the slow process. The two Poisson processes were observed even in the do-prescription order without correction by trained physicians. It is speculated that the quick process depends on availability in the order entry system and the slow process depends on peculiarities in clinics, and the mental condition of physicians.

Drug Prescriptions↗
PubMed2000

Clinical pathways--an evaluation of its impact on the quality of care in an acute care general hospital in Singapore.

A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia and Singapore. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimising cost to the patient. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous clinical quality improvement (CQI), and is essentially the application of these principles at the patient's bedside. However, despite the growing popularity of pathways, their impact on clinical outcomes and their clinical effectiveness remains largely untested and unproven through rigorous clinical trials. This paper begins with an overview of the nature of clinical pathways and the analysis of variances from the pathway, their benefits to the healthcare organisation, their application as a tool for CQI activities in direct relation to patient care, and their effectiveness in a variety of healthcare settings. The paper describes an evaluation of the impact of a clinical pathway on the quality of care for patients admitted for uncomplicated acute myocardial infarction (AMI) through an analysis of variances. The author carried out a one year evaluation of a clinical pathway on uncomplicated AMI in Changi General Hospital (CGH) to determine its effectiveness and impact on a defined set of outcomes. A before and after nonrandomized study of two groups of patients admitted to the Hospital for uncomplicated AMI was done. A total of 169 patients were managed on the clinical pathway compared to 100 patients in the control (historical comparison) group. Outcomes were compared between the two groups of patients. Restriction and matching of study subjects in both groups ensured that the patients selected were comparable in terms of severity of illness. The results showed that the patients on the clinical pathway and the comparison group were similar with respect to demographic variables, prevalence of risk factors and comorbidities. There was a statistically significant reduction in the average length of stay after implementation of the clinical pathway. This was achieved without any adverse effect on short term clinical outcomes such as in-hospital mortality, complication rate and morbidity. There were no significant difference in readmission rates at 6 months after discharge. The paper concludes that clinical pathways, implemented in the context of an acute care general hospital, is able to significantly improve care processes through better collaboration among healthcare professionals and improvements in work systems.

Analysis of Variance↗
PubMed2006

Hypoxaemia among children in rural hospitals in Papua New Guinea: epidemiology and resource availability--a study to support a national oxygen programme.

AIMS: To support a national approach to oxygen systems in Papua New Guinea, we conducted a study to document the incidence of hypoxaemia, its geographical distribution, epidemiological determinants and resource availability in several regions of the country. We also established baseline mortality rate data for all children admitted to five hospitals, for children with a diagnosis of pneumonia and for neonates to evaluate a future intervention. METHODS: Data were collected prospectively from over 1300 hospital admissions in five hospitals in 2004. To establish the baseline case fatality rates, data on outcome were collected retrospectively over 3 years (2001-2003) for over 20,000 children admitted to five hospitals. RESULTS: A total of 1313 admissions were studied prospectively in the five hospitals. Altogether, 384 (29.25%, 95% CI 26.8-31.8) had hypoxaemia, defined as SpO(2) <90%. The incidence of hypoxaemia was much greater in highland hospitals (40% of all admissions) than on the coast (10% of all admissions). This large difference in incidence persisted when the uniform definition of hypoxaemia was adjusted for altitude, and was largely because of differences in the incidence of acute respiratory tract infection. Oxygen was not available on the day of admission for 22% of children (range between hospitals, 3-38), including 13% of all children with hypoxaemia. Oxygen was less available in remote rural district hospitals than in provincial hospitals in regional towns. Clinical signs proposed by WHO as indicators for oxygen would have missed 29% of children with hypoxaemia and, if these clinical signs were used, 30% of children without hypoxaemia would have been considered in need of supplemental oxygen. CONCLUSIONS: Based on this study, an approach to improving the detection of hypoxaemia and the availability of oxygen has been trialled in these five hospitals where a programme of clinical and technical training in the use and maintenance of pulse oximetry and oxygen concentrators has been introduced.

Developing Countries↗
PubMed2000

Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome.

OBJECTIVE: To evaluate selected characteristics of occult bacteremia in the post-Haemophilus influenzae type b (HIB) vaccine era. METHODS: A retrospective cohort study was performed involving 5901 children 2 to 24 months old with fever >/=39.0 degrees C evaluated with a blood culture at an urban tertiary care children's hospital emergency department (ED) between February 1993 and June 1996. Patients were excluded if immune-suppressed, diagnosed with a focal infection, evaluated by lumbar puncture, or admitted to the hospital during initial evaluation. Prevalence of occult bacteremia, distribution of current pathogenic organisms, and time to positive culture in a continuously monitored system were determined. All patients with cultures positive for pathogenic bacteria were reevaluated and serious adverse outcomes were documented. RESULTS: The prevalence of occult bacteremia was 1.9% (95% confidence interval: 1.5%-2.3%). Streptococcus pneumoniae accounted for 82.9% of all pathogens and H influenzae was not a causative organism in this cohort. The mean time to positive culture was significantly shorter for pathogens compared with contaminants (14.9 hours vs 31.1 hours). A culture that was positive in </=18 hours was 13.0 (6.3-26. 6) times more likely to contain a pathogen than a contaminant. The average time from positive culture notification to reevaluation in the ED was 10.6 hours and over half of the patients recalled to the ED for positive cultures were admitted to the hospital. Of patients with occult pneumococcal bacteremia, 95.7% had resolution of their bacteremia without the use of parenteral antibiotics. Two patients had serious adverse outcomes. The rate of meningitis or death was. 03% (.004%-.12%). The contamination rate of blood cultures was 2.1% (1.7%-2.5%). Most (85%) of these patients were reevaluated in the ED and more than one third were admitted to the hospital before full identification of the organism. CONCLUSIONS: Prevalence of occult bacteremia in the post-HIB vaccine era is lower than previously reported. S pneumoniae is the most common causative organism and resolves without parenteral antibiotics in the vast majority of cases. Continuously monitoring blood culture systems allow for early identification and can aid in differentiating contaminated from true pathogenic cultures by time to positive culture. Serious adverse outcome is an uncommon result of occult bacteremia. Updated epidemiology and microbiologic technology may impact the evaluation and treatment of children at risk for occult bacteremia.

Bacteremia↗
PubMedDate not supplied

Evaluating the capability of information technology to prevent adverse drug events: a computer simulation approach.

BACKGROUND: The annual cost of morbidity and mortality due to medication errors in the U.S. has been estimated at $76.6 billion. Information technology implemented systematically has the potential to significantly reduce medication errors that result in adverse drug events (ADEs). OBJECTIVE: To develop a computer simulation model that can be used to evaluate the effectiveness of information technology applications designed to detect and prevent medication errors that result in adverse drug effects. METHODS: A computer simulation model was constructed representing the medication delivery system in a hospital. STELLA, a continuous simulation software package, was used to construct the model. Parameters of the model were estimated from a study of prescription errors on two hospital medical/surgical units and used in the baseline simulation. Five prevention strategies were simulated based on information obtained from the literature. RESULTS: The model simulates the four stages of the medication delivery system: prescribing, transcribing, dispensing, and administering drugs. We simulated interventions that have been demonstrated in prior studies to decrease error rates. The results suggest that an integrated medication delivery system can save up to 1,226 days of excess hospitalization and $1.4 million in associated costs annually in a large hospital. The results of the analyses regarding the effects of the interventions on the additional hospital costs associated with ADEs are somewhat sensitive to the distribution of errors in the hospital, more sensitive to the costs of an ADE, and most sensitive to the proportion of medication errors resulting in ADEs. CONCLUSIONS: The results suggest that clinical information systems are potentially a cost-effective means of preventing ADEs in hospitals and demonstrate the importance of viewing medication errors from a systems perspective. Prevention efforts that focus on a single stage of the process had limited impact on the overall error rate. This study suggests that system-wide changes to the medication delivery system are required to drastically reduce mediation errors that may result in ADEs in a hospital setting.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

[FARMAC: a program designed for monitoring the prescription of antimicrobials in hospitals].

INTRODUCTION: The use of computer programs for monitoring the prescription of antimicrobial agents in hospitals is of paramount importance in the incorporation of electronic databases developed and analyzed by several hospital committees, including the following: infection control; pharmacy; morbidity and mortality; and quality assurance committees, as well as other key areas or departments such as pathology, pharmacy, microbiology, radiology, or hospital administration. OBJECTIVE: To describe the development and use of an "information system" employed for monitoring the prescription of antimicrobial agents in hospitalized patients. MATERIAL AND METHODS: A printed format was developed in order for physicians to ask for authorization for the use of restricted antimicrobial agents (i.e. third-generation cephalosporins and other newly introduced beta lactams, fluoroquinolones, antifungals, antivirals, etc). A computer program, "FARMAC", was designed using the Dbase IV program. FARMAC contemplates the presentation on a screen of a main menu allowing for the use of several options: admissions; antibiotic changes; consultations; discharges; hospital transfers; reports, and distribution. The reports are generated from the menu and appear on the screen or are printed in representative tables and figures. Generally speaking, the system processes information on the use of antimicrobial agents, files information, allows for consultation, of the information and generates reports quickly and efficiently. RESULTS: The presentations were defined on screen, taking into account the space needed in order to avoid an inadequate distribution of the messages, therefore obtaining an optimal image. A database was created defining the necessary fields for storing information with reference to patients and usage patterns of restricted antimicrobial agents. DISCUSSION: The development of an information and surveillance system on the prescription of antibiotics allows for consulting updated information, making the data analysis easier for decision making. Its use will allow for surveying tendencies and usage patterns of controlled and non-controlled antimicrobial agents.

Anti-Infective Agents↗
PubMed1991

One year later: evaluating a changing delivery system.

One year after the introduction of primary nursing on four medical and surgical units in the tertiary hospital, a 23-item survey was distributed to primary and associate nurses on these units to evaluate the nurses' perceptions of the status of this change in nursing care delivery. Lewin's theory of change provided direction for evaluation of the change. The survey assessed improvements in patient care, changes in nursing practice, and interactions with other disciplines. The majority of nurses surveyed reported that patient care had improved under primary nursing; 100% of the primary nurses agreed that care had improved. The nurses identified continuity of care, communications, and awareness of patient problems as specific areas of improvement. They also identified improved interactions with many members of the healthcare team; the greatest were with dietitians, social workers, and physicians. The authors reported both positive and negative perceptions of how practice had changed under primary nursing. Results from the survey provided suggestions for continued support for staff nurses in this change in nursing care delivery within the studied facility, and suggested the need for future assessment and further evaluation.

Attitude of Health Personnel↗
PubMed2004

Incomplete and biased perpetrator coding among hospitalized assaults for women in the United States.

BACKGROUND: Since 1997, hospital discharge data have included external cause of injury (E codes) for designating perpetrator relationship in assaults. For intentional injuries, guidelines require using two E codes; one for the injury mechanism and another (E967.n) identifying perpetrator relationship. Completeness and characteristics of the use of these codes have not been studied on a multistate level among states with complete E coding. METHODS: Hospital discharge data for 1997 were solicited from states with good E coding completeness. Data were received from 19 states (51.9% of women in the United States, ages 15-49). For assaulted women, a regression model was constructed to identify factors associated with perpetrator code assignment using age, payment source, pregnancy status, race, and severity as covariates. RESULTS: Among 137 887 injured hospitalized women age 15-49, there were 7402 assaults (5.4%). Among all assaults to women, perpetrator coding was poor (8.8%). Among those that were perpetrator coded, 83.7% were spouse/partner related. Age was positively associated with probability of having a perpetrator code (p<0.001). Those paid by a private source were 42.9% more likely to have a perpetrator code (p = 0.007). Pregnant women were seven times more likely to have a perpetrator code (p<0.001). Non-white women were 66.8% less likely to have a perpetrator code (p<0.001) than white women. CONCLUSIONS: The poor use of perpetrator codes in hospital discharge data minimizes their usefulness for surveillance of serious injury from intimate partner violence. An implication of this research is the need to understand the gaps and strengthen the completeness of perpetrator documentation and coding. The findings suggest caution when interpreting the results from existing hospital discharge data based intimate partner violence surveillance systems.

Adolescent↗
PubMed2000

[Aetiological aspects of neurological diseases in Dakar: follow-up after 10 years (1986-1995)].

Because of the apparition of new risk factors and numerous progresses in investigation methods, authors take stock of neurological diseases of patients admitted in Clinique Neurologique of Fann during the last ten years. The 8539 cases repartition is as followed: 4736 males and 3803 female. Their ages ranged between 3 and 80 years with 2130 deaths corresponding to 24.94%. Annual mean of admission is 853 +/- 42 cases. Aetiological data are: stroke (3910 cases 45.78% with 60.56% of death). The following is peripheral neuropathieswith 714 cases(8.61%) and the spinal cord compression with 692 cases (8.10%). Comparision of frequencies of different aetiologies with those of previous studies shows that the small capacity of the neurological department is a restricting factor for the entry frequencies of neurological patients; the principal pathologies got small variations from one decade to another. In the opposite, some aetiologies have disappeared (neurological syphilitis, trypanosomiasis, neurocyticercosis, cerebral mycosis). Some eatiologies remain unprecised (infectious diseases, peripheral neuropathies, degenerative diseases).

Adolescent↗
PubMed1981

Implementation of a modified decentralized drug distribution system with the use of master medication carts.

A decentralized drug distribution system with the use of master medication carts was implemented. This system was designed so that roving pharmacists could dispense new medication orders quickly and develop a more personal means of nurse-pharmacist interaction for the benefit of better patient care. The key to the system using roving pharmacists is a master medication cart, a pharmacy dispensing unit on wheels, which travels to each nursing unit. The pharmacy medication profiles are kept with the cart, and at each nursing unit patient medication profiles are reviewed, new drug orders are filled, missing medications and discrepancies are resolved, and nurse-pharmacist consultations can take place. There are two roving pharmacists who make simultaneous rounds of all nursing units in the hospital with two similarly stocked master medication carts from 9 A.M. to 9 P.M., seven days a week. All unit dose drawers are filled in the central pharmacy and are exchanged once daily at 2 A.M. by the night pharmacy technician. Each master medication cart carries about 300 different medications, which comprise nearly 95% of the drug needs of the 340 patients served by the two medication carts. The pharmacy department has added 1.4 Full-Time Equivalent (FTE) registered pharmacists and eliminated 2.8 FTE pharmacy messengers in implementing the decentralized drug distribution system. Currently, three registered pharmacists per day are assigned to the inpatient unit dose drug distribution system (two roving pharmacists and one unit dose filling pharmacist). Our roving pharmacists play a vital role in improving patient care. The overwhelming support by the nursing and medical staff represents an attempt by the hospital to continue to provide an optimal health care delivery system.

Colorado↗
PubMed1986

Team care: an analysis of verbal behavior during patient rounds in a rehabilitation hospital.

Patient rounds are an important aspect of multidisciplinary team care. Team perceptions of ideally functioning rounds were compared with the actual communication patterns in rounds in a physical rehabilitation hospital. Perceptions of the patients' needs in the content areas of physical, psychosocial, and support systems were also compared with the actual distribution of content in rounds. Physicians spoke more (41%) and made more authoritative statements (62%) than did staff from any other discipline. The physicians participated far more than was perceived as ideal in all areas but the physical. Patients contributed only 9% of the discussion and less than 1% of authoritative statements. The physical content area was overemphasized (65%) and the psychosocial area was underemphasized (14%) when compared with the perceived needs of the patients. Interpretations of these findings and implications for investigation of the impact of team care are discussed.

Authoritarianism↗
PubMed1998

[Use of Intranet in the hospital setting].

In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.

Hospital Information Systems↗
PubMed2006

Deaths at Red Cross Children's Hospital, Cape Town 1999-2003--a study of death notification forms.

OBJECTIVES: The availability of cause-specific mortality data for children in South Africa is limited. Hospital-based data have the potential to contribute to understanding of the causation of childhood death in South Africa. The objectives of the study were to gain insights into the causes of death in a South African children's hospital. DESIGN: Prospective, descriptive study of death notification forms. SETTING: Red Cross War Memorial Children's Hospital, Cape Town. METHODS: Data from 1999 to 2003 were analysed by direct and underlying causes of death (using a modified Global Burden of Diseases (GBD) classification) and demographic variables. Death rates per 1 000 hospital admissions were calculated for certain common causes of death. Seasonal correlates of mortality were examined. RESULTS: There were 1 978 deaths. The number of deaths per year increased by 11.4% over the period. The death rate rose from 15.9 to 18.4 per 1 000 admissions from 1999 to 2002, declining to 17.4/1 000 in 2003. The death rate was higher for females than for males (18.4/1 000 versus 17.6/1 000, p = 0.007). Sixty per cent of deaths occurred in children less than 1 year old. GBD group I diseases (infectious, nutritional, perinatal) accounted for the greatest proportion of deaths (58.6%), followed by noncommunicable diseases (29.1%), and injuries (7.9%). HIV/AIDS accounted for 60% of infectious deaths (31.6% of all deaths). Diarrhoea-related mortality was 3 times higher in summer than in winter. Congenital conditions dominated GBD group II (57.5%). CONCLUSION: The analysis shows the value of routinely recording data on childhood hospital deaths. The results mirror those of the South African Medical Research Council's Burden of Disease studies but also reflect the hospital's tertiary functions. Female children were at higher risk of death. Childhood HIV-related deaths are a major challenge to the health system.

Age Distribution↗
PubMed2002

Delivering images to the operating room: a web-based solution.

As radiology departments become filmless, they are discovering that some areas are particularly difficult to deliver images. Many departments have found that the operating room is one such area. There are space constraints and difficulty in manipulating the images by a sterile surgeon. This report describes one method to overcome this obstacle. The author's institution has been using picture archiving and communication system (PACS) for approximately 3 years, and it has been a filmless department for 1 year. The PACS transfers images to a webserver for distribution throughout the hospital. It is accessed by Internet Explorer without any additional software. The authors recently started a pilot program in which they installed dual panel flat screen monitors in 6 operating rooms. The computers are connected to the hospital backbone by ethernet. Graphic cards installed in the computers allow the use of dual monitors. Because the surgeons were experienced in viewing cases on the enterprise web system, they had little difficulty in adapting to the operating room (OR) system. Initial reception of the system is positive. The use of the web system was found to be superior by the surgeons because of the flexibility and manipulation of the images compared with film. Images can be magnified to facilitate viewing from across the room. The ultimate goal of electronic radiology is to replace hardcopy film in all aspects. One area that PACS has difficulty in accomplishing this goal is in the operating room. Most institutions have continued to print film for the OR. The authors have initiated a project that may allow web viewing in the OR. Because of limited space in the OR, an additional computer was undesirable. The CPU tower, keyboard, and mouse were mounted on a frame on the wall. The images were displayed on 2 flat screen monitors, which simulated the viewboxes traditionally used by the surgeons. Interviews with the surgeons have found both positive and negative aspects of the system. Overall impression is good, but the timeliness of the intraoperative films needs to be improved. The author's pilot project of installing a web-based display system in the operating room still is being evaluated. Their initial results have been positive, and if there are no major problems that arise the project will be expanded. These results show that it is possible to provide image delivery to the OR over the intranet that is acceptable to the surgeons.

Computer Systems↗
PubMed2004

[Study of inequalities in hospital mortality using the Charlson comorbidity index].

OBJECTIVE: The evaluation of quality and equity in healthcare attendance requires adequate study methods and information systems. Thus, this study was performed with the objective of comparing mortality among elderly patients attended within the private network and within the Brazilian national health system (SUS). METHOD: An information system that recorded causes of hospitalization and associated diseases (comorbidity) in relation to public and private hospital admissions was utilized. The hospitalization of 21,695 patients in Ribeirão Preto, State of Sao Paulo, in 1998 and 1999 was studied. These patients had diseases of the circulatory and respiratory systems. Analysis was done via the methodology put forward by Charlson, in which comorbidities are scored to give the Charlson comorbidity index and age over 50 years (per decade) is scored to give the Charlson comorbidity-age index. The patients were stratified according to comorbidity and decade of age over 50 years, with separation of hospitalizations via SUS from those via the private network (non-SUS). The coefficient of hospital mortality was calculated for each stratum. RESULTS: It was observed that the risk of death increased almost sixfold when the number of associated diseases increased. The risk of death for SUS patients was more than twice the risk for non-SUS patients (relative risk: 2.12). Significant differences between SUS and non-SUS patients were found by associating the patient's comorbidity with decade of age. When the risk of death was very low or very high, there were no statistical differences between SUS and non-SUS patients. In other, intermediate situations, precisely where the attendance might make a difference, the mortality among SUS patients was more than twice as great (relative risk: 2.14). CONCLUSIONS: The difference in mortality between SUS and non-SUS patients, according to Charlson's criteria, is significant among patients of intermediate risk, for whom the care is most important. The Charlson comorbidity index correlates with hospital mortality.

Age Distribution↗
PubMed1975

Respiratory therapy unit dose medication distribution.

A unit dose system for distribution of respiratory therapy medication is described. One unit dose cart, containing respiratory therapy medication for each patient and equipment for administration of the medication, is used for each floor. Syringes are prefilled by the pharmacy for unit dose use. Storage and stability data are given for normal saline, isoproterenol, acetylcysteine, and combinations of these drugs. Cost factors of this respiratory therapy medication distribution system are discussed.

Costs and Cost Analysis↗
PubMed2001

[Minor head injury management in Spain: a multicenter national survey].

INTRODUCTION AND OBJECTIVES: Despite of the high incidence of minor head injury, there is still controversy and disparity of criteria regarding its management. The lack of consensual protocols and clinical guidelines can lead to deficiencies in the attention to these patients and to inadequate use of resources. The objective of this study has been to describe the present situation of the management of this entity in the neurosurgical departments of the Spanish public hospitals, and to compare it with other European countries. MATERIAL AND METHODS: A 57-item questionnaire regarding different aspects of minor head injury was designed and distributed to the 66 neurosurgical departments of the Spanish National Health System between December 1999 and February 2000. RESULTS: A 83.3% of responses were obtained. More than 92,000 patients per year are assisted at the Spanish third-level hospitals (general hospitals) after suffering a minor head injury. In-hospital on duty neurosurgeons are not available in 49.1% of the Spanish neurosurgical departments. Only in 7.3% of the centres the neurosurgeon is the first physician that assists these patients. However, in 52.7% of the hospitals neurosurgical evaluation is required if the patient refers transient loss of consciousness. A GCS score of 13 is still included in the group of minor head injuries in 29.1% of the centres. Although 89.1% of the surveyed neurosurgical departments considered as satisfactory the attention they provide to these patients, 85.5% think that it would be convenient to elaborate clinical guidelines. Cranial x-ray is considered a useful diagnostic tool by only 38.2% of the centres, however, 89.1% of them still use it as a routine. CT-scan is systematically indicated in all patients after suffering a mild head trauma only in 5.5% of the centres, although it is completely available in 74.5% of them. The study of economical costs shows that choosing cranial CT as screening tool in these patients would mean a 40.6% reduction in costs compared to a management based on x-ray plus in-hospital observation. CONCLUSIONS: This study shows the inter-hospital variability of minor head injury management in Spain. Clinical guidelines are considered as positive and necessary. Although the Spanish situation is similar to that in other European countries, following the tendency toward a broader cranial CT utilisation, would improve diagnosis profitability and economical efficiency. The results of this study may contribute to the creation of consensual protocols and clinical guidelines in our country that help in daily practice decision-making optimising assistance quality.

Adult↗