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At least 19 recordsLinked to original sources
PubMed2000

Hospital-at-home versus in-patient hospital care.

BACKGROUND: Hospital-at-home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. Hospital-at-home has become a popular response to the increasing demand for acute hospital beds. OBJECTIVES: To assess the effects of hospital-at-home compared with in-patient hospital care for patients. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register, MEDLINE to 1996, EMBASE to 1995, Cinahl to 1996, the Social Science Citation Index (1992 to 1995), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995), the Medical Care supplement on economic literature (1979 to 1990), and reference lists of articles. SELECTION CRITERIA: Randomised trials of hospital-at-home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. The outcomes were mortality, clinical complications, re-admissions, cost (to the patient and family, to general practice, to the hospital and to the community), hospital days saved from the provision of hospital-at-home, discharge destination from hospital-at-home, general and disease specific health status, functional status, psychological well-being, patient satisfaction, carer satisfaction, carer burden, and staff views (including the satisfaction of doctors working in primary care). DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Five studies were included involving 866 patients. All studies were small and lacked power. No statistically significant differences were detected for patient health outcomes. Patients discharged early from hospital to hospital-at-home following elective surgery expressed greater satisfaction with care than those who remained in hospital. Carers however expressed less satisfaction with hospital-at-home compared with hospital care. Only one trial formally tested for a difference in cost, with no statistically significant difference detected for overall health care costs. REVIEWER'S CONCLUSIONS: There is insufficient evidence to assess the effects of hospital-at-home on patient outcomes or the cost to the health service. Given the heterogeneity of what hospital-at-home encompasses and the uncertainty over its effects, future research should clearly specify the type of service being provided, both at home and at hospital, and the specific patient groups. Patient health outcomes, patient and carer satisfaction, and costs should be measured, and studies should include a formal, planned economic analysis. Studies should be large enough to detect important differences and to ensure generalisability of the results.

Home Care Services↗
PubMed1993

[Discussion on the Report of the Ministry of Health and Welfare's Deliberative Committee on Nursing Service, a proposition to improve working conditions of nursing personnel. How working conditions have been improved at four hospitals designated as model hospitals to implement projects of better conditions--Hibiya Hospital, St. Luke's International Hospital, Kawakita General Hospital, Daiyukai General Hospital].

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Health Services↗
PubMed2000

Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg.

AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

Adolescent↗
PubMed2002

Use of medical resources, complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital.

OBJECTIVE: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. PATIENTS: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) due to symptoms of acute chest pain during a period of 6 months. RESULTS: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1,592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. CONCLUSIONS: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.

Acute Disease↗
PubMed1997

[Patterns of hospitalization and nonhospitalization of the elderly based on individual data of total number of days hospitalized and frequency of hospitalization in one year].

With the aim of developing a method to determine the trends in the time spent by elderly at home or in the hospital, elderly living in a municipality of Hokkaido were classified into four groups according to the number of days spent at home or in the hospital in one year. The classification was based on individual data of the number of days hospitalized in one year obtained from health insurance records. The four groups were: "no hospitalization", "short hospitalization" (< or = 180 days in one year), "long hospitalization" (> 180 days in one year), and "continuous hospitalization". The number of subjects used in this study was 1,302 (532 men and 770 women) in 1992, and 1,345 (551 men and 794 women) in 1993. The findings were as follows: (the two figures in parentheses are the percentages for 1992 and 1993, respectively) 1) The percentage of "no hospitalization" was the highest (66%, 67%), followed by "short hospitalization" (24%, 25%), "continuous hospitalization" (6%, 4%), and "long hospitalization" (4%, 5%). There were no significant differences in the group percentages between 1992 and 1993. There were also no significant differences in the group percentages for men or women between 1992 and 1993. 2) In both years, there was a lower percentage of "short hospitalization", and a higher percentage of "long hospitalization" and "continuous hospitalization" among women than men. There was no difference in the percentage of "no hospitalization" between sexes. 3) In both years, about 70% of elderly people who had been hospitalized were only hospitalized once in the year. However, in the "long hospitalization" group, more than half of the people had been hospitalized two or more times in one year. This classification method is thought to be useful for a longitudinal study of hospitalization and nonhospitalization trends among the elderly in one community.

Aged↗
PubMed2003

Quality assurance with regard to outcome and use of medical resources for patients hospitalized with acute chest pain: a comparison between a city university hospital and a county hospital.

This study aimed to test the hypothesis that there is a difference in mortality between patients hospitalized with acute chest pain in a university hospital and those hospitalized in a county hospital, and to describe differences in characteristics and use of medical resources in these two settings. All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) with symptoms of acute chest pain during a registration period of 6 months were included in the study. A total of 1592 patients in the city hospital and 822 in the county hospital fulfilled the given criteria for inclusion. Patients in the urban area differed from those in the rural area in that they had a lower prevalence of previous angina pectoris and hypertension and a higher prevalence of previous cancer, previous percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) and current smoking. On admission to hospital, patients in the urban area less frequently showed clinical signs of congestive heart failure and acute ischaemia on the electrocardiogram (ECG) but more frequently had a pathological ECG without signs of ischaemia and more frequently had a heart rate >100 beats/min. The use of medical resources differed between the two hospitals. Revascularization was more frequent in the city hospital and the use of -blockers in the county hospital. The overall 30 day mortality was 4.7% in the urban area and 4.3% in the rural area (P=0.74). When correcting for differences at baseline, the risk ratio for death in the county hospital versus the city hospital was 0.84 (95% confidence interval 0.51-1.40, P=0.53). In conclusion, among patients hospitalized with acute chest pain in a city university and a county hospital the mortality during the subsequent 30 days did not differ. However, there were differences in terms of the use of medical resources and in previous history, chronic medication prior to hospital admission and status on admission between the two cohorts.

Acute Disease↗
PubMed1992

HIV infection among patients in U.S. acute care hospitals. Strategies for the counseling and testing of the hospital patients. The Hospital HIV Surveillance Group.

BACKGROUND: Routine, voluntary testing of hospital patients for the human immunodeficiency virus (HIV) has been proposed in order to identify those with early HIV infection in a setting where there is ready access to counseling, appropriate clinical referral, evaluation, and therapy. We studied the pattern of HIV infection among patients in 20 U.S. hospitals, in order to evaluate possible national strategies for the routine, voluntary HIV counseling and testing of hospital patients. METHODS: Blood specimens remaining after clinical use from a systematically selected sample of patients at 20 hospitals in 15 U.S. cities were tested anonymously for antibody to HIV type 1 (HIV-1). Multivariate regression was used to determine which variables best predicted HIV seroprevalence in individual hospitals. Using these data, we estimated the number of HIV-positive patients in all U.S. hospitals and considered the efficiency of routine counseling and testing in different subgroups of patients and hospitals. RESULTS: From September 1989 through October 1991, 9286 of 195,829 specimens (4.7 percent) were positive for HIV-1 in the 20 hospitals. The seroprevalence of HIV at these institutions ranged from 0.2 percent to 14.2 percent. Among HIV-positive patients, 32 percent had symptomatic HIV infection or the acquired immunodeficiency syndrome (AIDS) at the time of admission or evaluation. In the 20 hospitals, HIV seroprevalence was 10.4 times (95 percent confidence interval, 8.8 to 12.0) the AIDS-diagnosis rate (the annual number of patients with new diagnoses of AIDS per 1000 discharges in 1990). In a multivariate model that included 13 hospital-specific variables, only the AIDS-diagnosis rate was associated with the hospital-specific HIV-seroprevalence rate (P less than 0.001). Using these data and the AIDS-diagnosis rates for all U.S. acute care hospitals, we estimated that 225,000 HIV-positive persons were hospitalized (95 percent confidence interval, 190,000 to 260,000) in all 5558 such hospitals in 1990, including 163,000 persons presenting with conditions other than HIV or AIDS (95 percent confidence interval, 130,000 to 196,000). In 1990, in 593 U.S. hospitals with AIDS-diagnosis rates of 1.0 or more per 1000 discharges, HIV testing of patients 15 to 54 years old (3 million patients, or 12.0 percent of all patients in U.S. acute care hospitals) would have identified an estimated 68 percent of all HIV-positive patients (110,000 patients) who were admitted with conditions other than symptomatic HIV infection or AIDS. CONCLUSIONS: We estimate that about 225,000 HIV-positive persons were hospitalized in 1990, of whom only one third were admitted for symptomatic HIV infection or AIDS. Routine, voluntary HIV testing of patients 15 to 54 years old in hospitals with 1 or more patients with newly diagnosed AIDS per 1000 discharges per year could potentially have identified as many as 110,000 patients with HIV infection that was previously unrecognized.

AIDS Serodiagnosis↗
PubMed2000

Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

OBJECTIVE: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN: A retrospective cohort study was conducted. DATA COLLECTION: Demographic and clinical data were collected from patients' medical records and were used to develop multivariable models that estimated the risk of in-hospital and 30-day (post-admission) mortality. Standardized mortality ratios (SMRs) for in-hospital and 30-day mortality were determined by dividing observed death rates by predicted death rates. PRINCIPAL FINDINGS: In-hospital SMRs ranged from 0.54 to 1.42, and six hospitals were classified as statistical outliers (p <.05); 30-day SMRs ranged from 0.63 to 1.73, and seven hospitals were outliers. Although the correlation between in-hospital SMRs and 30-day SMRs was substantial (R = 0.78, p < .001), outlier status changed for seven of the 30 hospitals. Nonetheless, changes in outlier status reflected relatively small differences between in-hospital and 30-day SMRs. Rates of discharge to nursing homes or other inpatient facilities varied from 5.4 percent to 34.2 percent across hospitals. However, relationships between discharge rates to such facilities and in-hospital SMRs (R = 0.08; p = .65) and early post-discharge mortality rates (R = 0.23; p = .21) were not significant. CONCLUSIONS: SMRs based on in-hospital and 30-day mortality were relatively similar, although classification of hospitals as statistical outliers often differed. However, there was no evidence that in-hospital SMRs were biased by differences in post-discharge mortality or discharge practices.

Aged↗
PubMed1991

Characteristics of psychiatric discharges from nonfederal, short-term specialty hospitals and general hospitals with and without psychiatric and chemical dependency units: the Hospital Discharge Survey data.

Hospitalization for mental disorders (Major Diagnostic Categories 19 and 20) was examined using the 1980 Hospital Discharge Survey (HDS) data. We added to the HDS data by noting whether each hospital had a specialized psychiatric and/or chemical dependency unit, especially noting short-term specialty psychiatric and chemical dependency hospitals. Of the approximately 1.7 million episodes with MDC-19 and -20 diagnoses in the nation's nonfederal short-term hospitals in 1980, 13.5 percent were in specialty hospitals. Of the remaining general hospital episodes: 31 percent occurred in hospitals with only psychiatric units, 5 percent in hospitals with only chemical dependency units, 31 percent in hospitals with both types of specialized treatment units, and 33 percent in hospitals with neither type of unit. The last figure is much less than previously thought. The five hospital types may be arrayed on a continuum of resource utilization and severity of cases treated, with general hospitals with no special units at one end, specialty hospitals at the other, and general hospitals with psychiatric or chemical dependency units intermediate. Presence or absence of a chemical dependency unit influences a hospital's profile in this regard, particularly for MDC-20. Future studies should take into account the presence of a chemical dependency unit.

Adolescent↗
PubMed2001

[Attitude of hospital visitors towards cigarette smoking inside hospital buildings; one more step towards a "smoke free hospital" in Israel].

In order to determine a policy within the hospital restricting smoking we previously surveyed the attitude of the hospital staff towards smoking inside the hospital buildings. In the present survey we examined the attitude of the hospital visitors on the same issue. One hundred and fifty-seven hospital visitors participated in the survey and answered a questionnaire; 93 visitors were smokers, 64 were non-smokers. Eighty-eighth percent of the visitors smoked during their visit, 4 cigarettes on the average, during an average length of stay of 2.8 hours, until completing the questionnaire. Eighty-three percent of the smokers were aware of the law that prohibits smoking in public buildings, and 71% were aware of the signs and advertisements that prohibit smoking in the hospital. Two thirds of the smokers declared that they would have refrained from smoking in the hospital if others around them also refrained from smoking and justified the law that prohibits smoking in public buildings, including hospitals. Sixty-nine percent of the smokers declared that they were willing to cooperate with hospital management in restricting smoking to the hospital grounds outside the hospital buildings, and would accept directives regarding smoking restriction from any hospital personnel. In fact, only 11% of the smokers were requested to stop smoking during their visit. These findings reinforce the results of our pervious survey conducted among the hospital staff and indicates the existence of a paradoxical vicious cycle of behavior among smokers and non-smokers, visitors and staff, in the hospital. On the one hand the smokers do not have the self-obedience necessary to stop smoking while visiting in the hospital, although they are aware of their misdeed. On the other hand the non-smokers lack the confidence that they will obtain the cooperation of the smokers, although the smokers are willing to cooperate. Both groups except someone else to either actively restrict them from smoking or to encourage them to restrict the smokers. Our findings suggest that this "someone else" is the hospital management (and the staff endorsed to implement this directive).

Adult↗
PubMed2001

[Preclinic in the hospital. In-hospital emergency and rescue service in a large hospital].

BACKGROUND AND OBJECTIVE: Many hospitals have a special resuscitation service that is responsible for life-threatening emergencies outside the hospitals intensive care unit, i.e. in the wards and in patient-treatment areas. In contrast, there is generally no emergency service caring for patients, visitors or personnel outside of these areas. In order to provide emergency medical help in the entire hospital area, in 1999 we instituted an additional in-hospital emergency service to cover the larger hospital area. This paper describes the structure of our in-hospital emergency service and our experience in the first 26 months after its establishment. PATIENTS AND METHODS: We analysed the emergency protocols of all 147 episodes, that had occurred within the first 26 months. We classified them according to type of disease and/or injury by using the NACA score (range 1 to 7) to assess the severity of disease and/or injury. RESULTS: 45 episodes took place within one of the 17 hospital buildings. 92 requests for help came from the hospital service and treatment areas including walkways and passages, while 3 came from the immediate vicinity outside of the hospital. A total of 7 requests turned out to be pranks, and 31.3% responses proved to be unnecessary when the team arrived at the scene. Of the total of 125 treated cases, 30 had a NACA score between 4 and 6, denoting life-threatening injury and/or disease. 6 patients were found dead at the scene or died shortly after arrival of the team. 101 of the patients had to be admitted to the hospital's emergency room. CONCLUSION: Since its establishment, knowledge of the existence of our in-hospital emergency service has steadily increased within the hospital community. As a consequence, number of events have likewise steadily increased. We believe that a total of 20.4% life-threatening events underscores the importance of the service in our large and extended hospital area. We also feel that our adherence to the training and personnel requirements demanded of public emergency services is necessary in order to insure the quality and efficacy of the service. This is also important because of current intentions to use our in-hospital service as a back-up and/or reserve for the community's public emergency services.

Emergencies↗
PubMed1990

Definition of partial hospitalization. The National Association of Private Psychiatric Hospitals and the American Association for Partial Hospitalization.

The National Association of Private Psychiatric Hospitals (NAPPH) recently joined with the American Association for Partial Hospitalization (AAPH) to provide mental health professionals with a clear, industry-supported definition of psychiatric partial hospitalization, an option on the continuum of care used by clinicians to treat mental illnesses. In 1988, Congress approved a major benefit change for the Title XVIII Medicare program by including reimbursement for partial hospital programs that meet a strict definition and provide a series of treatment services. As defined by Congress, partial hospitalization means an outpatient program specifically designed for the diagnosis or active treatment of a serious mental disorder when there is a reasonable expectation for improvement or when it is necessary to maintain a patient's functional level and prevent relapse or full hospitalization. That definition and the service components are endorsed by NAPPH and AAPH, and they offer a model for other insurers or employers considering the addition of this highly specialized program to healthcare benefit plans. Partial hospital programs are usually furnished by a hospital as a distinct and organized intensive ambulatory treatment service of less than 24-hour daily care. Partial hospitalization is not a substitute for inpatient care. For some patients, the availability of partial hospitalization may shorten the length of stay of full hospitalization or serve as a transition from inpatient to outpatient care. It may allow some patients to avoid hospitalization. Placement in a partial hospital program is a clinical decision that can be made only by a physician thoroughly knowledgeable about the patient's illness, history, environment, and support system.

Day Care, Medical↗
PubMed1993

Variation in duration of hospital stay between hospitals and between doctors within hospitals.

Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, significant length-of-stay variations have been reported. As is the case for variations in the occurrence of common surgical procedures, the overall conclusion is that large variations in duration of hospital stay associated with these common surgical procedures are the rule rather than the exception. The objective of the study is to examine whether variations in hospital medical practice, indicated by the duration of hospital stay in this study, can be reduced to differences in practice style between individual doctors within the same institutional setting or to differences in practice style between groups of doctors within the same institutional setting. The latter is assumed to be the combined effect of restrictions on the (hospital) supply side and the predilection of doctors to conform to the practice of immediate colleagues. It was found out that the variation in length of hospital stay, adjusted for patient case-mix, within hospitals is much smaller than the length-of-stay variation between different hospitals. The within hospital variation between (partnership of) doctors is in most of the cases statistically insignificant. Doctors working in more than one hospital on average choose a length of stay close to the average length of stay prevailing in the different hospitals.

Appendectomy↗
PubMed1999

[Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 3. Current status of tuberculosis patient care in university hospitals and general hospitals in Japan].

A recent epidemiological survey has revealed that the incidence of Mycobacterium tuberculosis (TB) patients in Japan has just increased again after four decades of decline. In fact, recently there have been numerous reports of TB outbreaks in health-care facilities. Although our medical school hospital does not have TB isolation rooms, we have to take care of more than a few TB patients, most of whom have been transferred from primary care clinics. Although, some of these TB patients have highly infectious (sputum smear positive), most of them have not been diagnosed as having highly infectious TB, and therefore, some of their patients ultimately have to be retransferred to a TB hospital. This indicates that most physicians in primary care clinics have little knowledge about TB. This may be partly because of lack of training regarding TB during their medical student days and residencies. To elucidate current TB patient care status in university hospitals in Japan, a survey of physicians working in such hospitals was conducted from September 1997 to January 1998. The survey (questionnaire) revealed that the majority (76%) of these hospitals do not have TB isolation rooms. However, these hospitals have to take care of TB patients in their outpatient clinics and sometimes on their wards because the patients have serious complications that can not be treated in ordinary TB hospitals. The survey also showed that for this reason and from an educational point of view, the majority of the physicians (90%) working in these hospitals thought that university hospitals should have isolation rooms for such patients. Another questionnaire revealed that few physicians and nurses in university hospitals have sufficient experiences in taking care of TB patients. This situation may have been responsible for producing physicians with little knowledge about TB. Recent scientific advances have made it possible to construct TB isolation rooms in ordinary wards by means of separate ventilation systems. Although combatting TB requires a variety of strategies, appropriate education for both medical students and residents using isolation rooms in university hospitals may be an effective means of preventing spread of TB, and this approach may also increase awareness concerning the prevention of TB outbreaks in hospitals and health-care facilities.

Hospitals, General↗
PubMed2000

[Smoking by an Israeli general hospital staff, and attitude to smoking in hospitals. Are we in Israel ready to institute "smoke-free hospitals"?].

Smoking within hospitals is common in general hospitals in Israel. It has a strong negative educational impact, has a negative image and curing its ill effects help keep our hospitals busy. An anonymous questionnaire was answered by 128 members of our hospital staff (28%). Their distribution, according to occupation and sex was representative of the rest of our hospital staff. 19% of our workers are smokers, a much lower proportion than in our general adult population. The proportion was highest among maintenance (40%) and sanitary-help staff (36%). 23% of nurses and 15% of physicians were smokers. This situation is better than that among Italian or Japanese medical staff, but much worse than among North American medical staff. 75% of our workers who smoke declared that they smoke outside the room in which they work. 66% and 72% of the staff believe that hospital workers and visitors, respectively, should smoke outside hospital buildings. Only 19% of all workers do not believe that a "smoke-free hospital" is attainable. 34% believe that a "smoke-free hospital" is achievable, and 47% said that it is perhaps achievable. 86% of all the workers, and 41% of the smokers, expect the hospital director to implement an effective policy of enforcing the law limiting smoking within hospitals (and other public buildings) in Israel. 60% are willing to contribute actively to this effort. We believe these results strongly suggest that the time is ripe for implementation of the "smoke-free hospital" in Israel. This requires a strong and effective central policy, like that in the USA. We suggest measures that the Israel Ministry of Health take measures to successfully implement this policy.

Adult↗