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A course for 40 medical receptionists working in general practice was arranged at a local postgraduate centre. The curriculum was divided into two sections. The first dealt with the traditional, factual side of medical reception work and the second was concerned with the human behaviour aspect of a receptionist's work. It seems that there was some benefit to the receptionists from their experience of both aspects of this course.
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OBJECTIVE: To use DNA fingerprinting to characterize nosocomial spread of Mycobacterium tuberculosis following hospitalization of a patient with acquired immunodeficiency syndrome and active pulmonary tuberculosis, for whom respiratory isolation was not initiated promptly. DESIGN: Epidemiological investigation. SETTING: A tertiary-care medical center in Tennessee. PARTICIPANTS: Patients and healthcare workers potentially exposed to the infectious patient in 1992. RESULTS: Of 172 healthcare workers exposed, 35 (20%) were judged to have acquired tuberculous infection. Risk of acquisition was greatest for nurses and medical receptionists. Active tuberculosis later developed in one healthcare worker and one hospitalized patient. Nosocomial transmission was supported by epidemiological evidence and DNA fingerprinting. The outbreak strain of Mycobacterium tuberculosis differed from other isolates at this hospital, but its DNA hybridization pattern was highly similar to that of the multidrug-resistant outbreak strain W that has been prevalent in New York City, suggesting a common strain ancestry. However, the Tennessee isolates were susceptible to all first-line antituberculous agents. CONCLUSIONS: This report suggests the possibility that a molecular characteristic(s) shared by these successful outbreak strains is associated with increased transmissibility or pathogenicity and emphasizes the need for continued vigilance for tuberculosis in the nosocomial setting.
The primary goal of a successful pediatric radiology department is to arrive at the correct clinical diagnosis as soon as possible. This responsibility is shared by radiologists, technologists, nurses, secretaries and clerks. The goal of this study was to determine the optimum number and type of nonmedical staff required to correctly and efficiently perform these examinations. The secondary purpose of our study was to evaluate the effectiveness of technologists, nurses, secretaries and clerks regarding: 1) patient waiting time, 2) performance of multiple examinations, 3) actual time for completion of examination(s), and 4) time required for the radiology report to be in the patient's medical history. Our study analyzed the number and type of radiological examinations performed for a variety of patients (emergency room patients, outpatients and inpatients) examined in the Radiology Department of Childrens Hospital of Los Angeles, a 345 bed metropolitan pediatric teaching hospital. The results of these evaluations will be discussed in this paper. Our data suggests that the time spent by the technologists in psychological support of the parents and the patient is inversely proportional to the time required to complete the test. Based on our study and the conclusions it presented, significant changes were implemented in our pediatric radiology department; specifically, the number of clerical positions was reduced from three to one with the use of computer-assisted check-in and chart follow-up within the department. Childrens Hospital of Los Angeles is a 345-bed metropolitan pediatric teaching hospital affiliated with the USC School of Medicine.(ABSTRACT TRUNCATED AT 250 WORDS)
The ability to improve the efficiency of the use of medical image information is often believed to be one of the most important potentials of PACS. The organization within hospitals is however complex, which makes it difficult to predict the impact of the system. This paper addresses several methods for the analysis of the organizational impact and proposes a modelling method.
This paper examines the exercise of discretion by casualty reception staff, focussing on the problems of accountability that arise when their judgements help shape the process of patient categorization that culminates in clinical diagnosis. Rules and guidelines which ostensibly relate to bureaucratic objectives, are applied in ways which reflect situational exigencies of reception work, and values embedded in organisational culture. But reception staff are reluctant to acknowledge the importance of their decisions, and, particularly where judgements relate to patient condition, present rule-use as a straightforward and certain activity in which interpretation plays little part.
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Quality assurance (QA) refers to all planned, systematic activities that instill confidence that quality mammography is being performed. Quality control (QC) refers only to the technical aspects of the examination. Standardized labeling of mammograms and the format for mammographic reports are important parts of a QA program; recommendations for both have been published by the American College of Radiology. Minimum staff for a mammography service consists of a scheduler, technologist(s), medical physicist, and radiologist. The scheduler asks the patient questions to ensure that the appropriate examination is performed, gives the patient instructions, and asks the patient to complete a history questionnaire including a release form to obtain earlier mammograms. One certified, licensed technologist is designated to perform QC, which includes maintaining darkroom, screen, and view box cleanliness; reviewing processor performance, checked with sensitometer, densitometer, and phantom images; repeat analysis; analysis of fixative retained in film, darkroom fog, screen-film contact, and adequacy of compression; and visual inspection of equipment. A certified medical physicist performs equipment acceptance testing and annual QC visits thereafter. The radiologist oversees all aspects of the QA program, including selecting and regularly observing the technologists, selecting and meeting with the physicist, communicating results, ensuring patient follow-up, and assessing patient outcome data. The radiologist is ultimately responsible for image quality and the standard of patient care.
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Relations between the physician's office and the hospital are important to patients, physicians, and to the physician's office staff. Lack of communication, misinformation, and mistakes often can put unnecessary strain on the relationship and can cause conflict between the physician and his staff and the hospital. Several hospitals and their medical staffs have worked to promote good physician's office/hospital relations through programs that improve communications.
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