Health services delivery in Asir, Saudi Arabia: regional experience of integration

This paper presents the local experience of the General Directorate of Health Affairs in Asir, Saudi Arabia, regarding integration of health services. The geographical, sociodemographic and administrative situations of the region necessitate this approach. A historical background of the development of health services in the region in the recent past is presented. Restructuring of the health system, changes in management functions and advantages of integration of health services are discussed

Increase in cesarean section and decerase in intrumental delivery

Data, published by the ministry of health, on all deliveries that took place in its hospitals during the years 1401 H. through 1412 H. was used to estimate the incidence of CS deliveries and to determine whether CS rates reflected substituting the more invasive forms of vaginal delivery by CS delivery. Results revealed a significant upward trend in CS rates having increased from 4.3% in 1401 H. to 7.5% in 1412 H. and a significant downward trend in forceps and vacuum deliveries being decreased by 69.6% and 27.5% respectively. Significant negative correlations were found between the rates of CS deliveries and each of the rates of forceps deliveries [r = -.9125], vacuum deliveries [r =-.7733] and total instrumental deliveries [r =.8716]

Hospital bed requirements in Riyadh, Saudi Arabia

Based on hospital data published by the ministry of Heath, hospital bed requirements for Riyadh, Saudi Arabia in the year 1412/3 H. was estimated using the poisson approximation, and hospital efficiency was assessed based on the predicted improvement in bed occupancy and monetary saving which can be achieved by avoiding operating unnecessary empty beds. Results revealed that though Riyadh experienced a reduction in both bed supply and admissions to the hospital through the 12 year study period it still holds 23.1% of the total beds available in Saudi Arabia and constantly maintained higher bed population ratios and admission rates than nationwide. The demand for hospital care in Riyadh in 1412/3 H. could have been met by a lower number of beds and at a higher level of efficiency. The total number of beds that could have been saved is 738 beds and the annual operating expenses that could have been avoided amounted to 78 million SR

Cesarean section among health insured female population in Alexandria: five-year study 1986-1990

A review of 933 cesarean sections performed at Karmouz Health Insurance Organization Hospital in Alexandria in a 5-year period [1986-1990] showed that, CS rate had increased by 12.4%, the rates being 11.3% and 12.7% for 1986 and 1990 respectively. The main indications for CS responsible for this rise were a previous CS, fetal distress, and breech presentation. After the operation, 22% of cases developed complications [19.2% infections, and 2.8% non infectious complications], 4.8% of babies developed morbid conditions, and 2.4% were lost. If the CS rate is to fall, the biggest impact can be made by planning vaginal delivery in carefully screened patients with previous CS, by improving the management of non progressive labor, and by better training of obstetricians about the use and the right interpretation of fetal monitoring

Evaluating numbering, filing, and retrieval systems used in medical records departments of Jordanian hospitals

The present study was conducted in three general hospitals with modern MRD in Amman, Jordan; namely, King Hussein Hospital, Jordan University Hospital and Islamic Hospital. The aim was to evaluate numbering, filing and retrieval systems adopted in MRD of these hospitals. The study revealed that they were using unit numbering system, color coded terminal filing system, out-card record control system and record- order slip, while auditing and purging of files were not performed by any of them. Hussein Hospital had the highest percentage of defects in the filing system as well as in using out- card record control system

Barber-Johnson diagram: a hospital performance monitoring tool

The present study is interested in presenting and discussing the values and uses of Barber-Johnson diagram in monitoring the hospital performance. It is a method of presenting information about patients length of stay, turn-over interval, discharges and deaths per available bed [turnover rate] and percentage bed occupancy on one graph. It has the advantage of showing how these four variables are inter-related instead of being recorded and analyzed separately. Using annual statistical forms of the Health Insurance Hospitals in Alexandria [Gamal Abdel-Nasser and Karmouz], the explanatory properties of the diagram and its ability to compare activity patterns at various levels [comparison over times, comparison between units and comparison against standards] have been illustrated. It can be concluded that, the Barber-Johnson diagram is a quite relevant and sensitive tool to measure the quantitative aspect of the hospital performance. It has advantage of being within the existing capabilities of the statistical staff of the hospital

Appendectomy: developing a scoring system to improve diagnostic accuracy

Problems related to the diagnosis of appendicitis are evidenced by the significant negative laparotomy rate. The present study sought to assess the feasibility of decreasing this diagnostic error by studying two groups of patients and identifying and weighing details of history, physical examination and laboratory findings utilizing 20 predictive factors, 100 patients who underwent operation because of suspicion of acute appendicitis constituted the study sample, and were classified into AAp and NAp groups based upon the results of histologic examination. Rates of occurrence for each predictive factor were determined separately for both groups. These were converted into weights which were then added to yield a diagnostic score for each patient. A cutoff point established the score which designated one group for observation and the other for surgery. Scores were assessed at three different points by balancing risks of missed diagnoses against benefits of avoiding unnecessary operations. Seven predictive factors had differentiating weights and reached statistical significance [p

Study of the general intensive care units [ICUs] in Alexandria hospitals

The basic function of ICUs is to concentrate in one. area patients who are critically ill requiring continuous surveillance of their vital physiological parameters for definitive therapy by skilled personnel. The present study aims at surveying the general ICUs available in Alexandrin governorate for the pattern of physical structure and technical equipment. A validated check list has been designed to collect data. The number of units surveyed totalled to 15 in 12 hospitals representing the various sectors involved in the provision of hospital care at the governorate. Results,of the study showed many important results that lncluding seme equipments as ventilators or resuscitation bag were lacking in some units. Pacemaker was only present in 40% and crash cart in 53.3% of all units. Proper location of the nursing station to facilitate direct observation was present in73 .3%. Wearing gowns was practiced in 4 units [26.7%]. Circuit breaker presence of recommended number of electric outlets and mobile electric outlets in two thirds of all units Four units [26.7%] have less than 4 beds and the floor area per bed was less than 12 m in 3 units Central pipe-line system was available in 73.3% and most units did not have the recommended number of outlets. Many of the recommended design features including the availability of laboratory, isolation room and store were deficient in many units. Enough consideration snould be paid to the process of planning and design, establishing policies to guide unit operation and improving financial support to supply deficient equipment are highly advisable for upgrading the services provided by the ICUs

Pattern of utilization of obstetric services in health insurance hospitals in Alexandria

The present study was conducted to investigate the pattern of utilization of hospital OB services by the health insured working women in Alexandria. Data were collected from a representative sample of medical records of working women admitted to OB department at the Health Insurance hospitals [Gamal and Karmouz] during 1987, as well as from medical records of house-wives admitted to El-Mouhafza hospital [a Ministry of Health hospital] during the same period. The results indicated that the pattern of utilization of hospital OB services by health insured working women in Alexandria did not differ so much from of a non-working population, where women belonging to either group were uniformally admitted through days of the week; mostly during the day hours; they were admitted for either child-birth, abortion, antenatal care or postnatal care in that order of frequency; with no difference between working and housewife groups regarding hospitalization for abortion or the cardinal conditions for which the pregnant women seeked hospital antenatal care; and those admitted for delivery, whether working or not, gave rise to normal deliveries, instrumental and Caesarean deliveries came in the second and third order. On the other hand, the two groups differed in that, OB beds affiliated to health insurance hospitals seem to be run more appropriately than those of other hospitals in Alexandria and working women, in general, were kept in the OB department for a relatively longer periods than non-working women

demand for hospital obstetric services in Alexandria: present and future

The present study was carried out to examine the extent to which hospital OB beds are utilized for confinement, and to assess the present and future demand for OB resources [beds and manpower]. Data were collected through field visits to the hospitals and from the statistical registers and reports of Alexandria Health Directorate. estimations of present and projection of future demands for OB resources in the coming 15 years were made using the Poisson distribution as the basic method for estimation

Study of the utilization of the geriatric clinic at the main University Hospital in Alexandria

The present study was conducted at the Outpatient Geriatric Clinic of the Main Hospital of Alexandria University aiming to illustrate the characteristic of the elderly clinic users, their pattern of utilization and the quality of medical care provided. During a 6-week period, 99 elderly patients were included in the study. The majority were between 60 and 70 years of age, women, widowed or divorced, living with family members, of low income, residing close to the clinic and suffering most frequently from cardiovascular and musculoskeletal disorders. High rates of utilization were shown by elderly males; those living with a family member; those suffering from multiple health problems and those with very low income. Inadequate quality of medical care provided to elderly patients was also evidenced

Hospital cost accounting based on patient case mix: developing and testing a methodology

This study was carried out with the aim of constructing and experimenting a cost-accounting system for Karmouz general hospital in Alexandria based on the concept of diagnosis related groups [DRGS]. The study population consisted of patients with a primary diagnosis "Urinary Calculus" who were admitted to the hospital during the period Oct. Dec. 1983. The total number of cases was 30. The details of the system are discussed in part [I] and include: defining cost centers; method of allocating service department costs to production centre as well as estimating direct and indirect costs of surgery, X- ray, lab, diet as well as the urology department. Results of experimenting the system are presented in part [II]. These results are promising as significant differences was found between the average cost per case in different DRGS

Hospital case-mix definition by diagnosis related groups [DRGs]: developing and testing a methodology Part [2]: testing the methodology

A methodology for classifying hospital patients into diagnosis related groups [DRGs] was experimented in Abdel Nasser and Karmouz Hospitals in Alexandria. A random sample of patients admitted to the 2 hospitals constituted the data base. Using the methodology, these records were classified into 86 major diagnostic categories [MD Cs]. One of these MDCs i.e. urinary tract calculus was selected for further grouping. Following this methodology, this category was partitioned into 6 DRGs which were exclusive and exhaustive as well as clinically interpretable

Hospital cost accounting based on patient case mix: developing and testing a methodology

The methodology proposed by the authors for hospital cost accounting based on the concept of diagnosis related groups [DRGs] was presented. The system was experimented in Karmouz General Hospital in Alexandria. The study population consisted of 31 cases of urinary calculi. In this system three types of cost centers were identified: [1] production centers, [2] service production centers, and [3] administrative and financial centers. The costs of the last two centers were allocated to production centers using the matrix approach. The hospital cost of any case equals: direct department cost that can be traced to individual cases + departmental overhead cost/case + non departmental overhead cost per case. The method of estimating departmental cost was described in details

Hospital case-mix definition by diagnosis-related groups [DRGS]: developing and testing a methodology Part I Methodology

The need for case mix classification of hospital patients is increasing. Potential uses include hospital utilization studies and reviews: hospital cost accounting; hospital budgeting hospital cost control; quality assurance; hospital care monitoring and regional hospital planning. This paper describes a methodology for case mix classification based on the concept of Diagnosis Related Groups [DRGs]. The process of DRGs formation is based on a procedure referred to as the significant attribute method. The process begins by defining the data base. The data base is then divided into mutually exclusive and exhaustive primary diagnostic areas called Major Diagnostic Categories [MDCs]. Each MDC is then examined separately and further subdivided into groups based on the values suggested by the statistical algorithm. Physician review of these recommended subdivisions was also considered. Thus, at each stage of the process the subgroups were based both on statistical criteria as well as physician judgement. The variables included in class definition are age, sex, primary diagnosis, secondary diagnosis [up to 4], primary surgical operation, secondary surgical operations [up to 3] and type of admission. The length of stay was taken as the dependent variable as it is considered the basic index of hospital output utilization. All other variables constituted the independent attributes that may influence the length of stay