Case three. Developing a strategic plan through the use of task forces.

Although Carolina Community found itself continuing to grow and expand at a time when most facilities in the area were suffering from census declines, it was obvious that continuation of such growth would require more sophisticated strategic planning. At the time of the study, Carolina Community was growing in all areas. Inpatient census as well as outpatient utilization were taxing the resources of the organization. The strategic location of the facility and the support of a committed medical staff provided the institution with a competitive advantage over the other area facilities in the past. In the span of three months, two major competing institutions made strategically significant organizational changes. Both institutions hired new administrators known for their aggressiveness and organizational abilities. It became obvious very quickly that the playing field would soon be changing. No longer would Carolina Community's administration be able to move aggressively to protect and expand its markets without fear of competition. Carolina Community is a hospital with a long-standing tradition of formal strategic planning forced by a rapid "heating up" of the environment to respond much more quickly than it has had to in the past and much more quickly than it is currently able. The case report describes a change in strategy formulation process which was designed to speed up response time and to modify the organization along Ansoff's eight characteristics to a more environmentally appropriate configuration.

Oxygen desaturation during sleep as a determinant of the "Blue and Bloated" syndrome.

Certain patients with chronic obstructive pulmonary disease may be classified as blue bloaters or pink puffers. Recent studies suggest that physiologic changes during sleep contribute to the clinical expression of these syndromes. To investigate this, we monitored four blue bloaters and six pink puffers during one night's sleep to determine the incidence of sleep disordered breathing (SDB) and of arterial oxygen desaturation. There were no significant differences between the two groups for sleep period time, awake oxygen saturation, or the number of episodes of SDB. Blue bloaters had lower baseline oxygen saturations, more episodes of arterial oxygen desaturation, and larger falls in oxygen saturation and spent more time at low levels of oxygen saturation while asleep. We propose that the degree and the duration of sleep hypoxemia of blue bloaters but not of pink puffers may contribute to early pulmonary hypertension and cor pulmonale.

Physiological effects of corticosteroids in foodstuff aspiration.

Aspiration of gastric contents that contain small food particles has been shown to cause severe pneumonitis, even when the pH of the aspirate is greater than 2.5. The effects of corticosteroids on the hemodynamic and ventilatory consequences of this type of aspiration have not been investigated. Twenty healthy mongrel dogs were anesthetized and 2 mL/kg of gastric contents (pH 5.9) that contained small food particles were injected into their tracheas. Group 1 animals (controls, N = 10) received no therapy. Group 2 animals (steroid-treated, N = 10) were given methylprednisolone intravenously, 30 mg/kg, three times a day beginning one hour after aspiration. The animals were observed for 14 days, during which time there were no statistically significant differences between the groups in mortality, PaCO2, pH, systemic and pulmonary arterial blood pressures, fractional intrapulmonary shunt, or histological findings. Arterial PO2 was lower at 24 hours in group 2 dogs than in group 1 dogs. We conclude that steroids are of no benefit in the treatment of foodstuff-induced aspiration pneumonia.