ABSTRACT
If it hasn't started already, your hospital should waste no time in preparing for a potential chemical or biological attack. A key issue: collaborate with your hospital neighbors, public health department, and local fire, police, and EMS departments.
Subject(s)
Bioterrorism , Disaster Planning , Hospital Administration , Humans , MarylandSubject(s)
Health Services Needs and Demand/trends , Health Workforce/trends , Physicians/supply & distribution , Aged , Health Services Accessibility , Humans , Managed Care Programs/organization & administration , Pharmacists/supply & distribution , Population Dynamics , Quality of Health Care , Retirement , Specialization , United StatesABSTRACT
Reaching epidemic proportions, the nurse shortage may be the worst and most far-reaching problem hospitals have confronted in the last 10 years--a decade beset by health care woes. Hopefully, once trustees understand the reasons for the shortage, they can devise ways to alleviate it.
Subject(s)
Nursing Staff, Hospital/supply & distribution , Personnel Selection/methods , Career Mobility , Data Collection , Employee Incentive Plans , Governing Board , Humans , Job Satisfaction , Personnel Turnover/trends , Safety Management , Salaries and Fringe Benefits , United StatesABSTRACT
Like the public, health care leaders might feel overwhelmed by the prospect of preparing for a terrorist act, especially one involving biological agents. In our 10-page special report, we look at practical steps you can take today to get ready, drawing lessons from hospitals in New York City, Washington, D.C., and Israel, and from Salt Lake City's efforts to prepare for the possibility of terrorism at the Olympics in February. Please note that our report is based on the latest news about terrorism, reaction to it and readiness efforts as of H&HN's deadline.
Subject(s)
Disaster Planning/organization & administration , Hospital Administration , Terrorism , Aircraft , American Hospital Association , Bioterrorism/prevention & control , Chief Executive Officers, Hospital , Civil Defense , Government Agencies , Israel , Joint Commission on Accreditation of Healthcare Organizations , Leadership , New York City , Pennsylvania , Sports , Terrorism/prevention & control , United States , Utah , VirginiaABSTRACT
While many organizations are divesting their physician practices, Integris Health System decided to stick with theirs. Here's how they cut their losses by more than half in one year and plan to break even by next year.
Subject(s)
Financial Management, Hospital/methods , Governing Board , Practice Management, Medical/economics , Purchasing, Hospital/economics , Decision Making, Organizational , Efficiency, Organizational , Hospital-Physician Relations , Oklahoma , Organizational Case Studies , Ownership/economics , Practice Valuation and Purchase/economicsABSTRACT
Although the use of cooled dialysate during hemodialysis is associated with stabilization of intradialytic BP, the effects of blood cooling on hemodynamics and urea kinetics in high-efficiency hemodialysis have not been completely studied. In particular, the effects of blood cooling have not been elucidated in very short-time, high K/V dialysis treatments, in which postdialysis urea rebound is maximized. In theory, blood cooling could increase urea compartmentalization during treatment and decrease dialysis efficacy. Measurements of cardiovascular hemodynamics and urea kinetics were performed in 15 patients (56 studies) during dialysis, using a blood temperature monitor with control of dialysate temperature. Dialysate temperature was adjusted to either lower the core temperature or raise the core temperature by, respectively, producing negative heat-energy exchange (cooled dialysis) or keeping heat-energy exchange in the extracorporeal circuit neutral (thermoneutral dialysis) so that energy was not transferred to or from the patient. Each subject was studied on both protocols, thereby allowing each individual to act as his own control. In cooled dialysis, heat-energy exchange in the extracorporeal circuit was -266+/-15 kJ per treatment, and dialysate temperature averaged 35.7+/-0.02 degrees C. In thermoneutral dialysis, heat-energy exchange in the extracorporeal circuit averaged 5+/-31 kJ per treatment, and dialysate temperature averaged 37.1+/-0.02 degrees C. Dialysate cooling resulted in a reduction in mean body temperature compared with thermoneutral therapy (-0.22+/-0.04 versus +0.31+/-0.05 degrees C). Cooling resulted in a greater increase in peripheral vascular resistance index (+515+/-160 versus + 114+/-92 dyn.sec/cm5 per m2), an increase in mean arterial pressure (+4+/-3 versus -4+/-4 mmHg), a reduction in the maximum intradialytic fall in mean arterial pressure (-10+/-2 versus -18+/-3, mmHg), and a reduction in staff interventions for hypotension or dialytic symptoms (6 of 28 versus 12 of 28 studies). These differences occurred without differences in the change in blood volume (-14.3+/-1.8% versus -13.9+/-2.2%) or cardiac index (-0.4+/-0.1 versus -0.4+/-0.2, L/min per m2). Urea rebound (37+/-4% versus 38+/-3%) and effective Kt/V (1.29+/-0.05 versus 1.32+/-0.06) were not different between groups. Thus, body temperature cooling can be used to stabilize BP and reduce intradialytic events requiring staff intervention without compromising the efficacy of treatment in high-efficiency dialysis.
