Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases.

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System.

BACKGROUND: ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. METHODS: A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. RESULTS: The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). CONCLUSIONS: The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

Is there a relation between emergency department and inpatient lengths of stay?

INTRODUCTION: Emergency departments (EDs) are key entry points to hospital care, and issues of overcrowding and poor patient flow have become a priority in Canada. Studies have sought to determine factors that influence ED wait times in an effort to improve patient flow. We sought to identify the impact of factors such as patient age, triage level, comorbid factor level and sex to determine their effects on length of stay (LOS) and the role that they play in the ED and in an inpatient setting. METHODS: We analyzed 2 years of data from 2007 to 2009. We conducted a repeated-measures analysis of variance to measure the effects of age, triage level, comorbid level and sex as they relate to ED and inpatient LOS. RESULTS: Our analysis resulted in a final sample of 4743 patient visits. A longer LOS in the ED was correlated with a longer inpatient LOS. Age, comorbidity level and sex were shown to have an influence on LOS. CONCLUSION: Continued efforts to further reduce ED LOS are crucial, because this has the potential to influence outcomes, efficiency of EDs and succession to inpatient status, which may affect costs to the health care system. Patient-specific factors need to be considered when formulating and refining policies and processes to improve patient flow.

A comparison of egocentric and allocentric age-dependent spatial learning in the beagle dog.

Spatial discriminations can be performed using either egocentric information based on body position or allocentric information based on the position of landmarks in the environment. Beagle dogs ranging from 2 to 16 years of age were tested for their ability to learn a novel egocentric spatial discrimination task that used two identical blocks paired in three possible spatial positions (i.e. left, center and right). Dogs were rewarded for responding to an object furthest to either their left or right side. Therefore, when the center location was used, it was correct on half of the trials and incorrect on the other half. Upon successful acquisition of the task, the reward contingencies were reversed, and the dogs were rewarded for responding to the opposite side. A subset of dogs was also tested on an allocentric spatial discrimination task, landmark discrimination. Egocentric spatial reversal learning and allocentric discrimination learning both showed a significant age-dependent decline, while initial egocentric learning appeared to be age-insensitive. Intra-subject correlation analyses revealed a significant relationship between egocentric reversal learning and allocentric learning. However, the correlation only accounted for a small proportion of the variance, suggesting that although there might be some common mechanism underlying acquisition of the two tasks, additional unique neural substrates were involved depending on whether allocentric or egocentric spatial information processing was required.

Chronic antioxidant and mitochondrial cofactor administration improves discrimination learning in aged but not young dogs.

The present experiment was part of a 3-year longitudinal study examining the effects of age and antioxidant treatment on cognitive decline in beagles. Two size-concept tasks were administered following pretraining on a series of two-choice (six subtests) and three-choice size discrimination tasks. Thirty-nine young and aged dogs were matched for age and cognitive ability then divided into four treatment groups. A combined antioxidant-mitochondrial cofactor treatment led to significantly improved performance in aged dogs on the first subtest of the two-choice size discrimination series. Treated aged dogs did not significantly differ from the young. Aged dogs on the antioxidant diet continued to perform better than aged controls on the second and third subtests, but these effects did not achieve significance. Young dogs performed significantly better than the aged dogs on the second and third subtests. The remaining two-choice tasks of the discrimination series were comparatively easy, leading to a floor effect. The antioxidant animals performed better on the three-choice size discrimination, but not on the two size-concept tasks. Antioxidants improved the performance of aged dogs on the initial learning tests, suggesting a selective improvement of factors related to the aging process and specific cognitive processes rather than general cognitive enhancement.

Prior experience, antioxidants, and mitochondrial cofactors improve cognitive function in aged beagles.

Results of this study support the free-radical theory of aging and demonstrated that providing higher levels of vitamin E in food resulted in higher serum vitamin E concentrations and improved performance on landmark-discrimination tasks in aged dogs. Factors other than vitamin E also contributed to the response but remain undefined.

Response latency in Canis familiaris: mental ability or mental strategy?

Animal studies of cognitive aging typically use measures of response accuracy (RA) to evaluate cognitive function, which declines with age. Human aging studies, by contrast, frequently measure response latency (RL), with faster responses being indicative of superior performance. To examine the influence of age on RL in an animal model, the authors assessed RA with RL in young and aged beagle dogs (Canis familiaris) tested on a 3-component delayed nonmatching-to-position task, which comprised 3 subtests. Young dogs displayed significantly slower RLs and higher RAs and showed RL slowing with greater complexity, compared with aged dogs. In addition, the slower responding young dogs made fewer errors. Thus, RL appears to reflect the learning strategy applied, rather than the level of mental ability.

Visuospatial impairments in aged canines (Canis familiaris): the role of cognitive-behavioral flexibility.

This study used a novel delayed nonmatching-to-position task to compare visuospatial learning and memory in young and aged beagle dogs (Canis familiaris). The task used 3, rather than 2, spatial locations, which markedly increased difficulty. There were striking age differences in acquisition. Most of the aged canines did not learn the task, and those that did showed impaired learning when compared with the young canines. The aged canines also showed reduced maximal working memory capacity compared with the young canines. Analysis of the response patterns of individual canines indicated that the deficits were related to the use of ineffective strategies and inflexibility in strategy modification.