ABSTRACT
PURPOSES: Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. METHODS: This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. RESULTS: Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien-Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. CONCLUSION: Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Emergency Service, Hospital/trends , Hospital Planning/organization & administration , Hospital Planning/statistics & numerical data , Hospital Planning/trends , Patient Care Team , Surgery Department, Hospital/statistics & numerical data , Surgery Department, Hospital/trends , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Female , Humans , Japan/epidemiology , Male , Middle Aged , Multiple Trauma/mortality , Postoperative Complications/epidemiology , Retrospective Studies , Surgeons/education , Surgeons/supply & distribution , Wounds and Injuries/mortality , Young AdultABSTRACT
BACKGROUND: Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region. METHODS: The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year. RESULTS: The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities. CONCLUSIONS: Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.
Subject(s)
Healthcare Disparities/trends , Hospital Planning/trends , Length of Stay/trends , Outcome and Process Assessment, Health Care/trends , Patient Discharge/trends , Percutaneous Coronary Intervention/trends , Databases, Factual , Humans , Percutaneous Coronary Intervention/adverse effects , Time Factors , Treatment Outcome , United KingdomABSTRACT
Every year, the American Hospital Association compiles the Environmental Scan to provide hospital leaders with insight and information about market forces that are likely to affect the health care field. One common theme this year is the pace of change.
Subject(s)
Health Care Sector/trends , American Hospital Association , Biotechnology/trends , Health Care Sector/economics , Hospital Information Systems/trends , Hospital Planning/trends , Humans , Insurance, Health/trends , Leadership , Personnel, Hospital/economics , Personnel, Hospital/supply & distribution , Politics , Quality Assurance, Health Care/trends , United StatesABSTRACT
Markets with too many hospital beds could see trouble as providers seek to control spending and avoid expensive hospitalizations. "You'll need a lot fewer hospitals and hospital beds" because providers will do more to keep patients healthy enough not to need them, says Frank Trembulak, of Geisinger Health System.
Subject(s)
Ambulatory Care/economics , Economics, Hospital/trends , Hospitalization/economics , Ambulatory Care/trends , Cost Control/methods , Cost Control/trends , Health Promotion/economics , Health Promotion/trends , Hospital Bed Capacity/economics , Hospital Bed Capacity/statistics & numerical data , Hospital Planning/economics , Hospital Planning/trends , Hospitalization/trends , Humans , Insurance Coverage/legislation & jurisprudence , Medicaid/economics , Medicaid/legislation & jurisprudence , Needs Assessment , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/standards , United StatesABSTRACT
Hardly any other part of the healthcare sector is under such a pressure to change as the hospital sector. Hospitals are high-performers in coping with complex changes in modernising patient care, process design, quality, cost-effectiveness and service orientation. But, what really makes value to the patient? Currently, this question is raised with new seriousness. Those hospitals which consequently align their portfolio to value based and 'patient driven' healthcare delivery will succeed by both quality and cost-effectiveness. We receive such messages from the USA. In Germany there are on-going and admonishing pleas since the end of the 1990s not to lose sight of the patients' needs while designing new concepts for healthcare delivery. Future challenges imply not only the renaissance of patient centred care, but also demand for a comprehensive user orientation as a key factor to successful hospital modernisation. This is particularly true of concepts of structured, integrated and regional healthcare delivery. But a consequent alignment of healthcare with value for patients clearly exceeds the focus on integrating hospital and outpatient care. In designing new services of coordinated regional healthcare, hospitals gain strategic options for a single-source healthcare delivery. In terms of business development, user orientation does not only yield important impulses for stronger patient centred care, but also opens up chances for better quality and competitive advantages. Nevertheless, it requires a new understanding of innovation processes which considers value for patients and quality of results and outcome as a relevant scale for measuring effects of change management. Finally, the methods of the assessment of user oriented healthcare delivery are an essential challenge for the evaluation of cooperative healthcare services.
Subject(s)
Health Care Sector/trends , Hospital Administration/trends , Hospital Planning/trends , Patient Satisfaction , Quality Improvement/trends , Consumer Behavior , Cooperative Behavior , Delivery of Health Care, Integrated/trends , Forecasting , Germany , Hospital Restructuring , Humans , Interdisciplinary Communication , Marketing of Health Services/trends , Needs Assessment/trends , Patient Care Team/trends , Patient-Centered Care/trendsSubject(s)
Capital Financing/trends , Hospital Planning/economics , Investments/economics , Multi-Institutional Systems/economics , Decision Making, Organizational , Financing, Construction/trends , Health Services Needs and Demand , Hospital Planning/trends , Multi-Institutional Systems/organization & administration , Practice Valuation and Purchase/economics , United StatesABSTRACT
The crisis in the financial markets is having a major impact on hospitals' ability to access capital. Providers are seeking longer-term fixed-rate debt rather than shortterm debt. Hospital management teams and their boards need to understand the upside and downside of variable-rate debt and interest rate derivatives.
Subject(s)
Capital Financing/trends , Financial Management, Hospital/trends , Hospital Planning/trends , Governing Board , Government , Hospital Planning/economics , Humans , Income/trends , Insurance, Hospitalization , Investments/trends , Leadership , Risk Management , United StatesABSTRACT
Planning for capital development of public hospitals in Victoria is guided by a multi-stage process with comprehensive data analysis and thorough approval processes at each of the stages. The long development time frames and the limitations in the data available to project service utilisation may negatively impact upon the service planning processes, and in some cases newly developed hospitals have not been sufficiently planned to meet community needs. This paper suggests that service utilisation forecasts derived from administrative databases require a more detailed verification process than currently exists. The process requires consideration of the drivers of demand to document the core assumptions about the future drivers, benchmarks with other jurisdictions, epidemiological, comparative and corporate needs assessment to explain the differences in utilisation rates, and sensitivity analysis. Given the cost of hospital construction and the rate of change in the healthcare sector, it is important that future hospital planning processes do not accept current utilisation trends as valid for future planning without this level of verification.
Subject(s)
Health Services Needs and Demand/statistics & numerical data , Hospital Planning/trends , Hospitals, Public/statistics & numerical data , Databases, Factual , Forecasting , Health Care Sector/statistics & numerical data , Health Care Sector/trends , Hospital Design and Construction , VictoriaABSTRACT
As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the fifth in a 5-part series on applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, the concept of control is explored from a complex systems perspective.
Subject(s)
Decision Making , Hospital Planning/organization & administration , Nurse Administrators/organization & administration , Systems Theory , Forecasting , Hospital Planning/trends , Humans , Medical Errors/prevention & control , Medical Errors/statistics & numerical data , Nurse Administrators/trendsABSTRACT
The nation's children's hospitals are in the midst of a building boom, moving into dazzling new spaces, adding an array of amenities and boosting research.
Subject(s)
Hospital Design and Construction/trends , Hospital Planning/trends , Hospitals, Pediatric/supply & distribution , Child , Health Care Surveys , Health Facility Environment , Health Facility Moving , Health Services Needs and Demand/trends , Hospitals, Pediatric/organization & administration , Hospitals, Pediatric/trends , Humans , Patients' Rooms , Research Support as Topic , United StatesSubject(s)
Governing Board , Health Care Sector/trends , Health Services Needs and Demand/trends , Hospital Planning/trends , Leadership , Biomedical Technology/trends , Community-Institutional Relations/trends , Hospital Information Systems/trends , Hospital Planning/economics , Humans , Insurance, Health/trends , Politics , Quality Assurance, Health Care , Societies, Hospital/trends , United StatesSubject(s)
Hospital Planning/economics , Hospitals, Proprietary/supply & distribution , Hospitals, Voluntary/supply & distribution , Multi-Institutional Systems/economics , Economic Competition/trends , Health Care Sector/trends , Health Facility Merger , Hospital Planning/trends , Humans , Multi-Institutional Systems/trends , Population Growth , VirginiaABSTRACT
La alimentación demás de contribuir a mejorar el estado de salud de los pacientes, es un componente clave de la consideración del confort de la estancia en el hospital. Los hospitales precisan que el servicio de restauración garantice las condiciones higiénico-sanitarias de los alimentos, suministre una dieta adecuada a las necesidades nutricionales de cada paciente y respete en la medida de lo posible sus costumbres y preferencias alimentarias. Este artículo hace un repaso a todo ello con el ejemplo de la gestión de la restauración hospitalaria en el Hospital de Basurto (AU)
Food, as well as contributing to improving the health of patients, is a key component when considering the comfort of a stay in hospital. Hospitals need the catering service to ensure the hygienic and sanitary condition of the food, to provide a diet suited to the nutritional needs of each patient and as far as possible which respects their food customs and preferences. This article reviews all this, with the example of the hospital catering management in the Hospital de Basunto (AU)
Subject(s)
Humans , Male , Female , Hospitalization , Inpatient Care Units , /legislation & jurisprudence , /trends , /organization & administration , /standards , Hospital Administration/methods , Hospital Restructuring/methods , Hospital Restructuring/organization & administration , Hospital Restructuring/trends , /trends , Hospital Administration/instrumentation , Hospital Administration/statistics & numerical data , Admitting Department, Hospital/organization & administration , Hospital Administration/trends , Hospital Design and Construction/standards , Hospital Design and Construction/trends , Hospital Planning/methods , Hospital Planning/organization & administration , Hospital Planning/trendsABSTRACT
The continuing influx of new residents has been a boon for hospitals in the Sunshine State, where new state-of-the-art facilities seem to be sprouting next to every palm tree. But questions about Medicare payments, a large uninsured population, and shortages of doctors and other staff pose serious challenges.