Adecuación del uso de ketorolaco en un hospital de traumatología / Appropriateness of ketorolac use in a trauma hospital

Objetivo: Adecuar la prescripción y el uso de ketorolaco, así como los demás antiinflamatorios no esteroideos (AINE) y analgésicos disponibles en la "Guía farmacoterapéutica" del hospital (GFT). Material y métodos: Este trabajo se estructuró siguiendo los pasos que integran un ciclo de mejora (PDCA). Se analizó el problema mediante un diagrama de Ishikawa. Se elaboraron tanto indicadores de calidad cualitativos, que medían la calidad de la prescripción, como cuantitativos (dosis diaria definida [DDD]/100E), que medían el consumo de medicamentos, y se marcaron los objetivos a alcanzar. Dichos indicadores se cuantificaron en el periodo previo y posterior a la implantación de las estrategias de mejora. La población estudiada fueron los pacientes ingresados en los servicios de traumatología y cirugía plástica con sistema de distribución de medicamentos en dosis unitaria. La estrategia de mejora consistió en el aporte de información mediante sesiones informativas y entrega de documentación a los médicos prescriptores en el periodo preintervención. Los resultados obtenidos se compararon con los objetivos iniciales para comprobar su cumplimiento. Resultados: Indicadores cualitativos: se incrementó el uso de ketorolaco intravenoso hasta2 días en el 25,5% (p < 0,001), y en pacientes de 65 años o más a dosis ≤ 60 mg/día un27,7% (p < 0,05). Indicadores cuantitativos: el consumo de ketorolaco descendió (cirugía plástica, 61,8 DDD/100E a 14,8), y el consumo de tramadol, ibuprofeno y metamizol aumentó (cirugía plástica, de 0 a 14,1; de 8,7 a 48,6 y de 50,1 a 71, respectivamente). Conclusiones: Se ha adecuado la prescripción y el uso de ketorolaco, AINE y tramadol, lo que proporciona mayor seguridad al paciente. Las estrategias utilizadas han sido efectivas (AU)

Objective: To evaluate the suitability of ketorolac and non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesic drugs currently used in the hospital. Material and method: We have followed the steps to develop a PDCA cycle (plan, do, check, act) or quality improvement cycle. The quality problem was analysed using anIshikawa diagram. We defined both qualitative quality indicators, those that measure prescription quality, and quantitative ones (defined daily dose, DDD/100BDs), which measure drug consumption, being the objectives to achieve. The study was conducted in all patients admitted to the hospital and who were admitted to orthopaedic and trauma surgery and plastic surgery departments with unit-dose dispensing systems. The strategy used was to give information to physicians through meetings and documentation. Finally, the results were analysed and compared with the initial objectives. Results: The study was performed on 260 patients in the first study period and 292 in the second. Qualitative indicators: intravenous ketorolac use ≤ 2 days, increased in 25.5% (p< 0.001); in patients ≥ 65 years old at dose ≤ 60 mg/day it increased 27.7% (p < 0.05). Quantitative indicators: in the second study period, ketorolac use decreased (plastic surgery department: 61.8 DDD/100BDs to 14.8), whereas tramadol, ibuprofen and metamizole increased (plastic surgery department: 0 to 14.1 in tramadol, 8.7 to 48.6 in ibuprofen and 50.1 to 71 in metamizole). Conclusions: Appropriateness of ketorolac, NSAIDs and tramadol use has been achieved, thus improving patient safety. Strategies have been effective (AU)

Osteopathic medicine in transition: postmortem of the Osteopathic Medical Center of Texas.

The stand-alone osteopathic hospital was a necessity to the osteopathic medical profession in an era when it was isolated from allopathic medicine. As osteopathic medicine has become increasingly integrated with allopathic medicine, however, an independent osteopathic hospital is no longer a necessity. Moreover, a stand-alone institution seems to be economically out of place in today's market. The Osteopathic Medical Center of Texas in Fort Worth is an example of a stand-alone hospital that was unable to capitalize on the benefits realized by integrated hospital systems. The author believes that this failure contributed to the institution's demise. The market power of a hospital system can be used for more favorable contracting with vendors and providers, as well as facilitating negotiations with payers. System affiliation provides economic efficiency, security, and protection in the highly uncertain, complex, and competitive healthcare market.

Cost structure of osteopathic hospitals and their local counterparts in the USA: are they any different?

Due to the emphasis on preventive care and less invasive solutions to medical problems, osteopathic hospitals may deliver cost efficient and cost effective care. This study examines the cost structure of osteopathic hospitals and compares their performance to a local control group selected from allopathic hospitals. Osteopathic hospitals are identified in the 1999 American Hospital Association (AHA) data and matched to local allopathic hospitals with respect to location, bed size, system, for-profit and teaching status. Cost functions are estimated for both groups of hospitals, and significant differences in input, output and costs are highlighted. Results show that osteopathic hospitals are more costly and less productive in comparison to their counterparts. Inefficient production of outpatient services and high cost of medical education are two reasons for the poor performance. The study has important policy implications on two fronts: first, osteopathic hospitals are more costly to operate than their counterparts, and subsequently this requires further analysis of the osteopathic treatments and techniques. In an environment where health care revenues are shrinking and costs are rising, this is probably much needed information for osteopathic hospitals. Secondly, there is an emerging concern among osteopathic medical schools and osteopathic physicians due to the declining number of osteopathic hospitals, which translates to a smaller number of residency positions for osteopathic medical school graduates. Analyzing cost, input and output variables reveal some of the contributing factors to the decline of osteopathic hospitals and help preserve this rich tradition.

Engineering data exchange.

UNLABELLED: Mount Clemens General Hospsital, Mount Clemens, Mich. PROBLEM: performance anomalies due to multiple interfaces with separate systems. SOLUTION: implementation of an interface engine. RESULTS: improved management of data exchange among disparate systems. KEYS TO SUCCESS: up-front studies of vendor offerings, potential problems, and long-term needs.

Recovery strategies help faltering hospital pull back from brink of bankruptcy.

Delaware Valley Medical Center was slipping fast, heading toward bankruptcy or closure. But thanks to a corrective business plan established a year ago, the Langhorne, Pa., osteopathic facility has turned profitable a year ahead of schedule. Physician recruitment, new services and a flexible hospital board have played key roles.

Closed hospitals' legacies shine on.

Hospitals across the country, when realization sets in that they must eventually close, are setting up foundations that continue to serve the health needs of their communities in creative ways and leave a legacy for the closed facilities.