Journal articles on the topic 'Acute hospital building'
To see the other types of publications on this topic, follow the link: Acute hospital building.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Acute hospital building.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Bardell, Trevor, and Peter M. Brown. "Smoking Inside Canadian Acute Care Hospitals." Canadian Respiratory Journal 13, no. 5 (2006): 266–68. http://dx.doi.org/10.1155/2006/139359.
Full textAbstract:
OBJECTIVE: To assess smoking policies at Canadian acute care hospitals.METHOD: A questionnaire was designed, piloted and faxed to all acute care hospitals in Canada. The questionnaire was designed to address the following: what is the current policy regarding patient smoking? Are staff and/or visitors allowed to smoke inside the hospital? Is there a separate policy for psychiatric patients? Are smoking cessation products available at the hospital pharmacy? Is the policy governed by regional or municipal legislation?RESULTS: A total of 852 hospitals were included in the study. Of these, 476 responded to the questionnaire, for an overall response rate of 56%. Twenty-seven per cent of respondents allowed patient smoking inside the hospital. While staff smoking was not allowed inside most hospitals (93%), 32% of hospitals in Quebec allowed staff to smoke inside the building. Thirty per cent of hospitals had a separate policy for psychiatric patients, and 27% of hospitals had provisions for visitor smoking. Sixty-seven per cent of hospitals were able to offer patients smoking cessation products while they were in hospital.CONCLUSIONS: Many Canadian hospitals continue to allow smoking inside their facilities. There is considerable variation in hospital smoking policies across the country.
2
Chabrol, Fanny, Lucien Albert, and Valéry Ridde. "40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?" BMJ Global Health 3, Suppl 3 (April 2019): e001293. http://dx.doi.org/10.1136/bmjgh-2018-001293.
Full textAbstract:
Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.
3
Ellis, Elizabeth Fuselier, Thomas A. Mackey, Carolyn Buppert, and Kenneth E. Klingensmith. "Acute Care Nurse Practitioner Billing Model Development." Clinical Scholars Review 1, no. 2 (November 2008): 125–28. http://dx.doi.org/10.1891/1939-2095.1.2.125.
Full textAbstract:
As hospitals face increasing practice management challenges, as in decreased staffing, decreased reimbursement, increased malpractice, rising costs, and increased quality and safety demands, many hospitals today have turned toward increased use of nurse practitioners (NPs). Utilization of NPs within hospitals has been safe, effective, and profitable and is increasingly accepted. Hospitals are now developing defined clinical leadership roles to oversee the daily practice management of advanced practice providers. A doctor of nursing practice (DNP) is the ideal clinical leader to develop and implement such innovative practice solutions for hospital-based NP programs. This article will address the basic principles of building a practice billing model for acute care NPs at a major medical center in Houston, Texas. Creating new models requires comprehensive analysis and continued evaluation as the complexities in providing health care continuously shift. The direct benefit of NP utilization will become evident through direct reimbursement or practice improvement.
4
Holton, Donna, Shirley Paton, Helen Gibson, Geoffrey Taylor, Carol Whyman, and TC Yang. "Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1." Canadian Journal of Infectious Diseases 8, no. 4 (1997): 188–94. http://dx.doi.org/10.1155/1997/725723.
Full textAbstract:
OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.
5
Hu, Jingjing, Vannara Sokh, Sophy Nguon, Yang Van Heng, Hans Husum, Roar Kloster, Jon Øyvind Odland, and Shanshan Xu. "Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia." International Journal of Environmental Research and Public Health 19, no. 11 (May 26, 2022): 6471. http://dx.doi.org/10.3390/ijerph19116471.
Full textAbstract:
To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.
6
Xidous, Dimitra, Tom Grey, Sean P. Kennelly, and Desmond O’Neill. "Understanding the knowledge and engagement of facilities management with dementia-friendly design in Irish hospitals: an exploratory study." Facilities 39, no. 9/10 (January 11, 2021): 601–14. http://dx.doi.org/10.1108/f-01-2020-0012.
Full textAbstract:
Purpose This exploratory study stems from research conducted between 2015–2018 focussing on dementia-friendly design (DFD) in hospitals (Grey T. et al. 2018). Specifically, this study focusses on facilities management (FM) staff in Irish hospitals to gain a preliminary understanding of the level of knowledge and engagement of FM in the implementation of dementia-friendly hospital (DFH) design. Design/methodology/approach A mixed-methods approach based on a series of ad hoc semi-structured interviews, and an online survey. The aims were, namely, assess the extent of FM engagement in hospital works; measure the level of awareness regarding DFD; and identify facilitators and barriers to DFD in hospital settings. Participants (74) comprised FM staff in 35 Irish acute care hospitals. The research findings are based on thematic analysis of ad hoc semi-structured interviews (participants, n = 4) and survey responses (participants, n = 13). Findings While FM staff reported to possess important knowledge for building DFH, they also mentioned a lack of engagement of FM in design processes and hospital works. Practical implications The research has gained insight into the role of FM in promoting a dementia-friendly approach. Lack of or poor engagement of FM in design processes and hospital works means not fully tapping into rich expertise that would be invaluable in the development, implementation and maintenance of DFH. Universal design is a key driver for facilitating their engagement in the design, implementation and maintenance of DFH environments. Originality/value This is the first study exploring the role of FM in supporting a DFD approach in acute care hospitals.
7
IWATA, Yukari, Momoyo KAIJIMA, and Toshihiro HANAZATO. "COMMON SPACE REFURBISHMENT FOR IMPROVING THE THERAPEUTIC ENVIRONMENT IN AN ACUTE HOSPITAL." AIJ Journal of Technology and Design 22, no. 50 (2016): 237–42. http://dx.doi.org/10.3130/aijt.22.237.
Full text
8
Totman, Jonathan, Farhana Mann, and Sonia Johnson. "Is locating acute wards in the general hospital an essential element in psychiatric reform? The UK experience." Epidemiology and Psychiatric Sciences 19, no. 4 (December 2010): 282–86. http://dx.doi.org/10.1017/s1121189x00000592.
Full textAbstract:
AbstractLocating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the UK, however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence.Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards.Declaration of Interest: None.
9
Maddocks, W. T. Astrid, and Peter D. Maddocks. "Rehabilitation in a district general hospital." Psychiatric Bulletin 16, no. 7 (July 1992): 431–32. http://dx.doi.org/10.1192/pb.16.7.431.
Full textAbstract:
The Psychiatric Unit at Wexham Park Hospital has served a population of 230,000 with no entry to long-stay beds since 1972. There have been between 45 and 60 available beds for all types of mental illness except dementia. Various group homes and unstaffed halfway houses have been started, but the accumulation of more disabled patients showed the need for both a staffed group home, and rehabilitation to fit them for it. There was no separate ward or building in the hospital which could be used, and so rehabilitation had to be arranged on an acute ward. The staffed group home has a lower staff-patient ratio than a hospital hostel.
10
Bishop, Jaclyn L., Thomas R. Schulz, David C. M. Kong, and Kirsty L. Buising. "Sustainability of antimicrobial stewardship programs in Australian rural hospitals: a qualitative study." Australian Health Review 44, no. 3 (2020): 415. http://dx.doi.org/10.1071/ah19097.
Full textAbstract:
ObjectiveThe aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals’ AMS programs. MethodsLead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. ResultsFifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. ConclusionsStrategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic?AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add?Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners?Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care.
11
Duffy, Kerry, Adam Pearson, and Mark Waters. "Moving a hospital - a once in a lifetime experience." Australian Health Review 25, no. 2 (2002): 155. http://dx.doi.org/10.1071/ah020155.
Full textAbstract:
It is a hugely complex task to move a 525-bed acute tertiary health facility to a new building whilst continuing to provide services to the public - a task that was undertaken at Brisbane's Princess Alexandra Hospital in March/April 2001. There were complex issues to manage, ranging from clinical unit interdependence across a split campus to the development of detailed plans for transferring telephone extensions/personal computers in a "live environment". The success of the Princess Alexandra exercise is shown by there having been no adverse effects on patients, the lack of negative media attention and the occurrence of only two staff injuries during the move. Meticulous planning and good communication with staff and stakeholders (other hospitals, general practitioners)supported this success. The decision to reduce clinical services where possible during the shift was helpful.Understanding the complexity and richness of the information technology, the work environment and the humanelements on campus was also critical to success. One major error was the initial decision to schedule the move within weeks of receiving practical completion of the new building. It became all too clear in November 2000 that further time was required to commission the building. The Transition was therefore rescheduled from January to March 2001. This decision was critical to the success of the move.
12
Guirguis, Marianne Nabil, and Rania Rushdy Moussa. "Prevention and Control of Airborne Infections; investigating the efficiency of hospital design using (AIC) evaluation tool." IOP Conference Series: Earth and Environmental Science 1056, no. 1 (August 1, 2022): 012001. http://dx.doi.org/10.1088/1755-1315/1056/1/012001.
Full textAbstract:
Abstract Our world is resisting the new pandemic “severe acute respiratory syndrome Coronavirus 2” (SARS-CoV-2) causing the disease known as COVID-19. To date, more than two hundred and three million cases were confirmed out of who more than four million died. Sharing data that will help the community to intervene with measures that will decrease the spread of the virus and protect the population is an obligation. This will help the world cope with this pandemic. This research aims to highlight the different criteria that will determine that the building of a health facility is ready to control the infection of this virus and similar airborne viruses. The research developed an evaluation tool that can be used by hospital administration to assess the hospital building readiness to prevent and control airborne infection from the viewpoint of architecture if it is an existing one or alternatively it can assess the design in case of a new hospital building, determining required roles and responsibilities.
13
Lloyd, Jane, Gawaine Powell Davies, and Mark Harris. "Integration between GPs andhospitals: lessons from a division-hospitalprogram." Australian Health Review 23, no. 4 (2000): 134. http://dx.doi.org/10.1071/ah000134a.
Full textAbstract:
The aim of the study reported here was to evaluate current initiatives in GP-hospital integration and highlight areaswhere further research, development and evaluation are required. Seven pre-existing GP-hospital programs wereselected and given supplementary funding to allow for more effective evaluation. These local evaluations were thenincorporated into a national program on GP-hospital collaboration.We found that the seven projects made substantial progress towards their goals, and in the process highlighted importantaspects of successful collaboration. The collective evaluation of DHIP identified expected benefits of collaboration forpatients (improved access to services, reduced anxiety, and fewer post discharge complications), for GPs (increasedinvolvement in acute care and in hospital decision making), and for service organisations (stronger workingrelationships, increased capacity, and greater efficiency). Barriers to service integration were also identified, includingthe different cultures of Divisions and hospitals, their lack of internal coherence and the Commonwealth-state divide.The evaluation showed that much has been achieved in building the relationships and the capacity needed for GP-hospitalcollaboration, and that effective models exist. The current challenge is to extend successful models acrosshealth areas and make effective collaboration part of the normal system of care. Substantial progress towardsintegrated care relies on a shift from a focus on systems within general practice or hospital environments to a patientcentred approach. This will require general practice, hospitals, community services and consumer organisations toform long term partnerships and move beyond their currently disjointed view of acute and community care. Thedevelopment of practical indicators for integrated care will support the process and facilitate shared learning acrossCommonwealth and state divides.
14
MURAKAWA, Maki, and Asuka YAMADA. "A CASE REPORT ON NURSES’ BURDEN-FEELING IN ACUTE HOSPITAL HAVING DISTINCTIVE INPATIENT QUARTERS PLAN." AIJ Journal of Technology and Design 27, no. 66 (June 20, 2021): 841–46. http://dx.doi.org/10.3130/aijt.27.841.
Full text
15
Sapey, Elizabeth, Mona Bafadhel, Charlotte E. Bolton, Thomas Wilkinson, John R. Hurst, and Jennifer K. Quint. "Building toolkits for COPD exacerbations: lessons from the past and present." Thorax 74, no. 9 (July 3, 2019): 898–905. http://dx.doi.org/10.1136/thoraxjnl-2018-213035.
Full textAbstract:
In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.An ECOPD is ‘an acute worsening of respiratory symptoms that results in additional therapy’. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.
16
Lino, Bartholomew, Arie Eisenman, Richard Schuster, Carlos Giloni, Masad Bharoum, Moshe Daniel, and Cham Dallas. "The Second Lebanon War Experience at Western Galilee Hospital." Disaster Medicine and Public Health Preparedness 10, no. 1 (July 21, 2015): 152–56. http://dx.doi.org/10.1017/dmp.2015.80.
Full textAbstract:
AbstractThe summer of 2006 in northern Israel served as the battleground for the second war against Hezbollah based along Israel’s border with southern Lebanon. Western Galilee Hospital (WGH), which is located only 6 miles from the Lebanese border, served as a major medical center in the vicinity of the fighting. The hospital was directly impacted by Hezbollah with a Katyusha rocket, which struck the ophthalmology department on the 4th floor. WGH was able to utilize a 450-bed underground facility that maintained full hospital functionality throughout the conflict. In a major feat of rapid evacuation, the entire hospital population was relocated under the cover of darkness to these bunkers in just over 1 hour, thus emptying the building prior to the missile impact. Over half of the patients presenting during the conflict did not incur physical injury but qualified as acute stress disorder patients. The particulars of this evacuation remain unique owing to the extraordinary circumstances, but many of the principles employed in this maneuver may serve as a template for other hospitals requiring emergency evacuation. Hospital functionality drastically changed to accommodate the operational reality of war, and many of these tactics warrant closer investigation for possible implementation in other conflict zones. (Disaster Med Public Health Preparedness. 2016;10:152–156)
17
He, Jianqin, Yong Hu, Xiangzhou Zhang, Lijuan Wu, Lemuel R. Waitman, and Mei Liu. "Multi-perspective predictive modeling for acute kidney injury in general hospital populations using electronic medical records." JAMIA Open 2, no. 1 (November 15, 2018): 115–22. http://dx.doi.org/10.1093/jamiaopen/ooy043.
Full textAbstract:
Abstract Objectives Acute kidney injury (AKI) in hospitalized patients puts them at much higher risk for developing future health problems such as chronic kidney disease, stroke, and heart disease. Accurate AKI prediction would allow timely prevention and intervention. However, current AKI prediction researches pay less attention to model building strategies that meet complex clinical application scenario. This study aims to build and evaluate AKI prediction models from multiple perspectives that reflect different clinical applications. Materials and Methods A retrospective cohort of 76 957 encounters and relevant clinical variables were extracted from a tertiary care, academic hospital electronic medical record (EMR) system between November 2007 and December 2016. Five machine learning methods were used to build prediction models. Prediction tasks from 4 clinical perspectives with different modeling and evaluation strategies were designed to build and evaluate the models. Results Experimental analysis of the AKI prediction models built from 4 different clinical perspectives suggest a realistic prediction performance in cross-validated area under the curve ranging from 0.720 to 0.764. Discussion Results show that models built at admission is effective for predicting AKI events in the next day; models built using data with a fixed lead time to AKI onset is still effective in the dynamic clinical application scenario in which each patient’s lead time to AKI onset is different. Conclusion To our best knowledge, this is the first systematic study to explore multiple clinical perspectives in building predictive models for AKI in the general inpatient population to reflect real performance in clinical application.
18
Temple, RM, and A. Donley. "The future hospital – implications for acute care." Acute Medicine Journal 13, no. 1 (January 1, 2014): 4–5. http://dx.doi.org/10.52964/amja.0330.
Full textAbstract:
Acute physicians are confronted daily by the relentless increase in clinical demand, inadequate continuity of care, breakdown in out of hours care and a looming crisis in the medical workforce. The scale and gravity of these factors, together with changes to patient’s needs relating to the ageing demography, were detailed in the RCP report published in September 2012 ‘Hospitals on the edge’. The top concern of RCP members and fellows was the lack of continuity of care, ahead of financial pressures and clinical staff shortages. Worryingly one in ten physicians stated they would not recommend their hospital to a family member, and a further 25% were ambivalent on this question. Concern about the provision of acute medical care is not confined to consultants and specialist registrars. Another RCP report, ‘Hospital workforce, fit for the future?’ (2013) highlighted that 37% of FT2s and CMTs considered the workload of the medical registrar on call ‘unmanageable’. The outcome of the Mid Staffs independent inquiry in February 2013 provided critical context for the launch of the Future Hospital Commission (FHC) report, which was launched seven months later in September. The report was met with an extremely positive response from patients, carers, NHS staff, healthcare leaders and politicians. Lancet Editor Richard Horton said that the Commission had ‘produced the most important statement about the future of British medicine for a generation.’ Secretary of State for Health Jeremy Hunt praised the report and its ‘buck stops here’ approach. The Daily Mirror even noted that the report was one of the few areas on which the government and the opposition could agree! ‘Future Hospital: caring for medical patients’ places the patient at the centre of healthcare. Organising healthcare delivery around the needs of the patient is at its heart and features extensively in the core principles and 50 recommendations. A series of unequivocal commitments were made to patients, on issues generating considerable patient concern: moving beds in hospital, quality of communication and arrangements to leave hospital. Patients and carers were represented in each of the Commission’s five work streams, led on the recommendations relating to building a culture of compassion and respect, and participated in launch of the report to the media. The primary focus of the FHC report is on the acute care of medical patients and the views of acute physicians were key to articulating these recommendations. However the report is clear that the solution to current acute pressures on hospitals and specifically in-patient pathways, lie across the whole health and social care system. Care must be delivered in the setting in which the patient’s clinical, care and support needs can best be met and not merely delegated to the acute hospital site. This inevitably means 7 day services in the community as well as in hospital and a consistent new level of “joined up care” with integration, collaboration and information sharing across hospital and all healthcare settings. In keeping with this the report highlights the urgent need to establish alternatives to hospital admission including the extensive use of ambulatory emergency care (AEC), the provision of secondary care services in the community and an expansion of intermediate care rehabilitation services. Many of the report’s recommendations arose from clinical staff devising innovative solutions to improve the quality of care and ameliorate clinical demand. The report showcased a range of case studies describing service developments and new patterns of care, innovations that would not have been possible without the leadership and sheer determination of physicians and their teams. Dr Jack Hawkins, Acute Physician in Nottingham Queen’s Medical Centre, described how analysis of performance data showing that 50% of acute medical patients were discharged within 15 hours, led to the starting vision for their new AEC service as “everyone is ambulatory until proven otherwise”. The case studies highlight the resources needed to implement service change and the supportive staff relationships and changes to working practices that underpin their success. The report describes the “acute care hub” as the focus of acute medical services, comprising colocation of the AMU, short stay wards, enhanced care beds and the AEC. Much of this echoes the front door configuration described by the acute medicine task force report in 2007 ‘Acute medical care: The right person, in the right setting, first time’. What the FHC adds are recommendations to co-locate AEC and a clinical co-ordination centre to provide clinicians with real time data on capacity in community-based services (rehabilitation and social services), and link to rapid access specialist clinics or community services to support pathways out of AEC and AMU. Recommendations to structure acute services to maximise continuity of care is a major theme. There should be sufficient capacity in the acute care hub to accommodate admitted patients who do not require a specialist care pathway and are likely to be discharged within 48 hours. This is supported by recommended changes to working practices of consultant led teams where they commit to two or more successive days working in the hub. This allows the consultant led team who first assess the patient in AMU to continue to manage them on the short stay ward through to their discharge – an approach familiar to acute physicians but which may be novel to GIM physicians assigned a single on call day. Striving to deliver continuity by a stable clinical team should also simplify handover, improve training, feedback and the quality and safety of the care delivered. The commission recommends designating enhanced care (level 1) and high dependency (level 2) beds in the acute care hub to improve the care of acutely ill patients requiring an increased intensity of monitoring and treatment. The RCP acute medicine taskforce made the same recommendation in 2007 but acute trusts have been slow to embed level 2 beds in particular, on AMUs. In the future hospital every effort should be made to enhance rapid access to specialist pathways that benefit patients, including entry to pathways for acute coronary disease or stroke or the frail elderly direct from the community or emergency department. Here the report is clear that the responsibility for continuity of care rests with the specialty consultant, who should review the patient on the day of admission. Patient experience should be valued as much as clinical effectiveness. Patients want “joined up care” that is tailored to their acute illness, comorbidities and requirements for social support. From a patient’s perspective, failures of information sharing between primary and secondary care, or specialist services within the same or neighbouring Trusts, are incomprehensible. The report highlights that this informatics disconnect undermines accurate clinical assessment at the time of presentation with an acute illness, when patients are most vulnerable, and this deficit will impact on patient experience, timely access to specialist staff, patient outcome and resource use. Robert Francis, in commenting on the report of the Mid Staffordshire public enquiry highlighted that the subject was ‘too important to suffer the same fate as other previous enquiries .. where after initial courtesy of welcome, implementation was slow or non existent’. The RCP shares this urgency and having accepted the recommendations of the FHC as a comprehensive ‘treatment’ for the care of patients in the future hospital, is determined that the FHC report itself will not sit on a shelf, gathering dust. The RCP is now embarking on a future hospital implementation programme. This programme gathers momentum this month with the appointment of future hospital officers and staff and the immediate priority is to identify partners to set up national development sites. The RCP is seeking enthusiastic clinical teams to investigate changes to a range of hospital and community based medical services in line with the FHC principles and to evaluate the impact on patient care. Over the next 3 years it is envisaged that the programme will also include research and new approaches to commissioning, workforce deployment, healthcare facility design and integrated working across the health economy. The evaluation of these projects, in relation to the quality and safety of patient care and patient experience, will be crucial and will be shared through the RCP and its partners. In addition, from April the RCP will publish a Future Hospital journal to help share the learning from the implementation programme and welcomes submissions of innovative best practice in acute care. The challenge now is to convert the goodwill generated by publication of the FHC principles, into an implementation programme nationally, that helps build an effective evidence base to support new ways of providing high quality, safe, patient care. Acute physicians are crucial partners in meeting this challenge.
19
Pickering, Brian W., John M. Litell, Vitaly Herasevich, and Ognjen Gajic. "Clinical review: The hospital of the future - building intelligent environments to facilitate safe and effective acute care delivery." Critical Care 16, no. 2 (2012): 220. http://dx.doi.org/10.1186/cc11142.
Full text
20
McNulty, Kristy L. "Psychological and Emotional Recovery to Severe Burn Injury." Journal of Applied Rehabilitation Counseling 33, no. 1 (March 1, 2002): 7–12. http://dx.doi.org/10.1891/0047-2220.33.1.7.
Full textAbstract:
Burn trauma is not only physically painful, but the experience of sustaining a severe burn, dealing with a lengthy hospital stay, and being faced with long-term consequences can be emotionally devastating. This paper describes common reactions to critical injury within the acute and post-acute rehabilitation phases, and reviews the psychologic adjustment of both pediatric and adult survivors. Rehabilitation counseling interventions focus on building a convoy of social support, coping with pain and incapacitation, fostering a positive self-concept and body image, and promoting overall acceptance of the disability. The role of the rehabilitation counselor in assessing vocational potential is also discussed.
21
SUDA, Masafumi, Shinsuke KAWAI, Kentaro SAKAINO, Atsuo KAKEHI, and Tetsuro YAMASHITA. "ANALYSIS OF UNIT INDICATOR BY RELEVANT DATA IN SPECIFICATIONS OF THE OUTPATIENT DEPARTMENT OF GENERAL ACUTE CARE HOSPITAL." AIJ Journal of Technology and Design 25, no. 61 (October 20, 2019): 1233–37. http://dx.doi.org/10.3130/aijt.25.1233.
Full text
22
SUDA, Masafumi, Shinsuke KAWAI, Kentaro SAKAINO, Atsuo KAKEHI, and Tetsuro YAMASHITA. "ANALYSIS OF UNIT INDICATOR BY RELEVANT DATA IN SPECIFICATIONS OF THE NURSING UNIT OF GENERAL ACUTE CARE HOSPITAL." AIJ Journal of Technology and Design 27, no. 67 (October 20, 2021): 1355–60. http://dx.doi.org/10.3130/aijt.27.1355.
Full text
23
Prasad, Purnima Aishwarya, Dhruvi Joshi, Jennifer Lighter, Jenna Agins, Robin Allen, Michael Collins, Foohel Pena, Joan Velletri, and Cassandra Thiel. "Environmental footprint of regular and intensive inpatient care in a large US hospital." International Journal of Life Cycle Assessment 27, no. 1 (December 4, 2021): 38–49. http://dx.doi.org/10.1007/s11367-021-01998-8.
Full textAbstract:
Abstract Purpose Environmental sustainability is a growing concern to healthcare providers, given the health impacts of climate change and air pollution, and the sizable footprint of healthcare delivery itself. Though many studies have focused on environmental footprints of operating rooms, few have quantified emissions from inpatient stays. This study quantifies solid waste and greenhouse gas emissions (GHGs) per bed-day in a regular inpatient (low intensity) and intensive care unit (high intensity). Methods This study uses hybrid environmental life cycle assessment (LCA) to quantify average emissions associated with resource use in an acute inpatient unit with 49 beds and 14,427 hospitalization days and an intensive care unit (ICU) with 12 beds and 2536 hospitalization days. The units are located in a single tertiary, private hospital in Brooklyn, NY, USA. Results and discussion An acute care unit generates 5.5 kg of solid waste and 45 kg CO2-e per hospitalization day. The ICU generates 7.1 kg of solid waste and 138 kg CO2-e per bed day. Most emissions originate from purchase of consumable goods, building energy consumption, purchase of capital equipment, food services, and staff travel. Conclusions The ICU generates more solid waste and GHGs per bed day than the acute care unit. With resource use and emission data, sustainability strategies can be effectively targeted and tested. Medical device and supply manufacturers should also aim to minimize direct solid waste generation.
24
Bagot, Kathleen L., Christopher F. Bladin, Michelle Vu, Joosup Kim, Peter J. Hand, Bruce Campbell, Alison Walker, Geoffrey A. Donnan, Helen M. Dewey, and Dominique A. Cadilhac. "Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective." Journal of Telemedicine and Telecare 22, no. 8 (October 30, 2016): 489–94. http://dx.doi.org/10.1177/1357633x16673695.
Full textAbstract:
We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community.
25
Souza, Aparecida D. P., and Helio S. Migon. "Bayesian binary regression model: an application to in-hospital death after AMI prediction." Pesquisa Operacional 24, no. 2 (August 2004): 253–67. http://dx.doi.org/10.1590/s0101-74382004000200003.
Full textAbstract:
A Bayesian binary regression model is developed to predict death of patients after acute myocardial infarction (AMI). Markov Chain Monte Carlo (MCMC) methods are used to make inference and to evaluate Bayesian binary regression models. A model building strategy based on Bayes factor is proposed and aspects of model validation are extensively discussed in the paper, including the posterior distribution for the c-index and the analysis of residuals. Risk assessment, based on variables easily available within minutes of the patients' arrival at the hospital, is very important to decide the course of the treatment. The identified model reveals itself strongly reliable and accurate, with a rate of correct classification of 88% and a concordance index of 83%.
26
Pramanik, Md Azizur Rahman, Muhammad Rabiul Hossain, and Md Abul Kalam Azad. "Management of mass casualty in Rana Plaza tragedy, the worst industrial disaster in Bangladesh." Journal of Armed Forces Medical College, Bangladesh 9, no. 2 (February 2, 2015): 10–18. http://dx.doi.org/10.3329/jafmc.v9i2.21819.
Full textAbstract:
Introduction: On April 24, 2013, Rana Plaza, an 8 storied building accommodating 5 garment factories, a bank, a number of commercial shops and offices collapsed at Savar, Dhaka, Bangladesh, while more than 4 thousand people were working inside. A massive rescue operation was carried out in following 21 days by the Government of Bangladesh involving all of her associated organs with a key role played by the Armed Forces. A total of 2438 injured victims were rescued between 24 Apr 2013 and 10 May 2013 including a female garment worker who was rescued after 17 days of the building collapse. The death toll finally reached to 1132 including 2 rescue workers. This unprecedented disaster was mitigated by extraordinary responses from almost all the organs of government and also from non-government bodies. All available medical resources were utilized for immediate, short term and long term management of the injured victims. Objective: This study is aimed to find out the pattern of injuries in the victims of this catastrophe and also the management of mass casualty in Rana Plaza tragedy which occurred due to the multistoried commercial building collapse. Methods: This observational study was conducted on pre-hospital, in-hospital and post-hospital management of the victims of the disaster. Each of the injured individuals was tracked for a period of more than 3 months. Data were collected from interviews, observation and by studying the records of field medical units, secondary and tertiary hospitals and rehabilitation centres. Results: This was the deadliest garments factory accident in the history causing 1132 deaths and 2438 injured cases. The rescue operation was carried out upto 14 May 2013. Removal of the whole collapsed building rubbles took 21 days and 1127 dead bodies had been recovered. Two rescuers died during rescue operation. Out of 2438 casualties 407 were brought to SMH Savar, 28 victims of serious injury were evacuated to CMH Dhaka where only one patient died. One thousand and seven hundred casualties were taken to Enam Medical College and Hospital, Savar and 105 patients were taken to National Institute of Traumatology and Rehabilitation (NITOR). Two hundred and twenty six patients received management in the other private clinics. Out of 2438 patients, 951 received prolonged hospital treatment of which blunt trauma was found in 225(23.66%) cases, soft tissue injuries in 149(15.67%) cases, fractures in 137(14.41%) cases, crush syndrome in 46(4.84%), head injuries in 40(4.20%), limb loss in 33(3.47%) and other non lethal injuries were observed in 321(33.75) cases. Three patients expired during treatment due to complications like acute renal failure, ARDS and complication of head injury. Up to 26 Jul 2013, 36 cases were found disabled to sequelae of head injury, spinal injury, fracture of long bones of limbs and injury of peripheral nerves. Among the patients of mass casualty commonest complication or presentation was acute stress reaction in 44.92 percent of patients. Conclusion: Management of mass casualty in this building collapse provides us with a valuable experience which may be utilized in dealing with similar disasters that might take place in any densely populated city in an earthquake prone country like Bangladesh. DOI: http://dx.doi.org/10.3329/jafmc.v9i2.21819 Journal of Armed Forces Medical College Bangladesh Vol.9(2) 2013
27
Kipps, Alaina K., Steven C. Cassidy, Courtney M. Strohacker, Margaret Graupe, Katherine E. Bates, Mary C. McLellan, Ashraf S. Harahsheh, et al. "Collective quality improvement in the paediatric cardiology acute care unit: establishment of the Pediatric Acute Care Cardiology Collaborative (PAC3)." Cardiology in the Young 28, no. 8 (June 28, 2018): 1019–23. http://dx.doi.org/10.1017/s1047951118000811.
Full textAbstract:
AbstractCollaborative quality improvement and learning networks have amended healthcare quality and value across specialities. Motivated by these successes, the Pediatric Acute Care Cardiology Collaborative (PAC3) was founded in late 2014 with an emphasis on improving outcomes of paediatric cardiology patients within cardiac acute care units; acute care encompasses all hospital-based inpatient non-intensive care. PAC3 aims to deliver higher quality and greater value care by facilitating the sharing of ideas and building alignment among its member institutions. These aims are intentionally aligned with the work of other national clinical collaborations, registries, and parent advocacy organisations. The mission and early work of PAC3 is exemplified by the formal partnership with the Pediatric Cardiac Critical Care Consortium (PC4), as well as the creation of a clinical registry, which links with the PC4 registry to track practices and outcomes across the entire inpatient encounter from admission to discharge. Capturing the full inpatient experience allows detection of outcome differences related to variation in care delivered outside the cardiac ICU and development of benchmarks for cardiac acute care. We aspire to improve patient outcomes such as morbidity, hospital length of stay, and re-admission rates, while working to advance patient and family satisfaction. We will use quality improvement methodologies consistent with the Model for Improvement to achieve these aims. Membership currently includes 36 centres across North America, out of which 26 are also members of PC4. In this report, we describe the development of PAC3, including the philosophical, organisational, and infrastructural elements that will enable a paediatric acute care cardiology learning network.
28
Bernard, Laurence, Alain Biron, Anaïck Briand, Samy Taha, and Mélanie Lavoie-Tremblay. "Evaluation of a quality improvement program to prevent healthcare acquired infections in an acute care hospital." Journal of Nursing Education and Practice 11, no. 5 (January 13, 2021): 24. http://dx.doi.org/10.5430/jnep.v11n5p24.
Full textAbstract:
Objective: The general purpose of the study was to evaluate a specific prevention program and its effects on infection prevention practices as part of continuous improvements in patient safety. Infection prevention is a global priority aimed at reducing mortality and morbidity rates related to infections acquired while under care.Methods: A descriptive study was carried out through a documentation analysis and semi-structured interviews with 13 healthcare professionals working in a healthcare centre where the infection prevention program was developed and implemented.Results: The thematic analysis identified three major axes: perceptions concerning audits and huddles strategies, the positive effects of the program on team building and, finally, its sustainability and continuous improvement.Conclusions: Globally, program enhanced the habits of professionals by developing an accurate perception of infections and the way to manage the related risk. The program Controlling Specific Infections Successful Strategies (CSISS) is seen as effective and sustainable by the participants. It contributes to a collaborative safety culture to reduce nosocomial infection rates.
29
SUDA, Masafumi, Shinsuke KAWAI, Kentaro SAKAINO, Atsuo KAKEHI, and Tetsuro YAMASHITA. "ANALYSIS OF UNIT INDICATOR BY RELEVANT DATA IN SPECIFICATIONS OF THE DIAGNOSTIC AND TREATMENT DEPARTMENT OF GENERAL ACUTE CARE HOSPITAL." AIJ Journal of Technology and Design 26, no. 64 (October 20, 2020): 1060–65. http://dx.doi.org/10.3130/aijt.26.1060.
Full text
30
Seltzer, Jared D., and Jeffrey A. Atlas. "Case Study of a Conduct-Disordered Youngster: Building Ego Defenses and Improving Object Relations within a Therapeutic Alliance." Psychological Reports 75, no. 1 (August 1994): 59–70. http://dx.doi.org/10.2466/pr0.1994.75.1.59.
Full textAbstract:
The classification of Conduct Disorder, sometimes seen as a nonspecific designation descriptive of antisocial behavior, is illuminated through case study of a youngster admitted for acute hospital treatment. Drawing on psychodynamic theory and treatment, principles are used in illustrating how individual, historical, family, and trauma factors may contribute to disordered self-esteem and behavior, which may become a focus of therapeutic intervention. A concluding section delineates the possibility of two varieties of Conduct Disorder related, respectively, to trauma or failures in socialization. These may have implications for treatment and setting.
31
Do, Hien, Hien T. Ho, Phu D. Tran, Dang B. Nguyen, Satoko Otsu, Cindy Chiu de Vázquez, Tan Q. Dang, et al. "Building the hospital event-based surveillance system in Viet Nam: a qualitative study to identify potential facilitators and barriers for event reporting." Western Pacific Surveillance and Response Journal 11, no. 3 (September 30, 2020): 10–20. http://dx.doi.org/10.5365/wpsar.2019.10.1.009.
Full textAbstract:
Introduction: Hospitals are a key source of information for the early identification of emerging disease outbreaks and acute public health events for risk assessment, decision-making and public health response. The objective of this study was to identify potential facilitators and barriers for event reporting from the curative sector to the preventive medicine sector in Viet Nam. Methods: In 2016, we conducted 18 semi-structured, in-depth interviews, as well as nine focus group discussions, with representatives from the curative and preventive medicine sectors in four provinces. We transcribed the interviews and focus group discussions and used thematic analysis to identify the factors that appeared to affect public health event reporting. Results: We identified five major themes. First, the lack of a legal framework to guide reporting meant hospital staff relied on internal procedures that varied from hospital to hospital, which sometimes delayed reporting. Second, participants stated the importance of an enabling environment, such as leadership support and having focal points for reporting, to facilitate reporting. Third, participants described the potential benefits of reporting, such as support provided during outbreaks and information received about local outbreaks. Fourth, some challenges prohibited timely reporting such as not perceiving reporting to be the task of the curative sector and hesitancy to report without laboratory confirmation. Finally, limited resources and specialist capacities in remote areas hindered timely detection and reporting of unusual events. Discussion: This study identified potential opportunities to promote the detection and reporting of unusual events from health-care workers to the public health sector, and thus to improve the overall health security system in Viet Nam.
32
Narus, S. P., S. M. Huff, T. A. Pryor, P. J. Haug, T. Larkin, S. Matney, R. S. Evans, et al. "Building a Comprehensive Clinical Information System from Components." Methods of Information in Medicine 42, no. 01 (2003): 01–07. http://dx.doi.org/10.1055/s-0038-1634203.
Full textAbstract:
Summary Objectives: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture. Methods: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record. Results: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19sec. Discussion: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.
33
Fard, John, Kathy O. Roper, and Jeremy Hess. "Simulation of home-hospital impacts on crowding – FM implications." Facilities 34, no. 13/14 (October 3, 2016): 748–65. http://dx.doi.org/10.1108/f-07-2015-0048.
Full textAbstract:
Purpose This study aims to evaluate home-hospital implications for facility management (FM) and, in particular, ED crowding. Home-hospital programs, in which select patients receive hospital-level care at home, can extend hospital facility capacity. Emergency department (ED) crowding, a sensitive hospital capacity indicator, is associated with unsafe operations and reduced quality of care. Design/methodology/approach The impact of a home-hospital program on crowding was analyzed with a discrete-event simulation model using one month of historical data from a case hospital. Time ED patients waited for inpatient beds was the primary endpoint. Five scenarios with different levels of patient suitability for home-hospital were each run 30 times. Differences were evaluated using paired t-tests. Findings Implementing home-hospital reduced ED crowding by up to 3 per cent. Additionally, the simulation yielded insights regarding advantages and limitations of various home-hospital arrangements, suggested which hospital types may be the best candidates for home-hospital and highlighted the role of bed-cleaning turnaround times and environmental services staffing schedules in operations. Research limitations/implications This research examined home-hospital and crowding at one hospital. Developing a model that accounts for all hospital types requires significant data and many hospital partnerships but could allow for more informed decisions regarding implementation of such programs. Social implications This research has implications for ensuring access to ED care, an important source of acute care generally and particularly for the underserved. Originality/value This research systematically evaluates home-hospital’s impact on ED crowding. Simulation modeling resulted in analytical results and allowed for evaluation of what-if scenarios providing recommendations for hospital FMs on their role in decreasing ED boarding.
34
Combariza, J. F., L. F. Toro, and J. J. Orozco. "Effectiveness of environmental control measures to decrease the risk of invasive aspergillosis in acute leukaemia patients during hospital building work." Journal of Hospital Infection 96, no. 4 (August 2017): 336–41. http://dx.doi.org/10.1016/j.jhin.2017.04.022.
Full text
35
Daly, L., P. White, E. Harris, A. F. Carroll, and A. Murphy. "192 USING A COLLABORATIVE APPROACH TO IDENTIFY WAYS TO STRENGTHEN ENHANCED CARE PRACTICES IN A GENERAL HOSPITAL WHILE BUILDING RESEARCH CAPACITY." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.192.
Full textAbstract:
Abstract Background The Nursing department within an acute general hospital wished to illuminate and build on positive local enhanced care practices. A collaborative research team was formed between academics in the linked higher education institution and nurses within the hospital to address this intent by building nurse-led research capacity, while addressing the practice derived research question. Methods A mixed methods approach was employed involving; site visits, audit of enhanced care staffing requirements, documentary and activity box analyses and use of appreciative inquiry (AI) methodology. AI is a collaborative and strengths-oriented approach supporting organisational development. It was implemented via three World Café events (www.theworldcafe.com 2021) bringing together hospital stakeholders (n = 17) with direct experience of delivering enhanced care, to consider pre-defined questions. Thematic analysis was used to analyse the resultant data. Ethical approval was obtained. Results Overall, the findings demonstrated a positive focus on implementing therapeutic enhanced care within the hospital in contrast to a more passive primarily observational orientation. The site visits facilitated shared learning. Thematic findings from the World Cafés identified positive care practices and enabled a multidisciplinary, inclusive approach, which facilitated pragmatic suggestions on how to plan for, and build on existing foundations of, enhanced care practice. Conclusion Both the study approach and outcome resulted in positive impacts. Working collaboratively supported research capacity building for hospital-based members of the research team. Using AI supported constructive and inclusive stakeholder participation in the World Cafés with a focus on good practices and ways in which they could be strengthened. One year post completion, study recommendations have led to:
36
Fox, Chris, Simon P. Hammond, Tamara Backhouse, Fiona Poland, Justin Waring, Bridget Penhale, and Jane L. Cross. "Implementing PERFECT-ER with Plan-Do-Study-Act on acute orthopaedic hospital wards: Building knowledge from an implementation study using Normalization Process Theory." PLOS ONE 18, no. 2 (February 24, 2023): e0279651. http://dx.doi.org/10.1371/journal.pone.0279651.
Full textAbstract:
Background Delivering care to growing numbers of patients with increasingly ‘complex’ needs is currently compromised by a system designed to treat patients within organizational clinical specialties, making this difficult to reconfigure to fit care to needs. Problematic experiences of people with cognitive impairment(s) admitted to hospitals with a hip fracture, exemplify the complex challenges that result if their care is not tailored. This study explored whether a flexible, multicomponent intervention, adapting services to the needs of this patient group, could be implemented in acute hospital settings. Methods We used action research with case study design to introduce the intervention using a Plan-Do-Study-Act (PDSA) model to three different hospital sites (cases) across England. The qualitative data for this paper was researcher-generated (notes from observations and teleconference meetings) and change agent-generated (action plans and weekly reflective reports of change agents’ activities). Normalization Process Theory (NPT) was used to analyze and explain the work of interacting actors in implementing and then normalizing (embedding) the intervention across contexts and times. Data analysis was abductive, generating inductive codes then identified with NPT constructs. Across the three cases, change agents had to work through numerous implementation challenges: needing to make sense of the intervention package, the PDSA model as implementation method, and their own role as change agents and to orientate these within their action context (coherence). They had to work to encourage colleagues to invest in these changes (cognitive participation) and find ways to implement the intervention by mobilising changes (collective action). Finally, they created strategies for clinical routines to continue to self-review, reconfiguring actions and future plans to enable the intervention to be sustained (reflexive monitoring). Conclusions Successful implementation of the (PERFECT-ER) intervention requires change agents to recognize and engage with local values, and then to enable its fit with practice and wider contextual goals. A context of constant change fragments normalization. Thus, sustaining practice change over time is fragile and requires change agents to continue a recursive two-way sense-making process. This enables implementation and normalization to re-energize and overcome barriers to change.
37
Park, Se Yoon, Tae Hyong Kim, Eunjung Lee, Mark Loeb, Yeon Su Jeong, Jin Hwa Kim, Sun Mi Oh, Sojin Cheong, Hyein Park, and SoYea Jo. "A SARS-CoV-2 outbreak due to vaccine breakthrough in an acute-care hospital." Antimicrobial Stewardship & Healthcare Epidemiology 2, S1 (May 16, 2022): s83. http://dx.doi.org/10.1017/ash.2022.213.
Full textAbstract:
Background: The δ (delta) variant has spread rapidly worldwide and has become the predominant strain of SARS-CoV-2. We analyzed an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of healthcare workers were vaccinated. Methods: We investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed COVID-19 in patients, healthcare workers, and caregivers. Results: During the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction (rtPCR) testing. Testing identified infections in 61 health care workers, 18 patients, and 15 caregivers, and 70 (74.5%) of 94 cases were vaccine breakthrough infections. We detected 3 superspreading events: in the hospital staff cafeteria and offices (n = 47 cases, 50%), the 8th floor of the main building (n = 22 cases, 23.4%), and the 7th floor in the maternal and child healthcare center (n = 12 cases, 12.8%). These superspreading events accounted for 81 (86.2%) of 94 transmissions (Fig. 1, 2). The median interval between completion of vaccination and COVID-19 infection was 117 days (range, 18–187). There was no significant difference in the mean Ct value of the RdRp/ORF1ab gene between fully vaccinated individuals (mean 20.87, SD±6.28) and unvaccinated individuals (mean 19.94, SD±5.37, P = .52) at the time of diagnosis. Among healthcare workers and caregivers, only 1 required oxygen supplementation. In contrast, among 18 patients, there were 4 fatal cases (22.2%), 3 of whom were unvaccinated (Table 1). Conclusions: Superspreading infection among fully vaccinated individuals occurred in an acute-care hospital while the δ (delta) variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.Funding: NoneDisclosures: None
38
Nugraha, Boya, Klejda Tani, and Christoph Gutenbrunner. "Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach." International Journal of Environmental Research and Public Health 17, no. 19 (October 6, 2020): 7300. http://dx.doi.org/10.3390/ijerph17197300.
Full textAbstract:
Background: Rehabilitation is an important health strategy. Due to the lack of rehabilitation professionals (e.g., no physical and rehabilitation medicine, occupational therapist, and others) and lack of rehabilitation services (e.g., no multi-profession rehabilitation services in hospital, no post-acute rehabilitation services, no community-based rehabilitation services), the need to strengthen rehabilitation in Albania was pronounced. Therefore, this project aimed at rehabilitation service assessment and workforce capacity building in Albania. Methods: The World Health Organization’s Template for Rehabilitation Information Collection was used to collect available data related to rehabilitation services. Additionally, two site visits to different rehabilitation centers including interviews with relevant stakeholders were performed. A stakeholders’ workshop to prioritize recommendations was also performed before finalizing the report. Results: In Albania, rehabilitation service delivery, rehabilitation workforces, and financing in rehabilitation need to be strengthened. Conclusions: The project achieved the intended objectives. Additionally progress has been occurring in the development and implementation of the Physical and Rehabilitation Medicine specialization at the University of Medicine, Tirana.
39
Gottlieb, Jens, Philipp Capetian, Uwe Hamsen, Uwe Janssens, Christian Karagiannidis, Stefan Kluge, Monika Nothacker, et al. "German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients." Respiration 101, no. 2 (December 21, 2021): 214–52. http://dx.doi.org/10.1159/000520294.
Full textAbstract:
Background: Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. Methods: A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System (“The Oxford 2011 Levels of Evidence”) was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. Results: The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. Conclusion: This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
40
Bravo Herrero, S., I. Moreno Alonso, M. J. Sánchez Artero, and A. M. Matas Ochoa. "Building bridges between body and mind: liaison psychiatry." European Psychiatry 65, S1 (June 2022): S472—S473. http://dx.doi.org/10.1192/j.eurpsy.2022.1200.
Full textAbstract:
Introduction As liaison psychiatrists, it is very important to mantein a good relationship with other medical specialties in order to obtain the best result for our patients. Most of the times, the somatic process affects direct or indirectly to mental healt and vice versa, so our cooperation is extremely important for the patient’s welbeing. Objectives With this study we try to find special considerations and necesities of every specialty that count on us in our hospital. We have design this batebase with the aim of discovering which are the main problems that suffer the admitted patients, which doubts face our colleagues when evaluate mental health patients, etc. Thus, our team could help other physicians properly or so we could stablish a proper liaison in order to make things easier. Methods A database has been created with all the patients evaluated by our liaison psychiatry team during half a year. We have taken into account sex, age, referral specialist, mental health diagnosis (after our evaluation), previous mental health follow-up, if they are on psycopharmacology treatment, if they requiere psycopharmacology treatment and if they requiere follow-up once discharged. Results 22,9% were kid/adolescent patients. 25,8% were elderly people (>70 yo). 47% were men (of which, 6% were trans men), 53% were women. 22,9% suffered from adjustment disorder, 14,1% had no acute mental health problem, 11,76% presented substance abuse. Main petitions were made from Internal Medicine (30%) Conclusions With this information we can explore other specialists’ and admitted patients’ needs and concerns and focus our effort in solving them. Disclosure No significant relationships.
41
KIRKHAM, RICHARD J., A. HALIM BOUSSABAINE, and MATTHEW P. KIRKHAM. "Stochastic time series forecasting of electricity costs in an NHS acute care hospital building, for use in whole life cycle costing." Engineering, Construction and Architectural Management 9, no. 1 (January 2002): 38–52. http://dx.doi.org/10.1108/eb021205.
Full text
42
Herrera Tejedor, Juan Antonio. "Knowing Oldest Old’s Preferences May Improve their Healthcare." Revista Iberoamericana de Bioética, no. 12 (February 27, 2020): 01–11. http://dx.doi.org/10.14422/rib.i12.y2020.001.
Full textAbstract:
Oldest old people’s preferences are not taken into account though their importance in healthcare planning. To identify them, we undertook a qualitative study, using in-depth interviews, in a rural area of Toledo, Spain. The majority of participants rate the health care received as good. They favour building a trusting relationship with the physician, choosing to receive enough treatment to avoid the burden of suffering. They express the wish to die at home, but when an acute event occurs they want to be transferred to hospital. Knowing oldest old people health values will help to develop suitable healthcare systems.
43
Hertz, Julian T., Godfrey L. Kweka, Preeti Manavalan, Melissa H. Watt, and Francis M. Sakita. "Provider-perceived barriers to diagnosis and treatment of acute coronary syndrome in Tanzania: a qualitative study." International Health 12, no. 2 (July 22, 2019): 148–54. http://dx.doi.org/10.1093/inthealth/ihz061.
Full textAbstract:
Abstract Background The incidence of acute coronary syndrome (ACS) is growing across sub-Saharan Africa and many healthcare systems are ill-equipped for this growing burden. Evidence suggests that healthcare providers may be underdiagnosing and undertreating ACS, leading to poor health outcomes. The goal of this study was to examine provider perspectives on barriers to ACS care in Tanzania in order to identify opportunities for interventions to improve care. Methods Semistructured in-depth interviews were conducted with physicians and clinical officers from emergency departments and outpatient departments in northern Tanzania. Thematic analysis was conducted using an iterative cycle of coding and consensus building. Results The 11 participants included six physicians and five clinical officers from health centers, community hospitals and one referral hospital. Providers identified barriers related to providers, systems and patients. Provider-related barriers included inadequate training regarding ACS and poor application of textbook-based knowledge. System-related barriers included lack of diagnostic equipment, unavailability of treatments, referral system delays, lack of data regarding disease burden, absence of locally relevant guidelines and cost of care. Patient-related barriers included inadequate ACS knowledge, inappropriate healthcare-seeking behavior and non-adherence. Conclusions This study identified actionable barriers to ACS care in northern Tanzania. Multifaceted interventions are urgently needed to improve care.
44
Chiu, WT, PW Lin, H. Y. Chiou, W. S. Lee, C. N. Lee, Y. Y. Yang, H. M. Lee, et al. "Infrared Thermography to Mass-Screen Suspected Sars Patients with Fever." Asia Pacific Journal of Public Health 17, no. 1 (January 2005): 26–28. http://dx.doi.org/10.1177/101053950501700107.
Full textAbstract:
Fever greater than 38°C is a cardinal sign of patients with the severe acute respiratory syndromes (SARS). To reduce the risk of nosocomial cross infections, screening all patients and visitors who visit hospitals and clinics for fever at the entrance of every hospital building has become a standard protocol in Taiwan during the SARS epidemic from mid-April to mid-June 2003. We used a digital infrared thermal imaging (DITI) system (Telesis Spectrum 9000 MB) to conduct mass screening of patients and visitors who entered the hospital to identify those with fever. The DITI system has two components: a sensor head and a PC imaging workstation. The sensor head is an optic-mechanical device which consists of imagining optics for focusing the infrared source information on the infrared detector. The infrared images are further converted into electrical signals, which are then processed for real-time display on the monitor. During the period from April 13 to May 12 2003, 72,327 outpatients and visitors entered Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. A total of 305 febrile patients (0.42%) was detected by infrared thermography. Among them, three probable SARS patients were identified after thorough studies including contact history, laboratory tests and radiology examinations. The findings suggests that infrared thermography was an effective and reliable tool ideal for mass-screening patients with fever in the initial phase of screening for SARS patients at a busy hospital which sees approximately 3,000 outpatients every weekday during the SARS epidemic. Asia Pac J Public Health 2005: 17(1): 26-28.
45
Sampson, Elizabeth L., Victoria Vickerstaff, Stephanie Lietz, and Martin Orrell. "Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model." International Psychogeriatrics 29, no. 4 (December 21, 2016): 605–14. http://dx.doi.org/10.1017/s1041610216002222.
Full textAbstract:
ABSTRACTBackground:There are concerns about the quality of care that people with dementia receive in the general hospital. Staff report a lack of confidence and inadequate training in dementia care.Methods:A train-the-trainer model was implemented across eight acute hospital trusts in London via a large academic health and science network. Impact was evaluated using mixed methods. Data were collected at (a) individual level: “Sense of Competence in Dementia Care” (SCID), (b) ward level: Person Interaction and Environment (PIE) observations, (c) organization level: use of specific tools, i.e. “This Is Me,” (d) systems level: numbers and types of staff trained per trust. Results were analyzed with descriptive statistics and paired t-test with thematic framework analysis for PIE observations.Results:The number of staff trained per trust ranged from 67 to 650 (total 2,020). A total of 1,688 (85%) baseline questionnaires and 456 (27%) three month follow-up questionnaires were completed. Mean SCID score was 43.2 at baseline and 50.7 at follow-up (paired t-test, p < 0.001). All sub-scales showed a small increase in competence, the largest being for “building relationships.” Organizational level data suggested increased use of carer's passport, “This Is Me” documentation, dementia information leaflets, delirium screening scales, and pathways. PIE observations demonstrated improved staff–patient interactions but little change in hospital environments.Conclusions:There was a significant improvement in staffs’ sense of competence in dementia care and the quality of interactions with patients. More hospitals adopted person-centered tools and pathways. Work is required to investigate if these changes improve hospital outcomes for people with dementia.
46
Gorbenko, Ksenia, Emily Franzosa, Abigail Baim-Lance, Gabrielle Schiller, Heather Wurtz, Sybil Masse, David Levine, and Albert Siu. "CONTENDING WITH UNCERTAINTY: IMPLEMENTING THE CMS ACUTE HOSPITAL CARE AT HOME WAIVER PROGRAM IN THE UNITED STATES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 250–51. http://dx.doi.org/10.1093/geroni/igac059.994.
Full textAbstract:
Abstract As Congress considers renewing the Acute Hospital Care At Home (AHCaH) waiver, which provides a full hospital payment for Hospital at Home (HaH) care, evaluating uncertainty around the future of HaH payment is critical. Our qualitative study explored HaH leaders’ experiences with implementing HaH (N=18, clinical/medical directors, operational and program managers) from 14 new and pre-existing programs across the U.S. We conducted semi-structured interviews with HaH programs diverse by size, urbanicity, and geography. We analyzed transcripts using a thematic approach. Participants across settings and regions wanted greater clarity about the waiver’s future. Lack of clarity affected staffing (nurses reluctant to take temporary jobs) and investment in establishing programs (building EMR components, changing workflows, creating inpatient processes in an outpatient setting). Programs adapted to uncertainty in multiple ways: 1) operating parallel waiver and non-waiver programs; 2) seeking to determine/ calculate the HaH value for their institution; 3) determining which patients would benefit most from HaH; and 4) seeking additional health system financing options beyond the CMS reimbursement (new programs) or relying on existing contracts with payers (existing programs). Implementing HaH is a complex and resource intensive process. Greater clarity from CMS regarding the waiver’s future state will encourage programs to invest the resources that they need to establish their programs long-term. Waiver extension/ permanence would also enable programs to develop and test measures of value, making rigorous evaluations possible to optimize different HaH components.
47
Wibring, Kristoffer, Markus Lingman, Johan Herlitz, Sinan Amin, and Angela Bång. "Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study." BMJ Open 11, no. 4 (April 2021): e044938. http://dx.doi.org/10.1136/bmjopen-2020-044938.
Full textAbstract:
ObjectivesTo describe contemporary characteristics and diagnoses in prehospital patients with chest pain and to identify factors suitable for the early recognition of high-risk and low-risk conditions.DesignProspective observational cohort study.SettingTwo centre study in a Swedish county emergency medical services (EMS) organisation.ParticipantsUnselected inclusion of 2917 patients with chest pain contacting the EMS due to chest pain during 2018.Primary outcome measuresLow-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsOf included EMS missions, 68% concerned patients with a low-risk condition without medical need of acute hospital treatment in hindsight. Sixteen per cent concerned patients with a high-risk condition in need of rapid transport to hospital care. Numerous variables with significant association with low-risk or high-risk conditions were found. In total high-risk and low-risk prediction models shared six predictive variables of which ST-depression on ECG and age were most important. Previously known risk factors such as history of acute coronary syndrome, diabetes and hypertension had no predictive value in the multivariate analyses. Some aspects of the symptoms such as pain intensity, pain in the right arm and paleness did on the other hand appear to be helpful. The area under the curve (AUC) for prediction of low-risk candidates was 0.786 and for high-risk candidates 0.796. The addition of troponin in a subset increased the AUC to >0.8 for both.ConclusionsA majority of patients with chest pain cared for by the EMS suffer from a low-risk condition and have no prognostic reason for acute hospital care given their diagnosis on hospital discharge. A smaller proportion has a high-risk condition and is in need of prompt specialist care. Building models with good accuracy for prehospital identification of these groups is possible. The use of risk stratification models could make a more personalised care possible with increased patient safety.
48
Maben, Jill, Peter Griffiths, Clarissa Penfold, Michael Simon, Elena Pizzo, Janet Anderson, Glenn Robert, et al. "Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation." Health Services and Delivery Research 3, no. 3 (February 2015): 1–304. http://dx.doi.org/10.3310/hsdr03030.
Full textAbstract:
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
49
Pingel, Michael J. "A National Look at Hospital Bed Tower Design." HERD: Health Environments Research & Design Journal 14, no. 3 (March 9, 2021): 305–19. http://dx.doi.org/10.1177/1937586721996251.
Full textAbstract:
This study evaluates 171 hospital bed tower designs from the past decade. The Floor-building gross square feet (BGSF)/Bed, patient care area, ratio between them, and the bed count per unit were analyzed. The findings suggest that the average patient care area has decreased 5%–10% to a 305 departmental gross square feet (DGSF)/Bed average. The patient care area, support, circulation, and area grossing on floor were found to average 908 Floor-BGSF/Bed, and were impacted by the total beds/unit. It was determined that larger bed count per unit designs with 32–36 beds/unit average 21.9% less Floor-BGSF/Bed than designs with 24 beds/unit. The research evaluates design solutions impacted by a shifting environment of regulatory change and escalating costs. The hospital bed towers represent new facilities, horizontal/vertical expansions, and 25+ design teams. Design and/or construction took place during a 10-year period (2008–2018). The acute patient unit designs were reviewed and electronically quantified. The area measurement methodology aligns with the guidelines set forth in the “Area Calculation Method for Health Care” guidelines. Each project team was faced with a unique but similar set of circumstances. The balance between core values, guiding principles, budget, and quality of care was always present and included a diverse combination of owners, designers, construction delivery methods, profit models, and clinical approaches. In today’s world, common solutions are grounded in providing the best value. Project teams face a number of challenges during design. The lack of information should never be one.
50
Ingham, Tristram, Michael Keall, Bernadette Jones, Daniel R. T. Aldridge, Anthony C. Dowell, Cheryl Davies, Julian Crane, et al. "Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study." Thorax 74, no. 9 (August 14, 2019): 849–57. http://dx.doi.org/10.1136/thoraxjnl-2018-212979.
Full textAbstract:
IntroductionA gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.MethodsA prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control status were estimated, along with the population attributable risk of eliminating dampness–mould on hospitalisation for ARI among New Zealand children.Results188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp–mould index had a significant, adjusted dose–response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually.ConclusionsA dose–response relationship exists between housing quality measures, particularly dampness–mould, and young children’s ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness–mould would have a large impact on ARI hospitalisation.