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Penney, Randy. "Hemodialysis Unit at Renfrew Victoria Hospital." Healthcare Management Forum 8, no. 2 (July 1995): 5–10. http://dx.doi.org/10.1016/s0840-4704(10)60902-7.
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In June 1994, the Renfrew Victoria Hospital was selected as the first-ever recipient of the Health Care Quality Team Award in the “Small and Rural Provider” category. This award, offered by the Canadian College of Health Service Executives and 3M Health Care, was established to recognize health care organizations that have sustained measurable improvements in their network of services, and have done so through the use of a team. Renfrew Victoria Hospital's entry focused on the establishment of a hemodialysis unit for the residents of Renfrew County. This article summarizes the parameters of this award, as presented in our submission.
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Pugh, Janet, and Malu Campolo. "Mornington Peninsula Hospital Intensive Care Unit, Victoria, Australia." Australian Critical Care 8, no. 4 (December 1995): 8–9. http://dx.doi.org/10.1016/s1036-7314(95)70291-0.
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Wexler, Tina, Libardo Rueda Prada, Maria Cardozo-Diaz, Carlos Brazzarola, Sorab Gupta, Wyka Katarzyna, Joan Dorn, and Raghu Loganathan. "467: PREDICTING READMISSIONS AMONG MINORITIES IN AN URBAN COMMUNITY HOSPITAL." Critical Care Medicine 46, no. 1 (January 2018): 217. http://dx.doi.org/10.1097/01.ccm.0000528485.98840.48.
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Farrell, Maureen. "Health care leadership in an age of change." Australian Health Review 26, no. 1 (2003): 153. http://dx.doi.org/10.1071/ah030153.
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This study examined the leadership practices of a sample of network and hospital administrators in metropolitan Victoria, Australia. It was undertaken in the mid-1990s when the State Liberal-National (Coalition) Government in Victoria established Melbourne's metropolitan health care networks. I argue that leadership,and the process of leading, contributes significantly to the success of the hospital in a time of turmoil and change.The sample was taken from the seven health care networks and consisted of 15 network and hospital administrators. Bolman and Deal's frames of leadership - structural, human resource, political and symbolic - were used as a framework to categorize the leadership practices of the administrators. The findings suggest a preference for the structural frame - an anticipated result, since the hospital environment is more conducive to a style of leadership that emphasizes rationality and objectivity. The human resource frame was the second preferred frame,followed by the political and symbolic. These findings suggest that network and hospital administrators focus more on intellectual than spiritual development, and perhaps this tendency needs to be addressed when educating present and future hospital leaders.
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Cruz-Flores, Salvador, Gustavo J. Rodriguez, Mohammad Rauf A. Chaudhry, Ihtesham A. Qureshi, Mohtashim A. Qureshi, Paisith Piriyawat, Anantha R. Vellipuram, Rakesh Khatri, Darine Kassar, and Alberto Maud. "Racial/ethnic disparities in hospital utilization in intracerebral hemorrhage." International Journal of Stroke 14, no. 7 (March 14, 2019): 686–95. http://dx.doi.org/10.1177/1747493019835335.
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Background and purpose There is evidence that racial and ethnic differences among intracerebral hemorrhage (ICH) patients exist. We sought to establish the occurrence of disparities in hospital utilization in the United States. Methods We identified ICH patients from United States Nationwide Inpatient Sample database for years 2006–2014 using codes (DX1 = 431, 432.0) from the International Classification of Diseases, 9th edition. We compared five race/ethnic categories: White, Black, Hispanic, Asian or Pacific Islander, and Others ( Native American and other) with regard to demographics, comorbidities, disease severity, in-hospital complications, in-hospital procedures, length of stay (LOS), total hospital charges, in-hospital mortality, palliative care, (PC) and do not resuscitate (DNR). We categorized procedures as lifesaving (i.e. ventriculostomy, craniotomy, craniectomy, and ventriculoperitoneal (VP) shunt), life sustaining (i.e. mechanical ventilation, tracheostomy, transfusions, and gastrostomy). White race/ethnicity was set as the reference group. Results Out of 710,293 hospitalized patients with ICH 470,539 (66.2%), 114,821 (16.2%), 66,451 (9.3%), 30,297 (4.3%) and 28,185 (3.9%) were White, Black, Hispanic, Asian or Pacific Islander, and Others, respectively. Minorities (Black, Hispanic, Asian or Pacific Islander, and Others) had a higher rate of in-hospital complications, in-hospital procedures, mean LOS, and hospital charges compared to Whites. In contrast, Whites had a higher rate of in-hospital mortality, PC, and DNR. In multivariable analysis, all minorities had higher rate of MV, tracheostomy, transfusions, and gastrostomy compared to Whites, while Hispanics had higher rate of craniectomy and VP shunt; and Asian or Pacific Islander and Others had higher rate of craniectomy. Whites had a higher rate of in-hospital mortality, palliative care, and DNR compared to minorities. In mediation analysis, in-hospital mortality for whites remained high after adjusting with PC and DNR. Conclusion Minorities had greater utilization of lifesaving and life sustaining procedures, and longer LOS. Whites had greater utilization of palliative care, hospice, and higher in-hospital mortality. These results may reflect differences in culture or access to care and deserve further study.
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Cooper, Genevieve. "Hospital in the Home in Victoria: Factors Influencing Allocation Decisions." Australian Journal of Primary Health 5, no. 1 (1999): 60. http://dx.doi.org/10.1071/py99007.
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There is a question surrounding the funding of Hospital in the Home (HITH) as to whether the allocation policy was driven by customer service preference or was largely a financial imperative. HITH has the capacity to increase the throughput and therefore the efficiency of acute care facilities which is attractive to Government and Health Service Managers. There is insufficient evidence to indicate that this is true in all circumstances. Hospital in the Home is a desirable and safe option for some clients. Hospital in the Home has the potential to provide a more cost effective mode of delivery of acute care than hospital facilities. However, there is a need for identification of which clients, with which conditions and care needs, will benefit from being part of a HITH program in emotional, health and financial terms. Health professionals are still grappling with the impact that HITH has on their roles and relationships with other health care providers. More qualitative and quantitative research needs to be undertaken to identify the best models of HITH in both organisational and financial tems, and its impact on the wellbeing of clients and carers.
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Pawling-Kaplan, Marjorie, and Patrice O'Connor. "Hospice care for minorities: An analysis of a hospital-based inner city palliative care service." American Journal of Hospice Care 6, no. 4 (July 1989): 13–21. http://dx.doi.org/10.1177/104990918900600408.
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Brown, Elizabeth A., Mulugeta Gebregziabher, Diane L. Kamen, Brandi M. White, and Edith M. Williams. "Examining Racial Differences in Access to Primary Care for People Living with Lupus: Use of Ambulatory Care Sensitive Conditions to Measure Access." Ethnicity & Disease 30, no. 4 (September 24, 2020): 611–20. http://dx.doi.org/10.18865/ed.30.4.611.
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Background: People living with lupus may experience poor access to primary care and delayed specialty care.Purpose: To identify characteristics that lead to increased odds of poor access to primary care for minorities hospitalized with lupus.Methods: Cross-sectional design with 2011-2012 hospitalization data from South Carolina, North Carolina, and Florida. We used ICD-9 codes to identify lupus hospitalizations. Ambulatory care sensitive conditions were used to identify preventable lupus hospitalizations and measure access to primary care. Logistic regression was used to estimate the odds ratio for the association between predictors and having poor access to primary care. Sensitivity analysis excluded patients aged >65 years.Results: There were 23,154 total lupus hospitalizations, and 2,094 (9.04%) were preventable. An adjusted model showed minorities aged ≥65 years (OR 2.501, CI 1.501, 4.169), minorities aged 40-64 years (OR 2.248, CI: 1.394, 3.627), minorities with Medicare insurance (OR 1.669, CI:1.353,2.059) and minorities with Medicaid (OR 1.662,CI:1.321, 2.092) had the highest odds for a preventable lupus hospitalization. Minorities with Medicare had significantly higher odds for ≥3 hospital days (OR 1.275, CI: 1.149, 1.415). Whites with Medicare (OR 1.291, CI: 1.164, 1.432) had the highest odds for ≥3 days.Conclusions: Our data show that middle-aged minorities living with lupus and on public health insurance have a higher likelihood of poor access to primary care. Health care workers and policymakers should develop plans to identify patients, explore issues affecting access, and place patients with a community health worker or social worker to promote better access to primary care. Ethn Dis. 2020;30(4):611- 620; doi:10.18865/ed.30.4.611
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Ansari, Zahid, Norman Carson, Adrian Serraglio, Toni Barbetti, and Flavia Cicuttini. "The Victorian Ambulatory Care Sensitive Conditions Study: reducing demand on hospital services in Victoria." Australian Health Review 25, no. 2 (2002): 71. http://dx.doi.org/10.1071/ah020071.
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Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable ifpreventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare systemin Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12 100 admissions for diabetes complicationsin Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using theseindicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.
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Qu, Liang G., Tatenda Nzenza, Kevin McMillan, and Shomik Sengupta. "Delays in prostate cancer care within a hospital network in Victoria, Australia." ANZ Journal of Surgery 89, no. 12 (November 30, 2019): 1599–604. http://dx.doi.org/10.1111/ans.15554.
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Ong, Kevin, Andrew Carroll, Shannon Reid, and Adam Deacon. "Community Outcomes of Mentally Disordered Homicide Offenders in Victoria." Australian & New Zealand Journal of Psychiatry 43, no. 8 (January 1, 2009): 775–80. http://dx.doi.org/10.1080/00048670903001976.
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Objective: The aim of the present study was to describe characteristics and post-release outcomes of Victorian homicide offenders under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (and/or its forerunner legislation) released from forensic inpatient psychiatric care since the development of specialist forensic services. Method: A legal database identified subjects meeting inclusion criteria: hospitalized in forensic psychiatric care due to finding of mental impairment or unfitness to stand trial for homicide in Victoria; released into the community; and released between 1 January 1991 and 30 April 2002. Using clinical records, demographics, index offence, progress in hospital, diagnosis, psychosocial and criminological data were obtained. Outcomes (offending or readmission into secure care) were obtained from the clinical records. Results: Of the 25 subjects, 19 (76%) were male. Primary diagnoses on admission to forensic hospital care were schizophrenia, n = 16 (64%); other psychotic disorder, n = 5 (20%); depression, n = 3 (12%); and personality disorder, n = 1 (4%). Mean time in custodial supervision was 11 years and 2 months, less for those whose offence occurred after the development of forensic rehabilitation services. In the first 3 years after release, there was a single episode of criminal recidivism, representing a recidivism rate of 1 in 25 (4%) over 3 years. Twelve subjects (48%) were readmitted at some point in the 3 year follow up. Conclusion: There was a very low rate of recidivism after discharge, but readmissions to hospital were common. Lengths of custodial care were reduced after the introduction of forensic rehabilitation facilities. Recidivism is low when there are well-designed and implemented forensic community treatment programmes, consistent with other data suggesting a reciprocal relationship between safe community care and a low threshold for readmission to hospital, lessening re-offending at times of crisis. Further research should be directed at timing of release decisions, based on reducing identified risk factors to acceptable levels.
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SUNDARARAJAN, V., T. KORMAN, C. MACISAAC, J. J. PRESNEILL, J. F. CADE, and K. VISVANATHAN. "The microbiology and outcome of sepsis in Victoria, Australia." Epidemiology and Infection 134, no. 2 (August 19, 2005): 307–14. http://dx.doi.org/10.1017/s0950268805004796.
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We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonasaeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.
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Samaroo, Bethan. "Assessing Palliative Care Educational Needs of Physicians and Nurses: Results of a Survey." Journal of Palliative Care 12, no. 2 (June 1996): 20–22. http://dx.doi.org/10.1177/082585979601200205.
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The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians’ and nurses’ perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.
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Kirtane, Kedar, Lois Downey, Stephanie J. Lee, Jared Randall Curtis, and Ruth Engelberg. "Racial Disparities in End-of-Life Care Planning and Hospital Utilization: A Single Center Retrospective Study." Blood 130, Suppl_1 (December 7, 2017): 859. http://dx.doi.org/10.1182/blood.v130.suppl_1.859.859.
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Abstract Introduction- Some prior studies suggest patients with hematologic malignancies receive more aggressive end-of-life care when compared to patients with solid tumor malignancies. Hematologic malignancies differ from solid tumors because of the continued potential for cure even in advanced disease, and potential difficulty identifying the terminal portion of a patient's illness. Racial/ethnic minorities are reported to have lower rates of hospice care, advanced directive use, and palliative care utilization. We studied differences in hospital utilization patterns and documentation of advance care planning between solid tumor and hematologic malignancy patients. In the subgroup of patients with hematologic malignancy, we also examined differences in these outcomes associated with racial/ethnic minority status. Methods- We conducted a retrospective cohort study of 9,469 patients with a diagnosis of cancer who received care at University of Washington (UW) Medicine and died between 2010 and 2015. Administrative data were available for the following events during the last 30 days of life: emergency department use, hospitalizations, and intensive care unit (ICU) utilization. We also examined death in a hospital and any documentation of advance directives (AD) in the electronic health record. We regressed each outcome on the binary predictor, adjusting for confounders (taken from a pool of potential confounders: age at death, patient gender, racial/ethnic minority status, level of education, insurance type, attributed facility, and number of Dartmouth Atlas chronic conditions). A variable was considered a confounder if its addition to the bivariate model changed the coefficient for the predictor by at least 10%. Binary outcomes were modeled with logistic regression. For count outcomes, we included only patients who had 1 or more days of the relevant type of care and modeled the remaining cases with negative binomial regression. All estimation was done with restricted maximum likelihood. Statistical significance was p <0.05. Results- In the last 30 days of life, decedents with hematologic cancer were significantly more likely to have aggressive hospital-based care, as measured by receipt of inpatient care, hospitalization for 14 or more days, multiple hospital admissions, and more days of hospital care, once admitted, than were those with solid tumor malignancies. They were also significantly more likely to have received ICU care, and to have spent more time in the ICU, once admitted, in the last 30 days of life. Finally, patients with hematologic malignancies were more likely to have died in a hospital rather than in other locations and more likely to have had documentation of AD in their electronic record. Among patients with hematologic malignancies, racial/ethnic minorities were less likely than white non-Hispanics to have documentation of AD and more likely to have 2+ emergency department visits or 14+ days of inpatient care, and had more days of inpatient care and ICU care, once admitted, in the last 30 days of life Conclusions- Patients with hematologic malignancies received more aggressive care at the end of life as measured by hospital utilization, despite having more documentation of AD than patients with solid tumor malignancy. Racial/ethnic minorities with hematologic malignancies had lower rates of AD documentation and received even more aggressive care than their white counterparts. Although these are administrative data, they suggest opportunities to improve end-of-life care of patients with hematologic malignancies, particularly racial/ethnic minorities. Disclosures Lee: Mallinckrodt: Honoraria; Amgen: Other: One-time advisory board member; Bristol-Myers-Squibb: Other: One-time advisory board member; Kadmon: Other: One-time advisory board member.
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Hoare, Connie D., Dickran A. Malatjalian, Bernard W. Badley, Joseph J. Sidorov, and C. Noel Williams. "Acute Fatty Liver of Pregnancy: A Review of Maternal Morbidity in 13 Patients Seen Over 12 Years in Nova Scotia." Canadian Journal of Gastroenterology 8, no. 2 (1994): 81–87. http://dx.doi.org/10.1155/1994/357397.
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OBJECTIVE: To review the maternal and fetal survival in all cases of acute fatty liver of pregnancy seen by the Division of Gastroenterology at Grace Maternity Hospital and the Victoria General Hospital from 1979-91.DESIGN: A retrospective review of the clinical data obtained from the medical charts of 13 patients with a liver biopsy-based histopathological diagnosis of acute fatty liver of pregnancy.SETTING: Grace Maternity Hospital, a tertiary care centre serving d1e Atlantic provinces. Twelve patients were subsequently transferred to Victoria General Hospital for postpartum management in the setting of the medical intensive care unit.MAIN OUTCOME MEASURES: Classically, acute fatty liver of pregnancy is complicated by over 70% maternal and fetal mortality rate. Recent reports have indicated significantly improved maternal and fetal survival because of more awareness, improved management and the identification of milder forms of the disease.RESULTS: In this study of 13 cases of acute fatty liver of pregnancy, maternal survival was 100% and fetal survival was 93%.CONCLUSION: The excellent maternal and fetal survival in this series is attributed co awareness, close collaboration between obstetricians and gastroenterologists, prompt diagnosis and delivery and the management of postpartum patients in an intensive care unit setting.
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Jennings, Paul, and John Pasco. "Survival from out-of-hospital cardiac arrest in the Geelong region of Victoria, Australia." Emergency Medicine 13, no. 3 (September 2001): 319–25. http://dx.doi.org/10.1046/j.1035-6851.2001.00235.x.
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Prada, Libardo Rueda, Carlos Brazzarola, Maria Cardozo-Diaz, Tina Wexler, Wyka Katarzyna, Joan Dorn, and Raghu Loganathan. "450: PERFORMANCE OF ICU SCORING SYSTEMS AMONG CRITICALLY ILL MINORITIES IN AN URBAN CITY HOSPITAL." Critical Care Medicine 46, no. 1 (January 2018): 209. http://dx.doi.org/10.1097/01.ccm.0000528468.28443.92.
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Newman, D. "Maritime Pre-Hospital Emergency Care Primary Retrieval Team – Operational Considerations." Journal of The Royal Naval Medical Service 98, no. 1 (March 2012): 16–18. http://dx.doi.org/10.1136/jrnms-98-16.
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AbstractThis article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach.
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Tracy, James M., and Roger H. Koabayshi. "QUALITY OF CARE FOR PRESCHOOL CHILDREN WITH ASTHMA: THE ROLE OF SOCIAL FACTORS AND PRACTICE SETTING." Pediatrics 98, no. 2 (August 1, 1996): 330–31. http://dx.doi.org/10.1542/peds.98.2.330.
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Racial minorities admitted for asthma were less likely to have received maximally effective preventive therapy. Marked differences in the quality of care planned after hospital discharge differed significantly when comparing white patients with black and Hispanic patients. In an era of health care reform, attention should focus on the area of high quality care for underserved children who are already at high-risk for asthma-related morbidity. [See table in the PDF file]
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Motl, Susannah E., Katie J. Suda, John C. Kuth, and Thomas J. Gladney. "Racial Comparison of Outcomes and Costs for Inpatient Neutropenic Patients: A Multicenter Evaluation." Journal of Oncology Practice 2, no. 2 (March 2006): 53–56. http://dx.doi.org/10.1200/jop.2006.2.2.53.
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Purpose Racial disparities have been reported in the care and outcome of cancer patients. We evaluated whether race would influence the cost and outcomes of inpatient neutropenic cancer patients in a multicenter study from a large health care system in the southern United States. Methods Data was collected on all cancer inpatients with a diagnosis code for neutropenia in a 16-hospital system between October 1, 2002, and September 30, 2003. Demographics, treatment outcomes, and costs were compared between white and minority patients. A P value less than .05 was considered statistically significant. Results Two hundred seventy-nine cancer patients (0.29% of all admits) had a diagnosis of neutropenia. Demographics were similar between white and minority patients. However, minorities were more likely to be younger than whites (P = .002). With regards to outcomes, length of stay (LOS), LOS in the intensive care unit, and discharge status were not statistically different. Total hospital, medication, laboratory, radiation, surgery, and respiratory costs were also similar (P > .05), although minorities were less likely to receive myeloid colony-stimulating factors (P = .032) and more likely to have higher nursing care costs (P = .048). Conclusion In light of the escalating reports of racial disparities in cancer care, these minimal differences are encouraging.
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Cox, Shelley, Rohan Martin, Piyali Somaia, and Karen Smith. "The development of a data-matching algorithm to define the ‘case patient’." Australian Health Review 37, no. 1 (2013): 54. http://dx.doi.org/10.1071/ah11161.
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Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.
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Mercier, Eric, Peter A. Cameron, Karen Smith, and Ben Beck. "Prehospital trauma death review in the State of Victoria, Australia: a study protocol." BMJ Open 8, no. 7 (July 2018): e022070. http://dx.doi.org/10.1136/bmjopen-2018-022070.
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IntroductionRegionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients.Methods and analysisThe planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies.Ethics and disseminationThe present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 – 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.
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Ansari, M. Z., D. Simmon s, W. G. Hart, F. Cicuttin i, N. J. Carson, N. I. A. G. Brand, M. J. Ackland, and D. J. Lang. "Preventable Hospitalisations for Diabetic Complications in Rural and Urban Victoria." Australian Journal of Primary Health 6, no. 4 (2000): 261. http://dx.doi.org/10.1071/py00060.
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The objective of the study was to describe and explain variations in rates of hospital admissions for long-term complications of diabetes mellitus in rural and urban Victoria as an indicator of the adequacy of ambulatory care services. The Victorian Inpatient Minimum Database (VIMD), Health Insurance Commission data for 1998, Medical Labour Force Annual Survey 1998, Socioeconomic Indexes for Areas 1996 (SEIFA) and Accessibility/Remoteness Index of Australia (ARIA) were merged to determine the extent to which hospitalisation for complications of diabetes can be predicted from accessibility and utilisation of general practitioner services. The rural and urban differentials for long-term diabetic complications and their strong relationship with GP services, the degree of remoteness, lack of insurance, and Aboriginality reflect issues related to equity and access, patient and GP education, and inclination to seek care, all of which have implications for planning of primary health services in rural areas. This study describes a model for the analysis of ambulatory care sensitive conditions, and illustrates the important use of routine databases combined with other sources of information in quantifying the impact of factors related to primary care services.
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Lasser, Karen E., David U. Himmelstein, Steffie J. Woolhandler, Danny McCormick, and David H. Bor. "Do Minorities in the United States Receive Fewer Mental Health Services Than Whites?" International Journal of Health Services 32, no. 3 (July 2002): 567–78. http://dx.doi.org/10.2190/uexw-rarl-u46v-fu4p.
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Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The authors calculated visit rates per 1,000 population to either primary care or psychiatric providers for mental health counseling, psychotherapy, and psychiatric drug therapy. In the primary care setting, Hispanics and blacks had lower visit rates (per 1,000 population) for drug therapy than whites (48.3 and 73.7 vs. 109.0; P < .0001 and P < .01, respectively). Blacks also had a lower visit rate for talk therapy (mental health counseling or psychotherapy) than whites (23.6 vs. 42.5; P < .01). In the psychiatric setting, Hispanics and blacks had lower visit rates than whites for talk therapy (38.4 and 33.6 vs. 85.1; P < .0001 for both comparisons) and drug therapy (38.3 and 29.1 vs. 71.8; P < .0001 for both comparisons). These results indicate that minorities receive about half as much outpatient mental health care as whites.
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Boyle, Malcolm J., M. ClinEpi, Erin C. Smith, and Frank L. Archer. "Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia." Prehospital and Disaster Medicine 23, no. 1 (February 2008): 20–28. http://dx.doi.org/10.1017/s1049023x00005501.
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AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.
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Akhtar, Masood, Nasir Wakeel, Muhammad Asim Shafique, Saulat Sarfraz, M. Younas Varachue, and Fouzia Qayyum. "Ludwig’s Angina: Management of 32 Cases at Tertiary Care Hospital." Pakistan Journal of Medical and Health Sciences 15, no. 5 (May 30, 2021): 1090–92. http://dx.doi.org/10.53350/pjmhs211551090.
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Background: Ludwig’s angina is a rapidly expanding cellulitis involving the floor of mouth and sub mandibular space predominantly due to dental / periodontal infections. Aim: To determine the management outcomes in the patients of Ludwig’s Angina. Place and duration of study: Department of Otorhinolaryngology Bahawal Victoria Hospital Bahawalpur. Duration was two years from August 2018 to July 2020. Study design: Hospital based cross sectional descriptive type of study Methodology: Patients of any age and gender who were clinically diagnosed as Ludwig angina and required hospitalization during the study duration were included in the study. Data regarding age, gender underlying cause, mode of presentation, treatment and complications were collected and analyzed. Patients with mild infection who did not require hospital admission were excluded from the study. Results: Out of total 32 cases, 20(62.5%) were males and 12(37.5%) were females. Age range was 10 to 70 years. In 28 (87.5%) cases, the cause was dental infection. All patients presented with pain and swelling of sub mandibular region. Four (12.5%) patients were improved with conservative treatment while 28(87.5%) underwent incision and drainage. Two (6.25%) patients needed tracheostomy. One (3.1%) patient developed complication (mediastinitis) and could not revive. Conclusion: Ludwig's angina is a disease of any age and gender commonly seen among the patients of preexisting dental infection. It can be life threatening if presented late with complication. Early diagnosis and aggressive treatment decrease morbidity and mortality. Key words: Angina, Ludwing, Cellulitis, Submandibular region.
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Doherty, Zakary, Rebecca Kippen, David Bevan, Graeme Duke, Sharon Williams, Andrew Wilson, and David Pilcher. "Long-term outcomes of hospital survivors following an ICU stay: A multi-centre retrospective cohort study." PLOS ONE 17, no. 3 (March 28, 2022): e0266038. http://dx.doi.org/10.1371/journal.pone.0266038.
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Background The focus of much Intensive Care research has been on short-term survival, which has demonstrated clear improvements over time. Less work has investigated long-term survival, and its correlates. This study describes long-term survival and identifies factors associated with time to death, in patients who initially survived an Intensive Care admission in Victoria, Australia. Methods We conducted a retrospective cohort study of adult patients discharged alive from hospital following admission to all Intensive Care Units (ICUs) in the state of Victoria, Australia between July 2007 and June 2018. Using the Victorian Death Registry, we determined survival of patients beyond hospital discharge. Comparisons between age matched cohorts of the general population were made. Cox regression was employed to investigate factors associated with long-term survival. Results A total of 130,775 patients from 23 ICUs were included (median follow-up 3.6 years post-discharge). At 1-year post-discharge, survival was 90% compared to the age-matched cohort of 98%. All sub-groups had worse long-term survival than their age-matched general population cohort, apart from elderly patients admitted following cardiac surgery who had better or equal survival. Multiple demographic, socio-economic, diagnostic, acute and chronic illness factors were associated with long-term survival. Conclusions Australian patients admitted to ICU who survive to discharge have worse long-term survival than the general population, except for the elderly admitted to ICU following cardiac surgery. These findings may assist during goal-of-care discussions with patients during an ICU admission.
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Hanumanthaiah, Ramesh Gorghatta, Dheemantha Prasad, Panchakshari Prasanna Bangalore Krishnappa, and Sreelatha R. "Usage of blood products in emergency department at tertiary care centre." International Journal of Advances in Medicine 4, no. 4 (July 20, 2017): 903. http://dx.doi.org/10.18203/2349-3933.ijam20173096.
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Background: Blood usage in the emergency department is a formidable challenge to the treating doctor. Inadvertent use of blood can do more harm to the patient than good. Analyzing blood transfusion data will help in formulating policies for transfusion in Emergency medicine department. The present study is taken to formulate guidelines for transfusion in Emergency department of our hospital. The present study also helps us to analyze the blood requirement, utilization and wastage in Emergency department, Victoria hospital.Methods: The study done was a prospective study over a period of three months from March 2016 to May 2016. A descriptive, prospective study was conducted with a total of three hundred cases collected from the Emergency department (Casualty), Victoria hospital.Results: Commonest indication for packed red cell transfusion was anemia, for FFP was hypoproteinaemia and for platelet concentrate was viral hemorrhagic fever. Transfusion trigger for packed red cells is haemoglobin of less than 7gram/dl with no co-morbid conditions and 7-9 gram/dl when there are co-morbid conditions.Conclusions: A protocol has to be formulated to reduce the wastage and to effectively utilise blood and its products.
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Ofori-Asenso, Richard, Danny Liew, Johan Mårtensson, and Daryl Jones. "The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia." Journal of Clinical Medicine 9, no. 9 (September 22, 2020): 3055. http://dx.doi.org/10.3390/jcm9093055.
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Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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Rutman, Deborah, and Belinda Parke. "Palliative Care Needs of Residents, Families, and Staff in Long-Term Care Facilities." Journal of Palliative Care 8, no. 2 (June 1992): 23–29. http://dx.doi.org/10.1177/082585979200800205.
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While there is growing recognition that the physical needs of LTC residents have increased markedly in the 20 years, the palliative care needs of facility residents and their families are poorly understood. There also is a dearth of information on the educational and support needs of LTC facility staff vis-a-vis palliative care. Operating from the Juan de Fuca Hospital Society (a network of extended care facilities in Victoria), our Palliative Support Team (PST) was conceived in order to act as an educational resource to JdF staff as well as to provide expert consultation on palliative care issues. As part of the evaluation of this pilot program, a sample of 74 Juan de Fuca workers were interviewed to determine their perceptions of resident, family, and staff needs in relation to palliative care. In this paper, discussion is focused on the palliative care needs identified by professional caregivers. The ways in which a palliative care consultation team can address some of these needs are also discussed.
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Ore, Timothy. "Trends and disparities in sepsis hospitalisations in Victoria, Australia." Australian Health Review 40, no. 5 (2016): 511. http://dx.doi.org/10.1071/ah15106.
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Objective The aim of the present study was to determine the clinical and epidemiological characteristics of patients with sepsis admitted to hospitals in Victoria, Australia, during the period 2004–14. The data include incidence, severity and mortality. Methods In all, 44 222 sepsis hospitalisations were identified between 2004–05 and 2013–14 from the Victorian Admitted Episodes Dataset. The dataset contains clinical and demographic information on all admissions to acute public and private hospitals. Using the International Classification of Diseases (10th Revision) Australian Modification codes, incidence rates, severity of disease and mortality were calculated. Results Sepsis hospitalisation rates per 10 000 population increased significantly (P < 0.01) over the period, from 6.9 (95% confidence interval (CI) 5.6–7.8) to 10.0 (95% CI 9.1–11.1), an annual growth rate of 3.8%. The age-standardised in-hospital death rates per 100 000 population grew significantly (P < 0.01) from 9.2 (95% CI 7.8–10.4) in 2004–05 to 13.0 (95% CI 11.7–14.6) in 2013–14, an annual growth rate of 3.1%. Among people under 45 years of age, the 0–4 years age group had the highest hospitalisation rate (3.0 per 10 000 population; 95% CI 2.7–3.4). Nearly half (46.2%) of all sepsis hospitalisations were among patients born overseas, with a rate of 14.5 per 10 000 population (95% CI 12.4–16.2) in that group compared with a rate of 5.9 per 10 000 population (95% CI 5.3–6.7) for patients born in Australia. The age-standardised sepsis hospitalisation rate was 2.6-fold greater in the lowest compared with highest socioeconomic areas (12.7 per 10 000 population (95% CI 11.2–13.8) vs 4.8 per 10 000 population (95% CI 4.1–5.7), respectively). Conclusion This paper shows a significant upward trend in both sepsis separation rates and in-hospital death rates over the period; unlike sepsis, in-hospital death rates from all diagnoses fell over the same period. The results can be used to stimulate review of clinical practice. Greater understanding of the epidemiology of sepsis could improve care quality and outcomes. What is known about the topic? Sepsis is associated with high mortality rates and severe sepsis is the most common cause of death in intensive care units (ICU). The last published study of sepsis in Victoria (in 2005) showed a gradual rise in rates; since then, there is little information as to whether there has been any significant improvement in treatment outcomes. What does this paper add? This paper provides new information by analysing trends and variations in sepsis hospitalisations in Victoria by several demographic groups from 2004–05 to 2013–14. What are the implications for practitioners? Patients with severe sepsis consume approximately half the ICU resources. Reliable and recent data on the growth of this disease are important for prevention, allocation of resources and to track the effectiveness of care. A key area for intervention is promoting greater adherence to clinical guidelines.
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Johnson, Avalon. "Access to Elective Abortions for Female Prisoners under the Eighth and Fourteenth Amendments." American Journal of Law & Medicine 37, no. 4 (December 2011): 652–83. http://dx.doi.org/10.1177/009885881103700405.
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Victoria, a pregnant inmate housed in a Louisiana state prison, brought a civil rights action challenging the prison’s policy of requiring her to obtain a court order to receive an elective abortion. Although Louisiana state law purported to allow Victoria to obtain an elective abortion, Victoria was unable to obtain her abortion because of procedural delays. Victoria was released from prison before she gave birth but her pregnancy was too far along for her to legally obtain an abortion. She was therefore forced to carry her pregnancy to term and forced to place her newborn child with adoptive parents. Had she given birth in prison, she would have been shackled to her hospital bed, as Louisiana policies require.Little information regarding pregnancy, prenatal care, perinatal outcomes, and access to elective abortions for female inmates exists. We know, however, that between six and ten percent of the women entering jail or prison are pregnant and that more women may become impregnated in prison as a result of rape by prison guards.
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Basu, Jayasree, Amresh Hanchate, and Arlene Bierman. "Racial/Ethnic Disparities in Readmissions in US Hospitals: The Role of Insurance Coverage." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801877418. http://dx.doi.org/10.1177/0046958018774180.
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We examine differences in rates of 30-day readmissions across patients by race/ethnicity and the extent to which these differences were moderated by insurance coverage. We use hospital discharge data of patients in the 18 years and above age group for 5 US states, California, Florida, Missouri, New York, and Tennessee for 2009, the latest year prior to the start of Centers for Medicare & Medicaid Services’ Hospital Compare program of public reporting of hospital performance on 30-day readmissions. We use logistic regression models by state to estimate the association between insurance status, race, and the likelihood of a readmission within 30 days of an index hospital admission for any cause. Overall in 5 states, non-Hispanic blacks had a slightly higher risk of 30-day readmissions relative to non-Hispanic whites, although this pattern varied by state and insurance coverage. We found higher readmission risk for non-Hispanic blacks, compared with non-Hispanic whites, among those covered by Medicare and private insurance, but lower risk among uninsured and similar risk among Medicaid. Hispanics had lower risk of readmissions relative to non-Hispanic whites, and this pattern was common across subgroups with private, Medicaid, and no insurance coverage. Uninsurance was associated with lower risk of readmissions among minorities but higher risk of readmissions among non-Hispanic whites relative to private insurance. The study found that risk of readmissions by racial ethnic groups varies by insurance status, with lower readmission rates among minorities who were uninsured compared with those with private insurance or Medicare, suggesting that lower readmission rates may not always be construed as a good outcome, because it could result from a lack of insurance coverage and poor access to care, particularly among the minorities.
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Biro, Mary Anne, Jane S. Yelland, Stephanie J. Brown, and Georgina A. Sutherland. "Women’s experience of domiciliary postnatal care in Victoria and South Australia: a population-based survey." Australian Health Review 36, no. 4 (2012): 448. http://dx.doi.org/10.1071/ah11128.
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Objective. Despite the expansion of postnatal domiciliary services, we know little about the women receiving visits and how they regard their care. The aim of this study is to examine the provision of postnatal domiciliary care from a consumer perspective. Methods. All women who gave birth in September–October 2007 in South Australia and Victoria were mailed questionnaires 6 months after the birth. Women were asked if they had received a midwifery home visit, and to rate the care they received. Results. More women in South Australia reported receiving a domiciliary visit than in Victoria (88.0% v. 76.0%) and they were more likely to rate their care as ‘very good’ (69.1% v. 63.4%). Younger women, women on a lower income, who were holding a healthcare concession card or who had not completed secondary education were less likely to receive a visit. Conclusion. Although the majority of women in public maternity care in Victoria and South Australia receive domiciliary care and rate it positively, there are significant state-based differences. Those more likely to benefit from domiciliary care are less likely to receive a visit. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels. What is known about the topic? Postnatal domiciliary services have expanded dramatically over the past decade as the postpartum hospital stay has shortened. Despite its widespread introduction, there are no mechanisms in place to monitor or evaluate whether these services are meeting women’s expectations. We know little about the women who receive domiciliary postnatal visits in the first week after discharge from hospital, and how they regard their experience of care. What does the paper add? This is the first Australian population-based survey that describes the experience of domiciliary care according to the state in which women reside and to examine the sociodemographic, obstetric and organisational factors associated with the provision of services. What are the implications for practitioners? There were state-based differences in the provision of domiciliary care and whilst the majority of women received domiciliary care and rated it positively, an inverse care law seems to apply: women who were more likely to need and derive benefit from domiciliary care were less likely to receive it. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels.
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Turbitt, Erin, and Gary Lee Freed. "Paediatric emergency department referrals from primary care." Australian Health Review 40, no. 6 (2016): 691. http://dx.doi.org/10.1071/ah15211.
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Background Over the last decade, paediatric referrals from general practitioners (GPs) to the emergency department (ED) have increased by 60% in Australia. Objective To investigate the characteristics of Victorian children referred by GPs to the ED with lower-urgency conditions. Method Data were collected from four hospital EDs in Victoria, May–November 2014. Parents attending the ED with their child triaged as lower urgency were surveyed. Descriptive, frequency, and bivariate analyses were performed. Results Of the 1150 responses, 28% (320) visited their GP before attending ED. Of these 66% (212), were referred by their GP. A greater proportion with injury than illness (84% vs 59%; P < 0.0001) was referred to the ED if they had first visited their GP. Conclusion Motivations of GPs to send lower-urgency injured and ill children to ED are not well understood. The high number of referrals from GPs to the ED for lower urgency conditions suggests attention by policy makers and health professionals must be paid to the current patterns of care of children in general practice. What is known about the topic? Paediatric referrals in Australia from GPs to EDs have increased in the last decade, along with the absolute number of children in Victoria presenting to the ED. What does this paper add? A significant number of children (66%) who attend the GP before visiting the ED are referred to the ED for their lower urgency condition. What are the implications for practitioners? It may be appropriate for GPs to be further supported to manage lower urgency conditions, through better resources or education.
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Dowling, Pat. "The Discharge Brokerage Program." Australian Journal of Primary Health 2, no. 1 (1996): 134. http://dx.doi.org/10.1071/py96019.
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In response to government policies on case mix funding and Diagnosis Related Groups (DRGs), Caulfield Community Care Centre, in consultation with the Inner South Community Health Service in Victoria, made a submission for government funding to run an early discharge program. It was called a Discharge Brokerage Program rather than an early discharge program, because of not wanting patients to be anxious about leaving hospital early.
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McDermott, Francis T., Gregory J. Cooper, Philip L. Hogan, Stephen M. Cordner, and Ann B. Tremayne. "Evaluation of the Prehospital Management of Road Traffic Fatalities in Victoria, Australia." Prehospital and Disaster Medicine 20, no. 4 (August 2005): 219–27. http://dx.doi.org/10.1017/s1049023x00002570.
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AbstractIntroduction:This study was undertaken to identify prehospital system and management deficiencies and preventable deaths between 01 January 1997 and 31 December 1998 in 243 consecutive Victorian road crash victims with fatal outcomes.Methods:The complete prehospital and hospital records, the deposition to the coroner, and autopsy findings were evaluated by computer analysis and peer group review with multidisciplinary discussion.Results:One-hundred eighty-seven (77%) patients had prehospital errors or inadequacies, of which 135 (67%) contributed to death. Three-hundred ninety-four (67%) related to management and 130 (22%) to system deficiencies. Technique errors, diagnosis delays, and errors relatively were infrequent. One of 24 deaths at the crash scene or en route to hospital was considered to be preventable and two potentially preventable.Conclusion:The high prevalence of prehospital deficiencies has been addressed by a Ministerial Task Force on Trauma and Emergency Services and followed by the introduction of a new trauma care system in Victoria.
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Turbitt, Erin, Marina Kunin, Sarah Gafforini, and Gary L. Freed. "Motivators and barriers for paediatricians discharging patients." Australian Journal of Primary Health 23, no. 3 (2017): 284. http://dx.doi.org/10.1071/py16094.
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The aim of this study was to identify motivators and barriers that paediatricians face when discharging patients from outpatient specialty care. A questionnaire was administered to outpatient care paediatricians in Victoria working in one of five speciality public hospital clinics. Questions focused on how important various motivators and barriers were in respondents’ decision to discharge a patient from their clinic. Nearly all (91%, n=74) paediatricians invited to participate provided responses. The factor influencing the greatest proportion of paediatricians in their decision to discharge patients back to primary care was the potential that patients may not receive the required care from a GP. The next most highly rated barrier was that it is too complicated to arrange discharge; rated as a very important influence by one-third of paediatricians (33%, n=24). Improvements to the discharge process may encourage more paediatricians to discharge patients back to their GP, therefore freeing up appointment slots. This in turn could reduce waiting times for paediatric outpatient clinics in Victoria. The concern from paediatricians that patients may not receive the required care from a GP warrants attention and should be further investigated.
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Ravi, K., TM Maithili, David Mathew Thomas, and Sphoorti P. Pai. "Bacteriological profile and outcome of Ventilator associated pneumonia in Intensive care unit of a tertiary care centre." Asian Journal of Medical Sciences 8, no. 5 (August 31, 2017): 75–79. http://dx.doi.org/10.3126/ajms.v8i5.17630.
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Background: Ventilator associated pneumonia (VAP) complicates the course of 8-28% of patients receiving mechanical ventilation. Appropriate antimicrobial treatment significantly improves the outcome. Hence rapid identification of infected patients and accurate selection of antimicrobials are important clinical goals.Aims and Objectives: The present study was conducted with an aim to know the outcome of VAP and to identify pathogens, compare the bacteriological profile, duration of mechanical ventilation and length of hospitalization.Materials and Methods: Sixty patients who developed VAP during our study period of 2 years were included after meeting inclusion and exclusion criteria. Study was conducted in Victoria hospital and Bowring & Lady Curzon hospitals attached to Bangalore Medical College and Research institute.Results: Majority of patients were in the age group of 21-40 years. The occurrence of late VAP was 70 %. Klebsiella was the most common organism isolated in our study. Mortality was 13.3%. Average duration of intubation was 13.1±6.6days. Duration of hospital stay was 16.2±7.1 days.Conclusion: Our study concluded that occurrence of late VAP was more common than early VAP. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and length of hospitalisation. Above all utmost importance must be given to prevent VAP. Asian Journal of Medical Sciences Vol.8(5) 2017 75-79
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Rayner, Jo-Anne, Della Forster, Helen McLachlan, Jane Yelland, and Mary-Ann Davey. "A state-wide review of hospital postnatal care in Victoria, Australia: The views and experiences of midwives." Midwifery 24, no. 3 (September 2008): 310–20. http://dx.doi.org/10.1016/j.midw.2006.10.008.
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Tikkanen, Roosa Sofia, Steffie Woolhandler, David U. Himmelstein, Nancy R. Kressin, Amresh Hanchate, Meng-Yun Lin, Danny McCormick, and Karen E. Lasser. "Hospital Payer and Racial/Ethnic Mix at Private Academic Medical Centers in Boston and New York City." International Journal of Health Services 47, no. 3 (February 2, 2017): 460–76. http://dx.doi.org/10.1177/0020731416689549.
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Academic medical centers (AMCs) are widely perceived as providing the highest-quality medical care. To investigate disparities in access to such care, we studied the racial/ethnic and payer mixes at private AMCs of New York City (NYC) and Boston, two cities where these prestigious institutions play a dominant role in the health care system. We used individual-level inpatient discharge data for acute care hospitals to examine the degree of hospital racial/ethnic and insurance segregation in both cities using the Index of Dissimilarity, together with recent changes in patterns of care in NYC. In multivariable logistic regression analyses, black patients in NYC were two to three times less likely than whites, and uninsured patients approximately five times less likely than privately insured patients, to be discharged from AMCs. In Boston, minorities were overrepresented at AMCs relative to other hospitals. NYC hospitals were more segregated overall according to race/ethnicity and insurance than Boston hospitals, and insurance segregation became more pronounced in NYC after the Affordable Care Act. Although health reform improved access to insurance, access to AMCs remains limited for disadvantaged populations, which may undermine the quality of care available to these groups.
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Rauf-ul-Hassan, Muahmmad, Ahtesham Iqbal, Muhammad Waseem, Muhammad Zubair Ashraf, Tehreem Abaid, and Anam Saleem. "Non-Invasive Ventilation versus Invasive Mechanical Ventilation: Results from a Tertiary Care Hospital." Pakistan Journal of Medical and Health Sciences 16, no. 1 (January 18, 2022): 256–58. http://dx.doi.org/10.53350/pjmhs22161256.
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Objective: To compare the patient outcome in severe COVID-19 pneumonia between the non-invasive ventilation and invasive mechanical ventilation. Study design: Prospective, observational study Study Setting and Duration: Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur from January 2021 to June 2021. Methodology: We analyzed 660 patients of severe covid pneumonia. Conscious proning was done in those requiring ≥ 21 L oxygen and oxygen saturation < 90%. We defined typical ARDS according to Berlin criteria. Atypical ARDS did not fulfill set criteria. We divided ARDS into 2 types i-e H and L type. We managed ARDS with either NIV, invasive mechanical ventilation or both. We used multiple regression analysis to predict ICU stay. Results: Out of 660 patients, 285 (43.18%) developed biPAP failure and were subsequently intubated. We observed 273 (41.4%) overall mortality, 175 (64.1%) in IMV and 98 (35.9%) in the NIV group (p<0.0001). invasive mechanical ventilation had statistically significant correlation with mortality and also predicted ICU stay. (p=< 0.001, OR 3.2, p=0.001). Conclusion: NIV therapy is superior to invasive mechanical ventilation in terms of ICU stay and outcome. Keywords: ARDS, coronavirus, COVID-19, non-invasive ventilation, mechanical ventilation, pneumonia
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Joseph, Galen, and Daniel Dohan. "Recruiting minorities where they receive care: Institutional barriers to cancer clinical trials recruitment in a safety-net hospital." Contemporary Clinical Trials 30, no. 6 (November 2009): 552–59. http://dx.doi.org/10.1016/j.cct.2009.06.009.
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Tahir, Muhammad Younis, Iftikhar Ahmad, and Soufia Farrukh. "Frequency of Retinopathy in low birth weight infant at tertiary care hospital." Professional Medical Journal 27, no. 02 (February 10, 2020): 365–70. http://dx.doi.org/10.29309/tpmj/2020.27.02.4001.
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Objectives: To find out the frequency of retinopathy in low birth weight infant presenting at tertiary care hospital, Bahawalpur. Study Design: Cross sectional study. Setting: Department of Ophthalmology, Bahawal Victoria Hospital, Bahawalpur. Period: From July 2018 to December 2018. Material & Methods: Neonatal eye examination was performed for ROP. Results: Total 78 neonates were recruited for present study and ROP was assessed. Mean gestational age of neonates was 32.54 ± 3.79 weeks. Mean weight was 1445.51 ± 517.373 grams. Out of 78 neonates, ROP was observed in 28 (36%) neonates. ROP was found in 27 (42.19%) neonates of premature group and in 1 (7.14%) neonates of at term group. ROP was found in 1 (3.23%), 5 (29.41%) and 22 (73.33%) neonates respectively in weight group 1500-2500 g, 1000-1500 g and <1000 g group. Male neonates were 35 (44.87%) and female neonates were 43 (55.13%). Development of ROP was not significantly (P = 0.248) associated with gender of the neonates. Statistically significant association between ROP and oxygen supplementation was observed with p value 0.021. Conclusion: Results showed higher number of patients with ROP. Association of development of ROP with gestation was highly significant. Oxygen supplementation and oxygen concentration was also associated with ROP. Findings also showed no effect of gender and duration of hospital stay on ROP.
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Knock, Marion, David Newsome, and Barbara Poole. "The Medical Information Highway: Where is the Access Ramp?" Healthcare Management Forum 8, no. 3 (October 1995): 57–61. http://dx.doi.org/10.1016/s0840-4704(10)60920-9.
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In this article, an analogy is drawn between a health care information system and a freeway transportation system. Unfinished access ramps and disconnected road sections are likened to unlinked computer information systems. It is not until there is “connectivity” between roadways that vehicles can take advantage of the efficiencies of a freeway system or until there are comrehensive, integrated information systems that quality health care can be provided. The Greater Victoria Hospital Society used quality improvement techniques to improve the medical information highway, and theories of change management to encourage physician leaders to “buy into” the information system to produce needed change in the organization and in patient care.
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Zunaira Javed, Syed Usman Masood, and Javed Laal. "Outcome of acute bacterial meningitis among children in Tertiary care hospital." Professional Medical Journal 29, no. 02 (January 31, 2022): 167–71. http://dx.doi.org/10.29309/tpmj/2022.29.02.6533.
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Objective: To determine the frequency of Hemophilus Influenzae type b, streptococcus pneumonia and Niesseria Meningitidis and outcome in culture proven meningitis in children 6 months to 24 months of age admitted in children ward. Study Design: Cross Sectional Analytical study. Setting: Pediatric Medical Unit of Bahawal Victoria Hospital, Bahawalpur. Period: January 2019 to December 2019. Material & Methods: A total of 220 children of either sex with culture proven meningitis, aged 6 months to 24 months, were included in the study. Demographic characteristics, duration of fever, history of seizures, weight of child, vaccination status and bacteria isolated from Cerebrospinal Spinal Fluid (CSF) and outcome were analyzed. Confidentiality of data was maintained and it was assured that no harm to the participants will be done. The outcome in the form of mortality was noted during the first 10 days of hospital stay. There was no conflict of interest among the authors and study was self-funded. Results: Amongst a total of 220 children, 123 (55.9%) were male. There were 130 (59.1%) children who were less than or equal to 1 year of age. There were 154 (70.0%) children who were having a weight of 7 to 10 kg. Vaccination status showed that, 111 (50.5%) were fully vaccinated, 59 (26.8%) partially vaccinated and 50 (22.7%) not vaccinated. Duration of fever revealed that, 141 (64.1%) had fever for more than 5 days. There were 139 (63.2%) children who had a history of seizures. Streptococcus pneumonia was the commonest bacteria found in 110 (50%) children followed by Neisseria meningitides 53 (24.1%), H. Influenza 37 (16.8%). Overall mortality was noted in 34 (15.5%) children. Conclusion: In children with bacterial meningitis, mortality was high and most common bacteria were found to be S.pneumoniae followed by H.influenzae.
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Sharwood, Penny, and Bernadette O'Connell. "Assessing the relationship between inpatient and outpatient activity:a clinical specialty analysis." Australian Health Review 23, no. 3 (2000): 137. http://dx.doi.org/10.1071/ah000137a.
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General and specialist services in public acute hospital outpatient departments play a key role in the health care systemand represent a vital interface between inpatient and community care. Typically outpatient services involve millionsof patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions ofservice are provided each year. Drawing on the first full year of data from the Victorian Ambulatory ClassificationSystem (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatientencounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatientactivity at the clinical specialty level.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
Full textAbstract:
A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Clapperton, Angela, Jeremy Dwyer, Ciara Millar, Penny Tolhurst, and Janneke Berecki-Gisolf. "Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia." PLOS ONE 16, no. 6 (June 3, 2021): e0252682. http://dx.doi.org/10.1371/journal.pone.0252682.
Full textAbstract:
Aims The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide. Methods The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011–2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association. Results In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432). In the year prior to suicide, when compared with males aged 25–49 years (the reference group):males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reasonfemales aged 10–24 years and 25–49 years were significantly more likely to have mental-health-related hospital contactfemales aged 10–24 years and 25–49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm. Conclusions The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.
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Shackleton, Teri L., and Marie Gage. "Strategic Planning: Positioning Occupational Therapy to Be Proactive in the New Health Care Paradigm." Canadian Journal of Occupational Therapy 62, no. 4 (October 1995): 188–96. http://dx.doi.org/10.1177/000841749506200403.
Full textAbstract:
Strategic planning can be a powerful tool for occupational therapists seeking to position themselves to be leaders in the rapidly changing health care environment. The philosophical base and values of occupational therapy are consistent with those embraced by the emerging health care paradigm. However, occupational therapy staff at Victoria Hospital, an acute care university-affiliated health care institution, identified obstacles to seizing the opportunities offered by this shift in health care. In reviewing the literature, it was discovered that these obstacles were not unique to one particular facility, but were in fact common issues faced by the profession. The strategic planning process described in this paper provided a framework for addressing the identified barriers and positioning occupational therapists to play a proactive role in the evolving health care paradigm.