During 208 days 2836 patients were admitted to Sundby Hospital, medical ward. A total of 734 antibiotic cures were initiated. About 632 (22-23%) of the patients had antibiotic treatment. Penicillin, ampicillin and sulfamethizole were the most frequently used antibiotics. The use of erythromycin was 42-50% and 64-78% of that of penicillin and ampicillin respectively. Antibiotic treatment was changed in 99 cures in 73 patients. Fifty-seven of ninety-nine (43-71%) shifts were based on culture or serology and 42/99 (29-57%) shifts were based on clinical evaluation including microscopy and urinary stix. In 26 of the latter 42 cases positive culture or serology was obtained after the antibiotic was changed. Thirteen of the 26 shifts improved treatment, six were unlucky and seven indifferent, thus giving a net advantage of 13-6 = 7 of 26 shifts. This net advantage was due to shifts from penicillin. In ten cases the antibiotic was shifted to erythromycin due to suspected atypical pneumonia, but only one case was verified. In ten antibiotic shifts in pneumonia patients the etiologic agents were not identified. In 4/99 shifts in 4/73 patients relevant specimens were not obtained. The antibiotic most often changed compared with its total use was ampicillin (32/152 congruent to 1/5 of initiated cures) and shifts from ampicillin were more often (21/32) based on culture than shifts from penicillin (16/36) (p
The point of departure is that patient satisfaction surveys should be designed and organized in a manner that furthers ownership and responsibility ensuring follow-up by those who are to employ the results. This study therefore evaluates the perceived usefulness of patient satisfaction surveys among heads of departments and heads of hospitals.
During the period from 1999 to 2006, the County of Aarhus performed four patient survey series. After each series, heads of department and heads of hospital were asked to fill out questionnaires to evaluate the entire system. A total of 200 questionnaires were sent and 173 were returned (86.5%) with 640 comments to the open-ended questions.
82.5% of the leaders evaluated the concept as "Outstanding" or "Good". Leaders from teaching hospitals and heads of hospital were more satisfied. The highest scores were given for the option of having the results reported at ward level and/or diagnostic groups, and the option of collecting comments from patients. 82.4% of the leaders reported that the surveys had resulted in concrete follow-up activities. The main criticism of the concept was its lack of detail.
Generic patient satisfaction surveys can gain acceptance from the involved leaders. In part, the acceptance of the users is based on their possibilities of making individual choices within the standardized questionnaires. It is recommended to involve users of patient satisfaction surveys in the design and evaluation of concepts in the future, including frontline staff.
Though use of repeated generic measurements of patient satisfaction is increasing, we have limited knowledge of how results change over time. The present study focused on systematic changes of inpatients' satisfaction both at high and low organizational levels, and addressed the question of whether there is an association to occupancy rates, acute rates and local leaders' evaluation of the concept for monitoring patient satisfaction.
During the period from 1999 to 2006, the County of Aarhus carried out detailed patient satisfaction surveys over four periods in eight somatic hospitals. The 71 wards participating in the first three periods were included. Organizational data were drawn from a management information system. A questionnaire to heads of department and hospital was used to evaluate the concept after each period.
At county level there was no significant development in satisfaction during the period. However, the wards with the lowest evaluations from the first round experienced significant and persisting improvements over the next two periods. The wards which experienced significant improvements were characterised by having few acute patients.
The study shows that patient satisfaction can change over time. There seems to be a positive effect associated with first time measurements on a detailed organizational level. Persistent improvements of patient satisfaction were seen on the wards with lowest satisfaction at baseline, indicating that the concept seems to have a positive impact on performance. Wards with a high acute rate seem to have difficulties in improving patient satisfaction.
Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.
The use of patient questionnaires has increased widely in recent years. Their purpose, to incorporate patient perspectives into the orientation and design of health care, is, of course, commendable. However, the survey methods themselves have been less adequate, both in terms of validity and reliability, and with respect to the potential for using the results to improve the quality of health care. Presents a pilot study at three departments of ophthalmology in Sweden, involving a new method which meets reasonable demands for validity and reliability, and is explicitly change-oriented.
Practical peer review by means of a clinical audit requires complete documentation, critical assessment and open discussion of difficulties or errors in patient management. The quality of care in a large surgical department was monitored using weekly on-the-ward capture of complications and immediate feedback to involved surgeons. Retrospective peer review of surgical deaths judged the process of patient care in three categories--treatment, investigation and documentation; feedback was also provided. Seven of the 10 surgical services each collected morbidity data for at least 40 weeks in 1976 and 44 weeks in 1977. In 1978, 8 of the 10 services collected data for 50 weeks or more. The number of patients reviewed was 3520 in 1978. Of these, 822 (23%) had complications in 1976, 703 (16%) in 1977 and 918 (17%) in 1978. In 1976, 260 patients died; the quality of care was considered to have been adequate in 67%. In 1977, 278 patients died; in 76% the management was considered adequate. In 1978, 231 patients died; in 68% management was satisfactory. This clinical audit system is suitable for computer programming and can provide a complete and accurate report of the entire spectrum of complications.