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Creative solutions through utilization management.

https://arctichealth.org/en/permalink/ahliterature221679
Source
Leadersh Health Serv. 1993 Mar-Apr;2(2):25-9
Publication Type
Article
Author
B S Brown
R J Smith
Source
Leadersh Health Serv. 1993 Mar-Apr;2(2):25-9
Language
English
Publication Type
Article
Keywords
Appointments and Schedules
British Columbia
Cholecystectomy, Laparoscopic - utilization
Efficiency
Forms and Records Control - methods
Home Care Services - utilization
Hospital Administration - standards
Humans
Infusions, Intravenous - methods
Operating Rooms - utilization
Patient Care Planning - organization & administration
Program Development - methods
Utilization Review - organization & administration
Abstract
In this second and concluding report on utilization management practices at Lions Gate Hospital in British Columbia, the authors outline various initiatives that improve efficiency and increase quality of care. Topics explored are laparoscopic cholecystectomy as an example of new technology that can save time and resources, a home IV therapy program, co-ordinating care by means of coordinated care mapping, and improving operating room efficiency through rigorous scheduling.
PubMed ID
10125209 View in PubMed
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The electric shock hazard in hospitals.

https://arctichealth.org/en/permalink/ahliterature110643
Source
Can Med Assoc J. 1968 May 25;98(21):1002-7
Publication Type
Article
Date
May-25-1968
Author
J A Hopps
Source
Can Med Assoc J. 1968 May 25;98(21):1002-7
Date
May-25-1968
Language
English
Publication Type
Article
Keywords
Accident prevention
Canada
Electric Countershock - adverse effects
Electric Injuries - prevention & control
Electronics, Medical
Explosions
Hospital Design and Construction - standards
Hospitals
Humans
Intensive Care Units - utilization
Monitoring, Physiologic - adverse effects
Operating Rooms - utilization
Pacemaker, Artificial - adverse effects
Ventricular Fibrillation - etiology
Notes
Cites: Surgery. 1961 Jan;49:98-10813702668
Cites: Lancet. 1961 May 6;1(7184):975-713729491
Cites: Can Med Assoc J. 1962 Aug 11;87:286-813871966
Cites: Circ Res. 1962 Dec;11:1004-913999578
PubMed ID
5653660 View in PubMed
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Endovascular treatment for aortic disease: is a surgical environment necessary?

https://arctichealth.org/en/permalink/ahliterature172316
Source
J Vasc Surg. 2005 Oct;42(4):645-9; discussion 649
Publication Type
Article
Date
Oct-2005
Author
Randy D Moore
Laurencia Villalba
Paul F Petrasek
Gregory Samis
Chad G Ball
Mona Motamedi
Author Affiliation
Division of Vascular Surgery, Peter Lougheed Centre, University of Calgary, Alberta, Canada. RandyD.Moore@CalgaryHealthRegion.ca
Source
J Vasc Surg. 2005 Oct;42(4):645-9; discussion 649
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortic Aneurysm, Thoracic - mortality - radiography - surgery
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - methods
Cohort Studies
Emergency Treatment - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Needs Assessment
Operating Rooms - utilization
Prospective Studies
Prosthesis Design
Prosthesis Failure
Risk assessment
Severity of Illness Index
Surgical Procedures, Elective - statistics & numerical data
Survival Analysis
Treatment Outcome
Abstract
Interventional radiologists, cardiologists, and vascular surgeons are capable of performing endovascular procedures successfully in their respective environments. Suboptimal anatomy or intraoperative technical problems can be encountered, and endovascular management alone is not always suitable. The objectives of this study were to define the incidence of adjunctive surgical techniques, to discuss the rationale for endovascular reconstruction in a well-developed surgical environment, and to assess the effect of experience on the incidence of adjunctive repair.
All primary aortic and aortoiliac elective, urgent, and emergent endovascular procedures performed at the Peter Lougheed Center and entered into a prospective database from May 25, 1999 to June 01, 2005, were reviewed. All adjunctive surgical techniques to enable stent deployment, enhance attachment site, or solve intraoperative difficulties were captured. The study period was divided into two time periods based on learning curve data to assess the effect of experience on the rate of adjunctive repairs.
Four hundred thirty-eight patients underwent elective (80%), urgent (15%), or emergent (5%) endovascular procedures during the study period. These consisted of 101 thoracic and 337 abdominal operations, including the use of 13 fenestrated stents. One hundred thirty-nine patients (31.7%) required 180 open surgical procedures. Complete data were available for the entire patient cohort. The mean follow-up was 793.2 days (SD, 519.1 days). Procedures were necessary for vascular access, arterial dissection/rupture, limb ischemia, and enhancement/elongation of the stent attachment site. The persistent endoleak rate was 5.3%, the late rupture rate was 0.7%, the conversion rate was 1.6%, the 30-day surgical mortality rate was 3.2%, all-cause mortality to date is 7.3%, and the reintervention rate was 4.6%. There was no statistically significant effect of the learning curve on the incidence of surgical adjunctive procedures in either the thoracic group (11/26 [42.3%] for phase 1 vs 17/75 [22.6%] for phase 2) or the abdominal group (14/50 [28.0%] for phase 1 vs 97/287 [33.8%] for phase 2). Overall, 31.5% of patients required adjunctive surgical repair.
Successful endografting requires endovascular expertise in addition to a well-developed surgical environment to increase applicability and decrease patient risk. Despite advances in endovascular technology, hybrid techniques will continue to be required to achieve good overall success rates.
PubMed ID
16242547 View in PubMed
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Interest in alternative birthplaces among women in Ottawa-Carleton.

https://arctichealth.org/en/permalink/ahliterature229174
Source
CMAJ. 1990 May 1;142(9):963-9
Publication Type
Article
Date
May-1-1990
Author
B. Soderstrom
P J Stewart
C. Kaitell
M. Chamberlain
Author Affiliation
Ottawa-Carleton Health Department.
Source
CMAJ. 1990 May 1;142(9):963-9
Date
May-1-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Canada
Choice Behavior
Delivery Rooms - utilization
Female
Home Childbirth - utilization
Humans
Operating Rooms - utilization
Patient Acceptance of Health Care
Pregnancy
Questionnaires
Socioeconomic Factors
Statistics as Topic
Abstract
Birthing rooms, birth centres and home birth have been proposed as alternatives to the traditional in-hospital caserooms to meet the needs of women and their families more effectively. We performed a descriptive survey to determine the level of interest of childbearing women in the Ottawa-Carleton region in these birthplaces and to examine the characteristics of women who express an interest in using them. Of the 1629 women who gave birth between July 1 and Aug. 28, 1987, 1115 (68.4%) completed a self-administered questionnaire during the pregnancy, in the early postpartum period in hospital or at home. Of the respondents 577 (53.1%) said they would choose the caseroom, 316 (29.1%) the birthing room, 165 (15.2%) the birth centre and 30 (2.8%) home birth. The women who expressed an interest in a birthplace other than the caseroom were more likely than the others to be older, married, well-educated and interested in midwifery services and to breastfeed their babies (p less than 0.05). They were also more likely to have had a low-intervention vaginal birth (p less than 0.05). The interest expressed in birthing rooms, birth centres and home birth suggests that these alternatives should be considered for inclusion in the health care system.
Notes
Cites: J Fam Pract. 1979 Sep;9(3):407-14479772
Cites: Am J Obstet Gynecol. 1980 Jun 1;137(3):377-847377258
Cites: Dimens Health Serv. 1981 Jun;58(6):26-8, 30-17239040
Cites: CMAJ. 1986 Aug 15;135(4):285-83730994
Cites: CMAJ. 1988 Oct 15;139(8):773-43167739
Cites: Can Nurse. 1977 Nov;73(11):31-4922714
Comment In: CMAJ. 1990 Oct 15;143(8):707-92207928
PubMed ID
2328467 View in PubMed
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A new pathway for elective surgery to reduce cancellation rates.

https://arctichealth.org/en/permalink/ahliterature123569
Source
BMC Health Serv Res. 2012;12:154
Publication Type
Article
Date
2012
Author
Einar Hovlid
Oddbjørn Bukve
Kjell Haug
Aslak Bjarne Aslaksen
Christian von Plessen
Author Affiliation
Institute of Social Science, Sogn og Fjordane University College, Sogndal, Norway. einar.hovlid@hisf.no
Source
BMC Health Serv Res. 2012;12:154
Date
2012
Language
English
Publication Type
Article
Keywords
Appointments and Schedules
Efficiency, Organizational
Health Services Research
Hospital Information Systems
Humans
Interviews as Topic
Norway
Operating Rooms - utilization
Personnel Management - standards
Personnel, Hospital - psychology
Process Assessment (Health Care) - methods
Rural Health Services
Surgery Department, Hospital - manpower - organization & administration
Surgical Procedures, Elective - standards - statistics & numerical data - trends
Total Quality Management
Waiting Lists
Abstract
The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery and explored which factors affected the outcomes.
We collected the number of planned operations, performed operations, and cancellations per month from the hospital's patient administrative system. We then used Student's t-test to analyze differences in cancellation rates (CRs) before and after interventions and a u-chart to analyze whether the improvements were sustained. We also conducted semi-structured interviews with employees of the hospital to explore the changes in the surgical pathway and the factors that facilitated these changes.
The mean CR was reduced from 8.5% to 4.9% (95% CI for mean reduction 2.6-4.5, p
Notes
Cites: Anaesthesia. 2010 Jun;65(6):625-4020565395
Cites: J Perianesth Nurs. 2009 Dec;24(6):396-819962106
Cites: Eur J Anaesthesiol. 2011 Jul;28(7):493-50121623186
Cites: Anesth Analg. 2011 Sep;113(3):578-8521680860
Cites: Tidsskr Nor Laegeforen. 2001 Sep 10;121(21):2516-911875930
Cites: Otolaryngol Head Neck Surg. 2002 Apr;126(4):365-7011997774
Cites: Qual Saf Health Care. 2002 Jun;11(2):110-112448794
Cites: Jt Comm J Qual Saf. 2003 May;29(5):227-3712751303
Cites: Anaesthesia. 2003 Jul;58(7):692-912886919
Cites: Qual Saf Health Care. 2003 Dec;12(6):448-5214645761
Cites: Jt Comm J Qual Improv. 1993 Oct;19(10):424-47; discussion 448-528252125
Cites: Ann R Coll Surg Engl. 1993 Nov;75(6):441-48285550
Cites: Med J Aust. 2005 Jun 20;182(12):612-515963016
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Cites: Anesth Analg. 2002 Mar;94(3):644-9; table of contents11867390
Cites: Anesthesiology. 2005 Oct;103(4):855-916192779
Cites: J Health Organ Manag. 2007;21(1):54-817455812
Cites: Anaesthesia. 2007 Sep;62(9):895-90317697215
Cites: Rev Lat Am Enfermagem. 2007 Sep-Oct;15(5):1018-2418157457
Cites: JAMA. 2008 Mar 12;299(10):1182-418334694
Cites: Qual Saf Health Care. 2008 Dec;17(6):459-6319064663
Cites: Med Care Res Rev. 2009 Jun;66(3):235-7119176833
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Cites: Am J Surg. 2009 Nov;198(5):600-619887185
Cites: BMJ Qual Saf. 2011 Mar;20(3):251-921209149
PubMed ID
22686475 View in PubMed
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Prioritization for elective dental treatment under general anesthesia.

https://arctichealth.org/en/permalink/ahliterature163719
Source
J Can Dent Assoc. 2007 May;73(4):321
Publication Type
Article
Date
May-2007
Author
Michael J Casas
David J Kenny
Edward J Barett
Leslie Brown
Author Affiliation
Department of Dentistry, The Hospital for Sick Children, Toronto, ON, Canada. michael.casas@sickkids.ca
Source
J Can Dent Assoc. 2007 May;73(4):321
Date
May-2007
Language
English
Publication Type
Article
Keywords
Anesthesia, Dental - methods
Anesthesia, General
Child, Preschool
Dental Care for Children - organization & administration
Dentistry, Operative - organization & administration
Efficiency, Organizational - standards
Humans
Ontario
Operating Rooms - utilization
Surgical Procedures, Elective
Triage
Waiting Lists
Abstract
This paper describes the process and outcomes of an initiative to develop a system to prioritize operating room bookings for children who require elective dental treatment. This initiative had 3 objectives: to improve the timeliness of treatment in the operating room based on medical and dental need, to provide a means to identify and expedite the highest-priority cases when operating room time became available, and to document the prioritization of cases as a quality assurance measure. Each patient booked for treatment in the operating room was assigned a priority ranking based on a combination of their medical risk and dental status. Measures of interrater reliability between clinician raters were moderate to good. Use of the prioritization system demonstrated improved timeliness of treatment for urgent cases and the effects of additional measures taken to reduce the waiting list.
PubMed ID
17484795 View in PubMed
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8 records – page 1 of 1.