Skip header and navigation

Refine By

346 records – page 1 of 35.

5-year morbidity among very preterm infants in relation to level of hospital care.

https://arctichealth.org/en/permalink/ahliterature119186
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Publication Type
Article
Date
Jan-2013
Author
Liisi Rautava
Janne Eskelinen
Unto Häkkinen
Liisa Lehtonen
Author Affiliation
Department of Pediatrics, Turku University Hospital, 20520 Turku, Finland. liisi.rautava@utu.fi
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Child, Preschool
Cohort Studies
Female
Finland - epidemiology
Humans
Incidence
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - epidemiology - etiology - therapy
Intensive Care, Neonatal
Logistic Models
Male
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient transfer
Registries
Secondary Care
Tertiary Care Centers
Tertiary Healthcare
Abstract
To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.
A cohort study.
Finland.
All surviving 5-year-old children born very preterm (gestational age
PubMed ID
23128961 View in PubMed
Less detail

30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

https://arctichealth.org/en/permalink/ahliterature273361
Source
PLoS One. 2015;10(9):e0136547
Publication Type
Article
Date
2015
Author
Sahar Hassani
Anja Schou Lindman
Doris Tove Kristoffersen
Oliver Tomic
Jon Helgeland
Source
PLoS One. 2015;10(9):e0136547
Date
2015
Language
English
Publication Type
Article
Keywords
Comorbidity
Diagnosis-Related Groups
Episode of Care
Hospital Mortality
Hospital records
Hospitals - standards - statistics & numerical data
Humans
Length of Stay
Norway - epidemiology
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Patient transfer
Probability
Quality Improvement
Quality Indicators, Health Care
Survival Analysis
Abstract
The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.
Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013.
Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.
Notes
Cites: PLoS Med. 2010;7(11):e100100421151347
Cites: Med Care. 2010 Dec;48(12):1117-2120978451
Cites: BMC Health Serv Res. 2012;12:36423088745
Cites: Qual Saf Health Care. 2003 Apr;12(2):100-612679505
Cites: Int J Qual Health Care. 2001 Dec;13(6):475-8011769750
Cites: BMJ Open. 2015;5(3):e00674125808167
Cites: BMJ. 2003 Apr 12;326(7393):816-912689983
Cites: Int J Qual Health Care. 2003 Dec;15(6):523-3014660535
Cites: Stat Med. 1994 May 15;13(9):889-9038047743
Cites: Health Care Financ Rev. 1995 Summer;16(4):107-2710151883
Cites: Heart. 1996 Jul;76(1):70-58774332
Cites: Stat Med. 1997 Dec 15;16(23):2645-649421867
Cites: Med Care. 2005 Nov;43(11):1130-916224307
Cites: Circulation. 2006 Jan 24;113(3):456-6216365198
Cites: Am J Epidemiol. 2011 Mar 15;173(6):676-8221330339
PubMed ID
26352600 View in PubMed
Less detail

The accident process preceding overexertion back injuries in nursing personnel. PROSA study group.

https://arctichealth.org/en/permalink/ahliterature203517
Source
Scand J Work Environ Health. 1998 Oct;24(5):367-75
Publication Type
Article
Date
Oct-1998
Author
I L Engkvist
M. Hagberg
E W Hjelm
E. Menckel
L. Ekenvall
Author Affiliation
National Institute for Working Life, Solna, Sweden. ingalill@niwl.se
Source
Scand J Work Environ Health. 1998 Oct;24(5):367-75
Date
Oct-1998
Language
English
Publication Type
Article
Keywords
Accidents, Occupational - statistics & numerical data
Adult
Back Injuries - etiology
Cluster analysis
Female
Humans
Lifting - adverse effects
Male
Middle Aged
Nursing
Patient transfer
Prospective Studies
Risk factors
Sweden
Abstract
This prospective dynamic-population-based study investigated factors involved in the accident process preceding overexertion back injuries among nursing personnel.
The study covered all reported occupational overexertion back injuries due to accidents among of the approximately 24 500 nurses in the Stockholm County hospitals during 1 year. It was assumed that several factors interact in the accident process. Detailed information was obtained for each injury by interviews with the injured nurse and head nurse. Risks in the physical environment were identified using an ergonomic checklist.
During the study 136 overexertion back injuries were reported. Of the 130 nurses participating in the study, 125 had been injured in connection with patient work. Cluster analysis yielded 6 clusters and their pattern of contributing factors. The most frequent injury occurred during patient transfer in the bed or to or from the bed, without the use of transfer devices, when the patient suddenly lost his or her balance or resisted during the transfer and the nurse had to make a sudden movement. However, there were physical conditions, such as shortcomings in the physical work environment or a lack of a transfer device, that compelled the nurses to perform the tasks under unsafe conditions.
The clusters showed a complexity of different kinds of accidents and indicated that the measures for preventing accidents, or for blocking an accident process once started, have to be of different kinds and placed at several different levels in the organization of a workplace.
PubMed ID
9869308 View in PubMed
Less detail

Achieving the 'perfect handoff' in patient transfers: building teamwork and trust.

https://arctichealth.org/en/permalink/ahliterature122387
Source
J Nurs Manag. 2012 Jul;20(5):592-8
Publication Type
Article
Date
Jul-2012
Author
Diana Clarke
Kim Werestiuk
Andrea Schoffner
Judy Gerard
Katie Swan
Bobbi Jackson
Betty Steeves
Shelley Probizanski
Author Affiliation
University of Manitoba, Winnipeg, MB, Canada. diana_clarke@umanitoba.ca
Source
J Nurs Manag. 2012 Jul;20(5):592-8
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Checklist
Communication
Humans
Interview, Psychological
Manitoba
Models, organizational
Models, Psychological
Nurse's Role
Nursing Evaluation Research
Patient care team
Patient transfer
Program Development
Trust
Abstract
To use the philosophy and methodology of Appreciative Inquiry (AI) in the investigation of unit to unit transfers to determine aspects which are working well and should be incorporated into standard practice.
Handoffs can result in threats to patient safety and an atmosphere of distrust and blaming among staff can be engendered. As the majority of handoffs go well, an alternative is to build on successful handoffs.
The AI methodology was used to discover what was currently working well in unit to unit transfers. The data from semi-structured interviews that were conducted with staff, patients, and family informed structural process improvements.
Themes extracted from the interviews focused on the situational variables necessary for the perfect transfer, the mode and content of transfer-related communication, and important factors in communication with the patient and family.
This project was successful in demonstrating the usefulness of AI as both a quality improvement methodology and a strategy to build trust among key stakeholders.
Giving staff members the opportunity to contribute positively to process improvements and share their ideas for innovation has the potential to highlight expertise and everyday accomplishments enhancing morale and reducing conflict.
PubMed ID
22823214 View in PubMed
Less detail

Admissions and transfers from a rural emergency department.

https://arctichealth.org/en/permalink/ahliterature205679
Source
Can Fam Physician. 1998 Apr;44:789-95
Publication Type
Article
Date
Apr-1998
Author
T L De Freitas
G R Spooner
O. Szafran
Author Affiliation
Department of Family Medicine, University of Alberta.
Source
Can Fam Physician. 1998 Apr;44:789-95
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alberta
Child
Child, Preschool
Diagnosis-Related Groups
Emergency Service, Hospital
Female
Health Services Research
Humans
Infant
Infant, Newborn
Length of Stay
Male
Middle Aged
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Patient Transfer - statistics & numerical data
Retrospective Studies
Rural Health Services
Abstract
To examine the characteristics of patients transferred from a rural hospital emergency department, to compare them with patients admitted on an emergency basis, and to use this information to help plan physician education.
Descriptive study using records for the period January 1, 1991, to June 30, 1992.
The emergency department at Bonnyville Health Centre, an acute care rural hospital located 240 km northeast of Edmonton, serving a catchment population of approximately 10,000.
One thousand fifty-five patients seen in the emergency department who were either transferred to another centre or admitted to the Bonnyville Health Centre on an emergency basis.
For the transferred group, main diagnosis, category of transfer, and reason for transfer. For the admitted group, main diagnosis, length of stay, type of discharge.
Of the 1055 patients ill enough to be either admitted or transferred, 114 (10.8%) were transferred. Those transferred were predominantly men, the elderly, and people with orthopedic injuries or neurologic diseases. Those admitted presented primarily with internal, respiratory, gynecologic, or pediatric disorders. Reason for transfer was mainly lack of specialized services or equipment at the rural hospital.
Patients transferred out of the emergency department differed from those admitted in diagnoses and sex. Most transfers were considered "mandatory." Results of this analysis supported incorporating a formal rotation in orthopedics and adding 4 weeks to the existing emergency medicine rotation in our family medicine residency program.
Notes
Cites: Fam Med. 1991 Jul;23(5):351-31884928
Cites: Fam Pract Res J. 1990 Fall;10(1):19-262382578
PubMed ID
9585852 View in PubMed
Less detail

Adverse outcomes associated with delayed intensive care consultation in medical and surgical inpatients.

https://arctichealth.org/en/permalink/ahliterature123440
Source
J Crit Care. 2012 Dec;27(6):688-93
Publication Type
Article
Date
Dec-2012
Author
Louay Mardini
Jed Lipes
Dev Jayaraman
Author Affiliation
Montreal General Hospital, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada.
Source
J Crit Care. 2012 Dec;27(6):688-93
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Female
Humans
Intensive Care Units - statistics & numerical data
Length of Stay
Male
Middle Aged
Mortality
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Socioeconomic Factors
Tertiary Care Centers - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
The impact of delay in obtaining an intensive care unit (ICU) consult from inpatient wards is unclear. The goal of this study was to examine the effect of time to ICU consult from medical and surgical wards on mortality and length of stay (LOS).
This was a retrospective study of 241 adult medical and surgical inpatients admitted at 2 tertiary care ICUs in Canada between 2007 and 2009. Neither institution has medical emergency teams (METs). Patient demographics, time when the patient would have fulfilled MET calling criteria (MET time), time of ICU consult, and ICU admission were analyzed. The main outcome variables were 30-day mortality and ICU LOS.
Multivariate analysis demonstrated an increase in mortality (odds ratio, 1.8; 95% confidence interval, 1.1-2.9; P = .01) with increased duration from MET time to ICU consult for medical patients. There was no effect of this period on ICU LOS in medical patients. In contrast, in surgical patients, the MET time to ICU consult duration was associated with an increased ICU LOS (coefficient, 2.1 for delay; 95% confidence interval, 0.26-3.8; P = .02) but had no effect on mortality.
Increased duration to ICU consult from MET time is associated with adverse outcomes. These adverse outcomes are different between medical and surgical patients.
PubMed ID
22699035 View in PubMed
Less detail

An acute care unit in a multilevel geriatric facility: the first two years of the new Baycrest Hospital.

https://arctichealth.org/en/permalink/ahliterature229010
Source
J Am Geriatr Soc. 1990 Jun;38(6):728-9
Publication Type
Article
Date
Jun-1990

Analysis of prehospital transport of head-injured patients after consolidation of neurosurgery resources.

https://arctichealth.org/en/permalink/ahliterature189076
Source
J Trauma. 2002 Aug;53(2):345-50; discussion 350
Publication Type
Article
Date
Aug-2002
Author
Carol D Holmen
Terry Sosnowski
Karen L Latoszek
Darryl Dow
Brian H Rowe
Author Affiliation
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. cholmen@ualberta.ca
Source
J Trauma. 2002 Aug;53(2):345-50; discussion 350
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alberta - epidemiology
Brain Injuries - diagnosis - mortality - therapy
Emergency Medical Services - organization & administration
Female
Hospital Restructuring
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Transfer - statistics & numerical data
Retrospective Studies
Triage - methods
Abstract
Consolidation of neurosurgical (NS) services resulted in emergency medical services guidelines mandating transport of head-injured patients to the NS center if the Glasgow Coma Scale score is 3. This study determined what paramedic, system, or patient factors were associated with secondary head-injury transfer.
This study was a retrospective chart review from January 1996 to November 1998.
Ninety-one patient charts were reviewed. The median transport delay to the NS site was 4 hours 22 minutes. After transfer, 79 (96%) patients were admitted, 25 (30%) underwent craniotomy, and 18 (22%) died. The final diagnosis in 35 (43%) cases was subdural hematoma. Triage guidelines were violated in five patients (6%) and the NS center was on diversion in three (4%) cases. Most delays were related to patient presentations; 17 (21%) patients had no history of head trauma.
Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.
PubMed ID
12169945 View in PubMed
Less detail

An investigation of satellite hemodialysis fallbacks in the province of Ontario.

https://arctichealth.org/en/permalink/ahliterature152264
Source
Clin J Am Soc Nephrol. 2009 Mar;4(3):603-8
Publication Type
Article
Date
Mar-2009
Author
Robert M Lindsay
Janet Hux
David Holland
Steven Nadler
Robert Richardson
Charmaine Lok
Louise Moist
David Churchill
Author Affiliation
The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada. Robert.lindsay@lhsc.on.ca
Source
Clin J Am Soc Nephrol. 2009 Mar;4(3):603-8
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Community Health Centers - organization & administration
Delivery of Health Care - organization & administration
Female
Hospitalization
Hospitals, Satellite - organization & administration
Humans
Kidney Transplantation
Length of Stay
Male
Middle Aged
National health programs - organization & administration
Nephrology - organization & administration
Ontario - epidemiology
Outcome and Process Assessment (Health Care)
Patient Transfer - organization & administration
Personnel Staffing and Scheduling - organization & administration
Regional Health Planning - organization & administration
Renal Dialysis - adverse effects - mortality
Risk assessment
Risk factors
Treatment Outcome
Young Adult
Abstract
In Ontario, Canada, hemodialysis services are organized in a "hub and spoke" model comprised of regional centers (hubs), satellites, and independent health facilities (IHFs; spokes). Rarely is a nephrologist on site when dialysis treatments take place at satellite units or IHFs. Situations occur that require transfer of the patient back ("fallbacks") to the regional center that necessitate either in- or outpatient care. Growth in the satellite dialysis population has led to an increased burden on the regional centers. This study was carried out to determine the incidence, nature, and outcome of such fallbacks to aid resource planning.
Data were collected on 565 patients from five regional centers over 1 yr. These regional centers controlled 19 satellite dialysis centers including 7 IHFs.
There were 681 fallbacks in 328 patients: 1.21 incidents per patient or 2.1 incidents per patient year. Multiple fallbacks occurred in 170 patients. Fallback episodes lasted a mean of 10.3 d, requiring 4.6 dialysis treatments. Forty-five percent of fallbacks required hospitalization with a mean stay of 16.7 d. Access-related problems (33%) and nondialysis medical causes (32%) were the major causes of fallback. Resolution of the problem occurred in 87.8%, with the patient returning to the satellite. By the end of the study 77.3% were still satellite patients, 10.8% died, 3.8% returned to the regional center, 3.4% were transplanted, and 4.7% were transferred to other treatment modalities.
Fallbacks are common, yet the model operates well.
Notes
Comment In: Clin J Am Soc Nephrol. 2009 Mar;4(3):523-419261831
PubMed ID
19261829 View in PubMed
Less detail

346 records – page 1 of 35.