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Survival of patients transferred to tertiary intensive care from rural community hospitals
Stephen D Surgenor, Howard L Corwin, Terri Clerico
Critical Care , 2001, DOI: 10.1186/cc993
Abstract: In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital.The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.Some hospitalized medical and surgical patients develop the need for critical-care resources that are available only at tertiary hospitals. Differences in accessibility to tertiary intensive care exist among hospitals within a rural region. For example, some patients are admitted from rural community hospitals that do not provide the same access to critical-care resources as is available to patients in the wards of tertiary hospitals. Therefore, the location of care (rural community hospital versus tertiary care center) before admission to a tertiary intensive care unit (ICU) may affect outcome.Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population. Currently there is little direct evidence to support regionalization of adult medical and surgical critical-care services [1]. If accessibility proves to be a determinant of outcome, then development of a regional critical-care program might be beneficial. If
Unit Cost of Medical Services at Different Hospitals in India  [PDF]
Susmita Chatterjee, Carol Levin, Ramanan Laxminarayan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069728
Abstract: Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes.
Clinic-epidemiological analysis of an otorhinolaryngology emergency unit care in a tertiary hospital
Furtado, Paula Lobo;Nakanishi, Marcio;Rezende, Gustavo Lara;Granjeiro, Ronaldo Campos;Oliveira, Taciana Sarmento de;
Brazilian Journal of Otorhinolaryngology , 2011, DOI: 10.1590/S1808-86942011000400004
Abstract: emergencies are common in our otorhinolaringology specialty. however, the clinical and epidemiological features are not very well known. objectives: to evaluate the clinical and epidemiological profiles of otorhinolaryngological disorders in an emergency unit of a tertiary hospital, and to determine the appropriateness of the level of health care for a tertiary hospital. materials and methods: an analytical study using data records of an otorhinolaryngological emergency unit at a tertiary hospital in the federal district for a year, full time, and no screening. the age, sex, arrival time and clinical diagnosis were evaluated. the entities were separated into cases of pharingolaryngoesthomatology, otology, rhinology, and head and neck surgery. these were evaluated according to the urgency level, the required care, and the arrival time. results: 26,584 data records were selected, of which 2,001 were excluded. the group comprised 54. 48% women, and 45. 51% men. otological complaints (62. 27%) prevailed. 61. 26% of cases were considered emergencies. only 9. 7% of those required medium or high complex resources for resolution. conclusions: the study showed that 61. 26% of the otorhinolaryngological cases are emergencies, and only 9. 7% required medium or high complexity resources
Consumer assessment of perceived quality of antenatal care services in a tertiary health care institution in Osun State, Nigeria  [cached]
Esther Olufunmilayo Asekun-olarinmoye,James Olusegun Bamidele,Bolaji Emmanuel Egbewale,Ifeoluwapo Oyebola Asekun-Olarinmoye
Journal of the Turkish-German Gynecological Association , 2009,
Abstract: Objective: To describe consumer assessment of the perceived-quality of antenatal care services in a tertiary health care institution in Osun State.Material and Methods: In a descriptive cross-sectional study, information was obtained (utilizing a semi-structured questionnaire) from 289 pregnant women randomly selected from the Antenatal Clinic (ANC) of Obafemi Awolowo University Teaching Hospital. Chi-square statistic test was used to explore associations. Level of significance was p<0.05.Results: Mean age of respondents was 30.93 + 9.109 years, the modal age group was 26-30 years, 6.2% were single while 93.8% were ever-married, 3.5% had no formal education, while 39.1%, 53.3% had secondary and tertiary education respectively. Rate of adolescent pregnancy in this study was 4.2%. About a third each of respondents had parity of one and two respectively. Age, occupation, husband’s payment of booking fees, and previous ANC attendance were all significantly related to place of previous delivery (p<0.05). More than 90% of respondents assessed health personnel’s attitudes positively; however, an assessment of poor quality of care in terms of time spent in clinic (too long/too short) was given by 66.5% of respondents, whilst almost one quarter (22.5%) were not satisfied with the over-all perceived quality of care received. The most frequently mentioned reason for non-satisfaction with quality of care received was wasting of time in the clinic.Conclusion: Although the majority of respondents assessed the overall quality of care received as satisfactory, a major point of dissatisfaction in many respondents is the length of time spent in the ANC. To achieve the MDG of reduction in maternal mortality especially in Nigeria, the quality of ANC care needs to be improved, which will, in turn, lead to increased utilization of ANC services and an ultimate reduction in maternal mortality rate.
An Assessment of Patients Satisfaction with Services Obtained From a Tertiary Care Hospital in Rural Haryana  [PDF]
Syed Shuja Qadri,Rambha Pathak,Mukhmohit Singh,SK Ahluwalia
International Journal of Collaborative Research on Internal Medicine & Public Health , 2012,
Abstract: Introduction: Health care quality is a global issue. The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Hospitals are shifting from viewing patients as uneducated and with little health care choice, to recognizing that the educated consumer has many service demands and health care choices available. The closest most tool for measuring consumer experiences is the occasional patient satisfaction survey. Objective: To assess patient satisfaction with services provided in a tertiary care hospital situated in rural Haryana. Material & Methods: A cross –sectional study was conducted among patients (aged 18-80 years). A multistage sampling technique was used to select the respondents. A total of 450 patients attending various outdoor and indoor departments of the MM Institute of Medical Sciences and Research were taken for the study purpose. A self designed, pretested, semi structured questionnaire was developed to draw the patient’s satisfaction to the health care services. Results: Overall, 89.1% of the patients were satisfied with the services received from MMIMSR, while the remaining 10.9% were dissatisfied. Specifically, 90.9%, 78.6% and 74.6% of the patients were satisfied with patient provider relationship, medical care and information and support. However, 20.7% and 13.0% of the patients were dissatisfied with organization of care and cost of care respectively. Patients and their relatives complained about cost of drugs, delayed reports and long appointments for ultrasound and other radiological investigations. Conclusion: With the necessary inputs from the patients and the attendants by pointing various drawbacks or deficiencies should always be taken care of by the hospital administration that will turn into a good result of improvement in the hospital services to the satisfaction of the patients.
A Cross-Sectional Study of Patient’s Satisfaction Towards Services Received at Tertiary Care Hospital on OPD Basis  [PDF]
Patavegar Bilkish N,Shelke Sangita C,Adhav Prakash,Kamble Manjunath S
National Journal of Community Medicine , 2012,
Abstract: Objective: The main objective of the study is to measure the satisfaction of OPD patients in tertiary care hospital and to know the relationship between various determinants & OPD patient’s satisfaction. Materials and methods: The present cross sectional study was conducted among 450 patients attending the outpatient departments (OPDs) of Sassoon General Hospital Pune during 6 months period. Systemic random sampling was used for patient selection. Results: Maximum number of patients i.e. 197(43.78%) were in the age group of 49 and above. About 61% patients were females. About cleanliness of waiting area 44.5% patients were found unsatisfied. About explanation of treatment by pharmacist 77% patients were satisfied. 91% patient said that OPD timings were convenient. 176 (39.12%) patients had to wait less than 30 min before consulting doctor. Conclusion: According to the patient’s opinion, the study showed good satisfaction with respect to registration services, doctor services, nurse services, lab services and pharmacy staff services.]]>
Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series
Rehan Ali,Shakeel Ahmed,Maqbool Qadir,Prem Maheshwari
Oman Medical Journal , 2013,
Abstract: Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%), hyaline membrane disease (20%), meconium aspiration syndrome (20%) and congenital diaphragmatic hernia (10%). Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%). Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.
Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge
Denny P Laporta, Judy Burns, Chip J Doig
Critical Care , 2005, DOI: 10.1186/cc3543
Abstract: A group of Canadian interdisciplinary critical care leaders recently came together for a 2-day collaborative meeting [1]. While focusing on leadership and management themes, small groups were presented with difficult case scenarios. One such case that outlines the structured format of the cases has been previously published [2]. The present article considers high staff turnover in an intensive care unit (ICU).You have been recruited to be a leader in an existing 16-bed tertiary medical–surgical ICU in an urban center. The hospital's chief executive officer has pointed out to you that there appears to be a high multidisciplinary staff turnover in the unit in comparison with other areas of the hospital. The result of this turnover is that they have difficulty keeping up with recruitment efforts. Your job description specifically asks that you address this issue and implement possible solutions.The new ICU leader in this scenario has a difficult but not uncommon problem as staffing shortages are commonplace in our current health care system, and ICUs are among the first areas to experience them [3]. As high staff turnover jeopardizes the normal provision of ICU services, the remaining staff are under pressure to maintain critical care services, which may have a negative impact on their retention. Newly hired staff are often inexperienced and require time and attention before full integration into the team. Unfortunately, with limited staff, the resources for this needed nurturing are often lacking.The discussion in the present article is based on group discussion and primarily comes from the nursing literature, given the paucity of published references on this topic from other disciplines providing ICU care (e.g. medical doctor, respiratory therapy, pharmacy, social work, dietetics, physiotherapy, occupational and speech therapy) [4-8]. The authors would hope – without any published evidence – that the information provided could also apply to these disciplines in times
Application of the pediatric risk of mortality (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit
Costa, Graziela Araujo;Delgado, Arthur F.;Ferraro, Alexandre;Okay, Thelma Suely;
Clinics , 2010, DOI: 10.1590/S1807-59322010001100005
Abstract: introduction: to establish disease severity at admission can be performed by way of the mortality prognostic. nowadays the prognostic scores make part of quality control and research. the pediatric risk of mortality is one of the scores used in the pediatric intensive care units. objectives: the purpose of this study is the utilization of the pediatric risk of mortality to determine mortality risk factors in a tertiary pediatric intensive care units. methods: retrospective cohort study, in a period of one year, at a general tertiary pediatric intensive care unit. the pediatric risk of mortality scores corresponding to the first 24 hours of hospitalization were recorded; additional data were collected to characterize the study population. results: 359 patients were included; the variables that were found to be risk factors for death were multiple organ dysfunction syndrome, mechanical ventilation, use of vasoactive drugs, hospital-acquired infection, parenteral nutrition and duration of hospitalization (p < 0,0001). fifty-four patients (15%) died; median pediatric risk of mortality score was significantly lower in patients who survived (p=0,0001). the roc curve yielded a value of 0.76 (ci 95% 0,69-0,83) and the calibration was shown to be adequate. discussion: it is imperative for pediatric intensive care units to implement strict quality controls to identify groups at risk of death and to ensure the adequacy of treatment. although some authors have shown that the prism score overestimates mortality and that it is not appropriate in specific pediatric populations, in this study pediatric risk of mortality showed satisfactory discriminatory performance in differentiating between survivors and non-survivors. conclusions: the pediatric risk of mortality score showed adequate discriminatory capacity and thus constitutes a useful tool for the assessment of prognosis for pediatric patients admitted to a tertiary pediatric intensive care units.
Unit cost of CT scan and MRI at a large tertiary care teaching hospital in North India  [PDF]
Khurshid Rehana, Syed Amin Tabish, Tariq Gojwari, Reyaz Ahmad, Hakim Abdul
Health (Health) , 2013, DOI: 10.4236/health.2013.512279
Abstract:

Imaging department is an important department of a hospital contributing directly to patient care, providing diagnostic support to all specialties which cannot practice efficiently without their support. Hospital administrators are looking for newer tools to control costs without affecting the quality of patient care. It is well known that the escalation of costs for advanced technology has been dramatic and it has been labeled as one of the culprits for great increase in healthcare costs. A prospective study for a period of six months was carried out for calculation of unit cost of radiological investigations CT head, CT chest, CT abdomen and MRI. Unit costs were computed under direct and indirect costs. The actual cost incurred by the hospital on CT head was Rupees 581.40 (US $10.89), CT abdomen Rupees 2339.20 (US $43.83), CT chest Rupees 2339.20 (US $43.83), and MRI Rupees 4497.50 (US $84.28). However, in the hospital patients are charged Rupees 900 (US $16.86) for CT head, Rupees 1200 (US $22.48) for CT abdomen, Rupees 1200 (US $22.48) for CT chest and Rupees 2500 (US $46.85) for MRI. There is a substantial loss of revenue because of subsidies provided to patients in a tertiary care teaching hospital which needs revision of charges.

 

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