Australian clinical review最新文献

In 1987 the decision was taken by the Nursing Executive at Princess Margaret Hospital for Children to substitute the centralized approach to quality assurance (QA) with a unit-based system. The strategies used to ensure the successful implementation of the new system are discussed--together with the pitfalls encountered during the transition phase.

In spite of concerns on the part of doctors and hospitals regarding the level of malpractice litigation, they have failed to appreciate the value of effective quality management programmes in minimizing this risk. This paper describes some of the main components of these complex programmes, highlighting the importance of credentialling of medical staff and the need for an organizational framework if such programmes are to succeed.

The objective of this study was to evaluate the effect of an educational intervention on the knowledge and behaviour of hospital staff pertaining to death certification. A questionnaire was administered, and certification error assessed both before and after written educational material was provided. Although the response rate to the questionnaire was disappointing (19.1%), the findings revealed a poor baseline understanding of the subject that improved after reading the educational material. Certification error fell from a baseline of 22.4 to 15.1% 2 months later, although the magnitude of the fall was not statistically significant. It was concluded that a simple questionnaire used in conjunction with educational material can focus attention on potential knowledge gaps relating to death certification. However, the educational effort needs to be sustained and linked to outcome assessment of certification performance in the institution.

Minimally invasive therapy (MIT) is a new approach to conditions that previously would have been treated by open surgery. It is made possible by developments in endoscopes, medical imaging and vascular catheters. Minimally invasive therapy has many implications for the health system, as it makes it possible to perform many procedures on an outpatient basis or with a short hospital stay. In addition, surgical training is not always necessary to carry out MIT procedures, which means that other specialties such as internal medicine and radiology have become involved in the field. Minimally invasive therapy has already led to conflicts between different specialties in some countries. It also is giving further stimulus to the reduction in numbers of hospital beds. On the other hand, full implementation of MIT requires attention to the system of out-of-hospital care, which generally is not prepared to monitor patients after discharge or to deal with complications that may arise. Quality of care in the out-of-hospital setting also needs attention.

Data from the medical records of 100 children who had a chest X-ray versus 100 children who did not during an attack of acute asthma were compared. No evidence could be found to suggest that the two groups varied in terms of age, sex, severity of the presenting illness, or in the clinical measures of pulse rate, respiratory rate, wheeze and accessory muscle use. It appeared that the X-ray request was an action not based on sound clinical judgement. Cost savings and a reduction in radiation exposure can be made by eliminating unnecessary chest X-ray requests.

The use of antibiotics on a medical ward was monitored for 4 weeks. Medication charts were perused to identify all antibiotics prescribed and the notes were searched for microbiological evidence of pathogenic organisms. Presentation of the results at a clinical meeting led to the establishment of a hospital-wide antibiotic policy, where none had previously existed. The survey was repeated 1 year after the policy was instituted.

The National Confidential Enquiry into Peri-operative Deaths (NCEPOD) is now established in the United Kingdom (excluding Scotland) as a voluntary, confidential system designed to review the clinical practice which precedes a death within 30 days of surgery. The Enquiry is comprehensive, widely representative and authoritative. To date, two reports have been published and there is an ongoing programme planned. The influence of these reports on the practice of anaesthesia and surgery in Britain is undeniable.

Total quality management (TQM) was introduced into a clinical chemistry laboratory department. During the first 9 months, 35 quality improvement projects were introduced, involving 87% of the Department's staff. As a result of these projects and with a capped budget, a range of new clinical services was introduced, significant improvements in the speed of Departmental services was documented, productivity improvements were achieved, and a 10-fold reduction in staff resignations occurred. The major hindrance encountered was the lack of interest from other non-quality orientated departments elsewhere in the hospital.