Australian clinical review最新文献

Data on pathology testing in New South Wales public hospitals are extremely limited. Pathology laboratory billing files and hospital admissions and transfer files were used to obtain data on the pathology testing frequency and cost of testing at three New South Wales public hospitals. Data were also extracted that allowed a comparison of test ordering frequency and cost of testing for various groups of admitting specialists. A high degree of similarity was found in the test ordering patterns at each hospital with 16 common tests or test groups in the top 20 tests or test groups at each hospital. These 16 tests or test groups accounted for 78, 82 and 88% of the total pathology expenditure at each hospital. The total cost of pathology per occupied bed day was found to be A$26.23, A$34.63 and A$44.66 at each hospital and represented 5.5, 5.2 and 6.8% of the total cost per occupied bed day, respectively, at each hospital. Variation was found between hospitals in the cost per occupied bed day for surgery, medicine, obstetrics and gynaecology and paediatrics. Three major reasons for the variations in pathology costs were identified as variations in outpatient loads, variations in test ordering patterns among medical practitioners and casemix.

The objective of this study was to audit the management of acute laryngo-tracheo-bronchitis in a paediatric unit. This was achieved by retrospective case note audit and a review of the investigations and management of all admitted patients in light of the current literature. There was inappropriate use of radiography and outmoded therapies. There has been an increasing use of adrenaline and steroids in the past 4 years. Prescribing of adrenaline was lax and was associated with potential danger to the patient. For a common condition such as croup, an agreed protocol taking into account current published recommendations is warranted and has been introduced into this unit following this audit.

Analyses of acute hospital services in Australia reveal geographic differences in the rates of utilization. In order to meet the important challenge of improving the quality of services it is necessary to understand the nature and causes of the variation in these utilization measures. This paper provides examples of the variation in admission rates and lengths of stay for selected procedures in Australian States and shows that the length of stay is related to the variation in admission rates. It concludes that a greater understanding of both the admission and discharge processes is necessary to improve quality and produce cost savings.

Minimally invasive therapies (MIT), developed as alternatives to open surgery, offer the promise of reduction in morbidity and mortality, quicker return of patients to their normal activities and lower overall costs to society. However, minimally invasive therapies cause concern in that their comparative advantage over older methods may not always be well defined, their introduction may result in additional costs and reorganization for the institutions where they are used, and achieving adequate training of all who use them may not be easy. In this paper, the Australian experience in the introduction and assessment of some MIT is considered to illustrate a number of the issues facing those who use and fund such methods. Examples include both high capital cost technologies, such as shock wave lithotripsy and stereotactic radiosurgery, and less expensive techniques such as laparoscopic surgery.

Recent reshaping of health provision throughout New Zealand has brought many changes to virtually every area of the service. In some instances this has required a totally fresh approach with a different way of thinking. In others, it has meant the adaptation and remodelling of existing structures and approaches. This paper gives a brief overview of the West Auckland Health District Quality of Service Programme and, in particular, its introduction to the orderly service at Waitakere Hospital.

The relationship between quality assurance and marketing has been explored in workshops for physiotherapists. Quality assurance and marketing represent two sides of the same coin in health care. Quality assurance offers formal strategies with which to review performance, while marketing tools enable health professionals to assess the needs of the community within which they operate. Inherent in the concept of the interrelationship of marketing and quality assurance is that quality health care must reflect the changing demands of the consumers. Quality assurance and marketing techniques, performed interdependently, enable health professionals to provide quality, appropriate health care.

The objective of this study was to evaluate the effect of an educational intervention on the prescribing behaviour of doctors who order antimicrobial therapy for patients undergoing abdominal surgery. Two confidential criterion audits were separated by the intervention which involved completion of a 10-item questionnaire followed by a fully referenced answer sheet. The results showed a significant improvement in the prescribing habits of the junior surgical staff after the educational intervention. The overall error rate decreased from 50% to 20% (P = 0.003).

The quality assurance (QA) initiative has been slow to show results. Quality assurance tools have been underdeveloped, and quality by inspection unacceptable to clinicians. A base hospital's experience with continuous quality improvement (CQI) as a means to more effective quality assurance is described. Discharge data grouped into diagnosis related groups (DRG) and analysed for inter-hospital comparison provided reliable statistical data with which to monitor the hospital's performance. The CQI tools were used to analyse the nature of the problem, and correct the deficiency. The new methodology would seem to indicate greater promise for successful quality assurance programmes in the future.