Australian clinical review最新文献

The Royal Victorian Eye and Ear Hospital has developed a culture around the Accreditation process and quality assurance. All staff members are regularly challenged to ask themselves the question, 'What are we doing now that we could do better?' During the financial year 1990-91, over 350 quality assurance programmes were undertaken addressing more than 150 individual issues. Many aspects of a clinical nature were addressed and these will be dealt with briefly. The main focus of this paper is to indicate the windows of opportunity available to hospitals in tight economic times. Programmes were undertaken in every department throughout the hospital and, in the financial year under review, savings of $351,589 were not only identified but accomplished. These savings are ongoing during the next 5 years and will amount to approximately $1.75 million. The Auxiliaries of The Royal Victorian Eye and Ear Hospital have assisted the hospital and over the last 10 years have raised $2.5 million without any direct public appeals.

An analysis was made of 82 public hospitals surveyed by the ACHS in 1990 that had received recommendations for improvement within their Accident and Emergency service. The major areas requiring attention included quality assurance, scope of service, policy and procedure manuals, signposting and the appointment of a medical practitioner responsible for the service. The analysis also revealed that 90% of the recommendations for improvement made by ACHS surveyors at a previous survey had been fully or partially implemented upon resurvey in 1990.

In this paper the authors look at the proactive role performance indicators can and should play in managing for quality in health care facilities. In particular, they highlight the use of clinical indicators as a means of providing evidence of value-for-money and best quality delivery of care. The argument is presented that management can no longer ignore indicators as a quality assurance tool and an important component of managing for quality over time. The authors demonstrate where indicators fit into the traditional quality assurance cycle and describe strategies for analysing problems and setting priorities. They also argue that managers need to invest in management information systems in order to provide the data needed for performance monitoring. Accurate and complete indicator data are needed if the goals of quality management and optimal quality of care are to be achieved.

The quality of nursing care delivered to two groups of patients suffering from diabetes mellitus was examined. Using Phaneuf's Nursing Audit, a retrospective audit of the nursing documentation regarding the care of all patients was carried out, and a comparison made of the numeric scores obtained. The nursing care of the group of patients from the Professional Nursing Unit (PNU) obtained mean scores which were 26.4% higher than those obtained by the group from the general hospital wards. There are major variations in scores in specific areas. These give rise to some questions regarding the value to nurses of the caring and nurturing component of nursing work, and how this is affected by differing philosophies and environments.

The objective of this study was to assess the quality of the medical contribution to patient records in a children's department. It was carried out in a tertiary level teaching hospital. A structured audit of 100 randomly selected case records, with independent observers using a grading system for 3 of the measures, was performed. The outcome provides a comparison with the hospital's guidelines for case histories and notes. The results of this study show inadequate documentation of basic information. Communication was hindered by poor hand writing and the use of abbreviations. Overall comprehension of the course of the patients' illnesses was regarded as only fair to average. Recording of diagnosis and initial plans of management were present in over 70% of records. While discharge information was well recorded, the recommendation for the duration of drug therapy was inadequate. Mediocre handwriting and poor documentation are still prevalent in medical records. Strict supervision of this important area of medical practice is mandatory.

This paper examines the current situation regarding the implementation of quality assurance (QA) programmes in relation to the Tamworth Base Hospital and Health Service. The importance of organizational design and the establishment of a Quality Resource Department are examined as means of achieving effective QA.

Eight hundred and ninety-eight patients of the Royal Women's Hospital, Brisbane were surveyed by phone and questionnaire to identify their hospital related child-care needs. In addition, staff in acute admitting areas of the hospital were asked to provide details of child-care problems. Twenty-five (5.2%) of the sample reported hospital related child-care problems, 166 (39.7%) respondents stated that they would use a hospital child-care service on a casual basis and 45 (10.8%) that they would use one for the duration of their stay.

This article reports on an analysis of 109 hospitals that received recommendations for improvement within their Medical Record Service when surveyed by the Australian Council on Health Care Standards (ACHS) in 1990. Seventy-five per cent of Medical Record Service recommendations made at an earlier survey had been fully implemented and 17% partially implemented by hospitals at the time of their next survey in 1990. The major area receiving recommendations for improvement was medical record content. Other areas of concern were quality assurance, organization and administration, and space for research and work within the service. Certain aspects of medical record content also appeared to be resistant to change from one survey to the next.

The rapid increase in the number of day only admissions during the last decade has led to an increased awareness of this type of hospital admission. Health planners are now interested in which procedures are causing the increase in the day only activity and how best to accommodate it in the future. To address these issues, routinely collected hospital data were used to analyse trends in day only admissions and to extrapolate future demand via regression models. The results suggest that day only admissions will constitute 45% of all admissions to NSW acute hospitals by the year 2001. Detailed review of patient caseloads suggest that 13.5% of all patients will be potentially treatable through day surgery units, as opposed to general wards, by 2001. Assuming 80% of these potential patients actually do get treated in day surgery units, then the workload generated could be accommodated within 30 day surgery facilities.

Prescription of non-steroidal anti-inflammatory drugs was recorded for 6 weeks in general practitioner hospital inpatients as a quality assurance activity. Concomitant use of H2 receptor antagonists and diuretics was also recorded. The survey was repeated 1 year later when it was found that the use of non-steroidal anti-inflammatory drugs had fallen from 30% of all patients to 24% in the follow-up study.