Australian clinical review最新文献

A total of 187 home glucose meters have been issued to Illawarra residents by the Program of Aids for Disabled Patients (PADP) Scheme operating out of Port Kembla District Hospital in a 5-year period ending 31 December 1989. These meters, representing a valuable health resource, have been loaned to patients without audit or follow up. Sixteen per cent of meters were unable to be located and 33.2% could not be located using existing PADP records. Of those meters which could be tested, 16.4% were inaccurate; the recipient's technique was inadequate for accurate results in 36.1% of instances. This survey has revealed a significant loss of health resources in addition to inadequate clinical assessment and supervision.

Objectives: To develop appropriate standards to assess the intervention with cerebrovascular accident (CVA) patients by allied health professionals; to establish baseline data with which subsequent information collected could be compared.

Method: Retrospective criteria auditing of hospital files was undertaken to evaluate whether the allied health professionals were meeting the expected clinical standards for patients admitted with a diagnosis of CVA.

Results: Written documentation in hospital files did not meet expected standards in all criteria and varied between professions. The data obtained provided a baseline against which future results could be measured. It was expected that subsequent evaluations would provide improved results. All departments agreed that meeting clinical standards was important and it was agreed to repeat the audit in one year and to include some outcome standards using patients' perceptions of service provision.

Objective: A study of two large groups of patients was conducted in a large general hospital, comparing the admission characteristics of those referred to nursing homes and those returning home, to identify factors on admission that would facilitate more rapid discharge planning and placement.

Method: Discharge planning at the Royal Brisbane Hospital was analysed over 12 months, comparing the admission characteristics of 191 patients placed in nursing homes with 444 patients returning home.

Results: Referral of patients to social workers was delayed and poorly co-ordinated, leading to prolongation of the discharge process or placement for nursing home patients. The data indicate that the process can be expedited by attention to readily recognizable factors already present on admission.

Modern health care is changing--we have more chronic disease, increasing demands for documentation from government and legal bodies, and greater emphasis on disease screening and prevention. Quality assurance is important in developing health care services to meet these changing needs because it provides standards by which we can measure the activities involved in the delivery of health care, and quality assurance programmes are more likely to ensure that the predefined standards of health care are being met. This paper provides: (i) an acceptable definition of quality assurance (QA); (ii) an explanation of why we need it; (iii) evidence that the medical decision-making process is failing under the modern technological advances; and (iv) guidelines for meeting future health care standards by using the modern technological tools of computers and computer software to support the beleaguered clinical decision-making process.

Studies of chest physiotherapy in medical patients have consistently shown benefit only in patients who produce large amounts of sputum. Among surgical patients systematically repeated maximal inspiration is the only procedure that clearly reduces the incidence of post-operative pulmonary complications. Rationalization of the use of physiotherapy requires data on the pattern of its use. To obtain such data an audit was conducted on the use of physiotherapy in patients discharged from Royal Newcastle Hospital in October 1989. It was suspected that respiratory physicians would account for the bulk of chest physiotherapy. All patients admitted under respiratory physicians and random samples of patients admitted under other physicians and under surgical specialists were surveyed. Chest physiotherapy was ordered in 13/44 (30%) patients cared for by respiratory physicians, 5/45 (11%) other medical patients and 11/48 (23%) surgical patients (P = 0.049). Chest physiotherapy was ordered in 28 of 29 instances for conditions in which it is of no proven benefit. From the total numbers of medical and surgical patients it was estimated that 71% of chest physiotherapy referrals in October 1989 were for non-medical patients. About half of all referrals were initiated by junior medical staff. Much of the chest physiotherapy performed in the hospital was unlikely to have been of major clinical value and patients with respiratory illnesses were minor consumers of chest physiotherapy. Attempts to reduce wasteful overuse of chest physiotherapy may be most effective if directed at physiotherapists. If medical staff are targeted it would be essential to reach those attached to surgical units.