Australian clinical review最新文献

The seminar was held under the auspices of the National Demonstration Project, which is a combined effort of the Juran Institute and the Harvard Community Health Plan (HCHP). About 60 delegates attended the conference. Most were from the United States, the rest were from Canada, the Netherlands, the United Kingdom and Australia. The seminar was aimed at introducing those attending to the topic of clinical algorithms. The algorithms were presented as part of a total quality management process concerned with clinical decisions. Algorithms are designed as a pattern, or a map, of a clinical process. It is the aim of an algorithm to ensure stability in a clinical process and to enhance the quality of care given by the process. The seminar was a combination of general sessions and workshop sessions. The general sessions were managed by presenters who had considerable experience in the development of algorithms, and the same presenters then chaired the separate workshop sessions on a group basis. The workshop sessions concentrated on the simulation of algorithm development at the institutions of the attendees.

The aim of this study was to evaluate factors relevant to morbidity and mortality in 54 patients undergoing oesophagectomy at Royal Newcastle Hospital between 1985 and March 1989. There was a high incidence of concurrent medical problems. Significant anaesthetic complications occurred in 6 patients. There were 16 serious general medical complications and 10 surgical complications. Respiratory complications included basal collapse (19), sputum retention (6), pulmonary oedema (2), pleural effusion/haemothorax (5), and severe aspiration syndrome (5). Seven patients required mechanical ventilation for more than 3 days. Two deaths occurred postoperatively. As a result of this audit, changes have occurred in patient selection, management of chylothorax, epidural analgesia and timing of tracheal extubation.

Table 3 shows the summary of activity since the programme began in August 1990. Of the 8.4% of inpatients who were screened by the programme, 9% initiated some action. In the A&E Department, 1.1% of patients were screened and 10% of these resulted in action.

A clinical estimate of asthma severity using a clinical score and oxygen saturation measurements by pulse oximetry was carried out on a group of 41 children aged 3 years or older. The measurements were performed at the time of each child's admission to hospital with an acute asthma attack. The correlation coefficient (r) between the asthma score and the oxygen saturation was -0.76. For children older than 3 years, clinical scoring methods may have a place in the assessment of those with acute asthma, especially when they are receiving high flow oxygen treatment.

The aims of the survey were: to obtain data on children being seen in the department in order to determine whether the needs of parents and children are being met; to discover parents' attitudes to 'parent-based' treatment; and to establish whether physiotherapists' expectations of what parents can do at home are realistic. A parent satisfaction survey was developed and sent to outpatients who had attended the physiotherapy department in the previous 6 months. Results were collated and analysed in the areas of: referral source; appointments; treatment; and general opinion. The results are reported in detail and discussed. Results are generally positive and indicate that the physiotherapists are catering for the needs of parents and children, and have appropriate ideas of what can be achieved at home. Several areas of potential improvement are identified and discussed.

This paper is a slightly modified version of a paper presented at a quality assurance seminar at Royal North Shore Hospital, Sydney on 7 December 1990. The paper uses the seminar given by Professor Avedis Donabedian in Sydney 13-17 August 1990, to emphasize two issues. First, while there are claims from many hospitals that they are conducting quality assurance, such activity demands the use of explicit criteria in one form or another and, in the author's view, few if any hospitals are, in fact, using this technology. What, then, of their claims to be conducting quality assurance? The second point is that Australian efforts at quality assurance have been focused on projects, ignoring the need for a program or system in the hospital, and a program or system is essential if efforts at ensuring effective quality assurance are to succeed.