Best practices and benchmarking in healthcare : a practical journal for clinical and management application最新文献

During the 1994 flu season, the Missouri Patient Care Review Foundation (MPCRF) began working on a systems-oriented, hospital-focused influenza immunization project for the 1995-96 flu season with four acute care hospitals. The results of the project indicate that a combination of hospital policies, nurse-driven standing order protocols for immunization, and emphasis on beneficiary education resulted in the highest rate of influenza vaccination.

The following article is a descriptive summary of telemedicine evolution in rural Kansas. Multiple electronic applications are used to manage information, time, and distance. Conservation of limited health related resources is emphasized.

Rural hospitals are among those at greatest risk in the changing world of healthcare delivery. There are, however, those that are continuing to thrive despite the odds. The common thread among these are factors found in select Midwest rural hospitals.

The problem of unrelieved pain in the PostAnesthesia Care Unit (PACU) is an outcomes management concern. This article discusses the steps taken by the PACU staff to establish a benchmark for unrelieved pain and to evaluate the effect of the Multidisciplinary Pain Management Initiative (MPMI) action plan on the outcomes of length of stay and cost.

Background: We evaluated a new psychological test (Paindex) for identifying and quantifying psychological factors associated with poor surgical outcome, and predicting the degree of pain relief and return to work.

Method: This test was administered to 120 randomly selected patients before carpal tunnel and laminectomy surgeries.

Results: This test correctly predicted the probability of pain relief and return to work in 46 of the 50 laminectomy patients (92%), and 63 of the 70 carpal tunnel patients (90%). The overall test sensitivity was 86% and the specificity 94%.

Conclusion: These findings indicate that this can be a useful adjunctive test for identifying psychological problems that could have a bearing on the decision to operate and then problems that could occur after surgery, particularly in cases where the extent and degree of pain and disability are judged to be considerably in excess of the objective medical findings.

The purpose of this study was to examine if registered nurses' (RNs) reports of the structure, work processes and performance of Massachusetts hospitals have changed over a five year period. Responses of 928 randomly selected RNs surveyed in 1989 and 858 randomly selected RNs in 1994 to the RN Quality of Worklife Survey (RNQOWS) were compared. Data analysis was performed with a between-subjects multivariate analysis of covariance, controlling for number of years as an RN and as a member of a collective bargaining unit. Significant differences were found in the variables that measure human resources, administrative motivating conditions, task effectiveness, and efficiency (p < 0.001). The implications of the findings for nursing practice in hospitals is discussed and recommendations are made for further research.

Practitioners in the field of behavioral healthcare are under increasing pressure to demonstrate the effective and efficient delivery of services. While there are a variety of models that provide important elements of a framework for defining and measuring organizational performance, few appear to integrate the unique perspectives of all the organization's key constituent or customer groups.

Background: The success of a cultural diversity training program in an acute care health facility was due in large part to the use of the focus group method.

Method: This method enabled us to identify sensitive issues to be addressed in educational programs for staff. Some of the criteria for successful use of the focus group method applied to our situation.

Result: We found that much of the traditional wisdom did not necessarily apply in a diversity program.

Conclusion: Several additional benefits such as ethnic group empowerment and the enhancement of a more team-oriented approach made use of the focus group method a very worthwhile venture for this project.

Managed care challenges physicians to learn to collaborate with healthcare executives to achieve cost containment while enhancing quality of patient care. This report describes specific steps to successful working relationships between physicians and healthcare executives. "Learning the culture," recognizing differences, offering assistance, taking steps toward closer collaboration, and avoiding pitfalls are interpersonal skills and behaviors that allow physicians to become part of the decision process in a managed care environment.