Medicine and Health Sciences Commons^™

Organizational Culture Change In A Texas Hospital, Alberto Coustasse-Hencke M.D., M.B.A., M.P.H.

Alberto Coustasse, DrPH, MD, MBA, MPH

Coustasse-Hencke, Alberto, MD, MBA, MPH, Organizational Culture Change in a Texas Hospital. Doctor of Public Health (Health Behavior), June 2004, 329 pp., 11 tables, 8 illustrations, bibliography, 198 titles. The purpose of this research was to analyze a Balanced Scorecard (BSC) approach in a Texas hospital with a main focus in Patient Satisfaction (PS), and to measure organizational change and its impact on PS. This dissertation also applied a "Shared Vision" of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The development of …

Retrospective Cohort Study Of The Efficacy Of Azithromycin Vs. Doxycycline As Part Of Combination Therapy In Non-Intensive Care Unit Veterans Hospitalized With Community-Acquired Pneumonia, Justin Spivey, Heather Sirek, Robert Wood, Kalpit Devani, Billy Brooks, Jonathan Moorman

Billy Brooks

The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.

Medical Mental Health Screening, Michelle Flaum Hall, Scott E. Hall

Scott E. Hall, Ph.D., LPCC-S

Fall Prevention In Hospitals: An Integrative Review, Sandra L. Spoelstra, Barbara A. Given, Charles W. Given

Sandra L. Spoelstra, PhD, RN, FGSA, FAAN

Purpose: This article summarize research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Method: Data were obtained from published studies. Thirteen articles were retrieved that focused on fall interventions in the hospital setting. An analysis was performed based on levels of evidence using an integrative review process. Results: Multifactoral fall prevention intervention programs that included fall risk assessments, door/bed/patient fall risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and …

Tweeting And Treating: How Hospitals Use Twitter To Improve Care, Christian Gomes, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Hospitals that have adopted Twitter primarily use it to share organizational news, provide general healthcare information, advertise upcoming community events, and foster networking. The purpose of this study was to explore the benefits that Twitter utilization has had in improving quality of care, access to care, patient satisfaction, and community footprint while assessing the barriers to its implementation. Methodology: The methodology used in this study was a qualitative study with a semi structure interview combined with a literature review which followed the basic principles of a systematic review. Results: The utilization of Twitter by hospitals suggest that it leads …

Implementation Of A Rapid Assessment Unit (Intake Team): Impact On Ed Length Of Stay., Richard Mackenzie, David Burmeister, Jennifer Brown, Melissa Teitsworth, Christopher J Kita, Megan Dambach, Shaheen Shamji, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

The Value Of The Hospital-Based Nurse Practitioner Role: Development Of A Team Perspective Framework, Christina Hurlock-Chorostecki, Cheryl Forchuk, Carole Orchard, Scott Reeves, Mary Van Soeren

Carole A Orchard, BSN, MEd, EdD (UBC)

No abstract provided.

Evaluation And Management Of Mild Traumatic Brain Injury: An Eastern Association For The Surgery Of Trauma Practice Management Guideline., Ronald J. Bross Md, Randeep Jawa, Jennifer M Watters, Jennifer C. Knight, Andrew J Kerwin, Eleanor S Winston, Robert D. Barraco Md, Brian Tucker, James M Bardes, Susan E Rowell

Robert D Barraco MD, MPH

BACKGROUND: An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time. METHODS: The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined. RESULTS: A total …

Evaluation And Management Of Mild Traumatic Brain Injury: An Eastern Association For The Surgery Of Trauma Practice Management Guideline, Ronald Barbosa, Randeep Jawa, Jennifer Watters, Jennifer Knight, Andrew Kerwin, Eleanor Winston, Robert Barraco, Brian Tucker, James Bardes, Susan Rowell

Robert D Barraco MD, MPH

BACKGROUND: An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time.

METHODS: The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined.

RESULTS: A total …

Evaluation And Management Of Mild Traumatic Brain Injury: An Eastern Association For The Surgery Of Trauma Practice Management Guideline., Ronald J. Bross Md, Randeep Jawa, Jennifer M Watters, Jennifer C. Knight, Andrew J Kerwin, Eleanor S Winston, Robert D. Barraco Md, Brian Tucker, James M Bardes, Susan E Rowell

Robert D Barraco MD, MPH

BACKGROUND: An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time. METHODS: The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined. RESULTS: A total …

Nationwide Acute Care Physical Therapist Practice Analysis Identifies Knowledge, Skills, And Behaviors That Reflect Acute Care Practice, Sharon L. Gorman, Ellen Wruble Hakim, Wendy Johnson, Sujoy Bose, Katherine S. Harris, Molly H. Crist, Karen Holtgrefe, Jennifer M. Ryan, Michael S. Simpson, Jean Bryan Coe

Sujoy Bose

Background and Purpose. Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. Subjects and …

Comparing Data Envelopment Analysis (Dea) And An Integrated Approach Of Dea And Malmquist Index (Dea-Mi) In Evaluation Of Hospitals Performances, Amin Yazdani Kachoei, Mohammad Mahdi Mozaffari, Amin Vafadarnikjoo, Mahdi Saeedpoor

Amin Vafadarnikjoo

Productivity in hospitals where are major centres for health and medical services has always been emphasised, on the other hand considering development of countries, various methods are presented to measure this factor. It should be noted that not using the scientific measurement methods and indexes correctly will end up misleading and generalising productivity and will lead to poor compliance with scientific principles, wasting resources and failing to achieve productivity in both enterprise and the whole economic system. The purpose of this paper is to compare two approaches; data envelopment analysis (DEA) and the hybrid of DEA and Malmquist index in …

Impact Of Radio-Frequency Identification (Rfid) Technologies On The Hospital Supply Chain: A Literature Review, Alberto Coustasse, Shane Tomblin, Chelsea Slack

Shane Tomblin

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce …

Family Presence During Trauma Resuscitation: Ready For Primetime?, Mae Pasquale, Michael Pasquale, Leslie Baga, Sherrine Eid, Jane Leske

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: The concept of family presence during trauma resuscitation (FPTR) remains controversial. Healthcare providers have expressed concern that resuscitation of severely injured trauma patients is inappropriate for family members as they may have psychologic distress, disrupt resuscitative efforts, or misinterpret provider actions, which can ultimately impact satisfaction with care. The minimal evidence that exists is descriptive or anecdotal.

METHODS: Using a previously developed FPTR protocol, a prospective, comparative study assessing 50 adult family members, who were present (n = 25) or not present (n = 25) with their severely injured adult family member during resuscitation, was conducted. Family member anxiety …

Impact Of Radio-Frequency Identification (Rfid) Technologies On The Hospital Supply Chain: A Literature Review, Alberto Coustasse, Shane Tomblin, Chelsea Slack

Alberto Coustasse, DrPH, MD, MBA, MPH

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce …

Observations Of Mealtimes In Hospital Aged Care Rehabilitation Wards, Karen Walton, Peter Williams, Linda Tapsell, Matthew Hoyle, Zhi Wei Shen, Lauren Gladman, Martin Nurka

Peter Williams

Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over 2 days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance …

Plate Waste In Hospitals And Strategies For Change, Peter G. Williams, Karen Walton

Peter Williams

Plate waste in hospitals refers to the served food that remains uneaten by patients. High levels of plate waste contribute to malnutrition-related complications in hospital, and there are also financial and environmental costs. Plate waste is typically measured by weighing food or by visual estimation of the amount of food remaining on the plate, with results presented as the percentage by weight of the served food, or by calculating the protein, energy or monetary value of the waste. Results from 32 studies in hospitals show a median plate waste of 30% by weight (range: 6-65%), much higher than in other …

A Review Of Radio Frequency Identification Technologies And Impacts On The Hospital Supply Chain: 2002–2012, Alberto Coustasse, Shane Tomblin, Chelsea Slack

Shane Tomblin

Supply costs are the second largest expenditure in hospitals, accounting for more than one third of the average operating budget. RFID technology can reduce these costs, improve patient safety, and supply chain management by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Findings of this study have shown that the application of RFID on medical equipment and supplies have resulted in efficiency increase in healthcare with lower costs and increased quality services. Even though the cost of RFID implementation is decreasing, the total expenditures are still significant and the …

A Review Of Radio Frequency Identification Technologies And Impacts On The Hospital Supply Chain: 2002–2012, Alberto Coustasse, Shane Tomblin, Chelsea Slack

Alberto Coustasse, DrPH, MD, MBA, MPH

Supply costs are the second largest expenditure in hospitals, accounting for more than one third of the average operating budget. RFID technology can reduce these costs, improve patient safety, and supply chain management by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Findings of this study have shown that the application of RFID on medical equipment and supplies have resulted in efficiency increase in healthcare with lower costs and increased quality services. Even though the cost of RFID implementation is decreasing, the total expenditures are still significant and the …

Organizational Culture In A Terminally Ill Hospital, Alberto Coustasse, Douglas A. Mains, Kristine Lykens, Sue G. Lurie, Fernando Trevino

Alberto Coustasse, DrPH, MD, MBA, MPH

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. …

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications., Kathy L Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison G Cahill, Peter Cram

Donna A. Santillan

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications.

STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles.

RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and 8.5% vs 7.6%, respectively; P < .0001). Sixty percent of decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.

CONCLUSION: Women who deliver at very low-volume hospitals have higher complication rates, as do women who deliver at …

Electronic Medical Records: Is It Working In Long Term Health Care?, Krista Phillips, Chris Wheeler, Josh Campbell, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Long-term care (LTC) facilities possess unique characteristics in terms of implementation and utilization of electronic medical records (EMRs). The focus of LTC is on a population requiring care encompassing all aspects associated with quality of life rather than simply acute treatment. Because this focus is of a larger scale than traditional medical facilities, the priorities in the implementation and utilization of EMRs are higher in accessing patient history information. The purpose of this study was to determine the EMR utilization in the chronic care settings. In conclusion, the literature review performed does not support the fact that EMRs are currently …

Electronic Medical Records In Long-Term Care, Krista Phillips, Chris Wheeler, Josh Campbell, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Long-term care (LTC) facilities possess unique characteristics in terms of implementation and utilization of electronic medical records (EMRs). The focus of LTC is on a population requiring care encompassing all aspects associated with quality of life rather than simply acute treatment. Because this focus is of a larger scale than traditional medical facilities, the priorities in the implementation and utilization of EMRs are higher in accessing patient history information. The purpose of this study was to determine the EMR utilization in the chronic care settings. In conclusion, the literature review performed does not support the fact that EMRs are currently …

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications., Kathy L Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison G Cahill, Peter Cram

Stephen K. Hunter

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications.

STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles.

RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and 8.5% vs 7.6%, respectively; P < .0001). Sixty percent of decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.

CONCLUSION: Women who deliver at very low-volume hospitals have higher complication rates, as do women who deliver at …

The Costly Skeleton In Hospital Closets, Karen Charlton

Karen E. Charlton

No abstract provided.

Rehabilitation Inpatients Are Not Meeting Their Energy And Protein Needs, K. Walton, P. G. Williams, Linda C. Tapsell, M. Batterham

Dr Marijka Batterham

Background & aims: This study aimed to determine the amounts of energy and protein required, ordered and consumed daily by long stay rehabilitation inpatients. Methods: A quantitative, weighed plate waste study. Thirty inpatients (16 females, 14 males; mean age 79.2 years; mean length of stay 52 days) from three rehabilitation hospitals in the Illawarra region of Australia. Data were collected over two days, including nutrition assessment details and weighed plate waste. Daily energy and protein requirements, amounts ordered and consumed were the outcome measures. Statistical analyses included paired t-tests, Wilcoxon Signed Rank tests and Spearman correlations. Results: Although adequate amounts …

Initial Management Of Poisoned Patients In The Out-Of-Hospital Environment, Alison Jones

Alison L Jones

Poisoning and suspected poisoning are very common problems in pre-hospital emergency care. The challenge is to identify the 1-2% of individuals who have taken sufficient toxin to be at risk of developing serious sequelae and use and develop effective methods of preventing such sequelae. Few randomised controlled clinical trials are available, and management decisions often have to be made on isolated case reports in the more unusual cases of poisoning. Care of the unconscious poisoned patient includes care of the airway, breathing, and circulation. Clues to the aetiology of poisoning in such cases may be gained from clinical signs which …

Rehabilitation Inpatients Are Not Meeting Their Energy And Protein Needs, K. Walton, P. G. Williams, Linda C. Tapsell, M. Batterham

L. C. Tapsell

Background & aims: This study aimed to determine the amounts of energy and protein required, ordered and consumed daily by long stay rehabilitation inpatients. Methods: A quantitative, weighed plate waste study. Thirty inpatients (16 females, 14 males; mean age 79.2 years; mean length of stay 52 days) from three rehabilitation hospitals in the Illawarra region of Australia. Data were collected over two days, including nutrition assessment details and weighed plate waste. Daily energy and protein requirements, amounts ordered and consumed were the outcome measures. Statistical analyses included paired t-tests, Wilcoxon Signed Rank tests and Spearman correlations. Results: Although adequate amounts …

Fall Prevention In Hospitals: An Integrative Review, Sandra Spoelstra

Sandra L. Spoelstra, PhD, RN, FGSA, FAAN

Career Commitment In Nursing, Diane Gardner

Diane Huber

There are different patterns and styles to careers in nursing. The concept of career commitment in nursing is explored, and the results of some research are discussed for their implications for nursing careers. A longitudinal, repeated-measures descriptive survey was used to measure career commitment and explore its relationship to turnover and work performance in 320 newly employed registered nurses at one hospital. Career commitment scores dropped significantly over the first year. Although career commitment does correlate with turnover, and there is a relationship with job performance, the direct association is weak. Career commitment is not a stable phenomenon in the …