The implementation of an Electronic Nursing Record in a general hospital in the Netherlands: lessons to learn.

This article describes the implementation of an Electronic Nursing Record (ENR) in Maasland Hospital (Orbis Medical and Healthcare group) in Sittard, the Netherlands. Through analysis of documents, structured interviews and participatory observation, a study was made of the plans prior to the introduction of the ENR, how the process proceeded, which enhancing and constraining factors influenced the process and how the nursing staff experienced the introduction of the ENR. The implementation of the system took place in 2006 and 2007. The selection and design of the system was carried out first, followed by a pilot phase. After thorough review and adjustment, the introduction of the ENR in the other wards of the hospital followed according to plan. The implementation process was carried out by several nurses in different roles (project management, project group members, key-users and teachers). The introduction of the system had two objectives: saving time by promoting efficiency and quality improvement by the introduction of standardization in documentation and the use of nursing care plans. The study indicates, however, that no time-efficiency was achieved by using the ENR so far. This had an adverse effect on the acceptance of the system by the nurses. The nurses were positive about the set-up of the implementation process, especially the contribution of the project group, the key-users on the ward and the resources which were made available (the staffing, external expertise and training).

New concepts in health care: some preliminary ideas.

Health care discussions in many countries tend to focus on cost containment without taking into account the problem of quality of care. The starting point for our ideas is the description of quality as the optimal relation between care demander and care provider. The difficulties in assessing quality of care are outlined. The question remains which health care model offers the best opportunities to have both high quality care and affordable costs. A proposal is made for a model in which the care demander and care provider, i.e. the client and physician, are natural allies. A special role is fulfilled by the family physician: a key role, as case manager, as gatekeeper. Special attention should be directed towards the financial consequences. It is proposed that small-scale experiments should be started to evaluate the model advanced in the text.

Epilepsy in general practice: the Dutch situation.

Treatment and supervision of epileptic patients is part of specialist medicine. A possible change in the role of specialists and general practitioners in the care of these patients was explored by a questionnaire mailed to all Dutch neurologists and a random sample of general practitioners. Patients were also asked their opinion. The real situation was studied in a group of patients retrieved from the registers of general practitioners. Demographic, psychosocial, and epilepsy characteristics were sampled. Specialists tend not to want a change in their role; general practitioners desire a change. At present, patients do not want a change, but in future a change might be acceptable to them. More patients than expected were supervised by their general practitioner only. Their demographic and psychosocial characteristics did not differ from those in the population at large. Epilepsy characteristics corresponded with those in other studies.

The rectus abdominis syndrome: a case report.

The case is reported of a patient with a rectus abdominis syndrome. Attention is drawn to the possibility that patients with abdominal pain, in whom no intra-abdominal cause is found, may suffer from this presumed nerve entrapment syndrome. No surgery is required and therapy can be simple.

Spinal cord compression by extramedullary hemopoietic tissue in pyruvate-kinase-deficiency-caused hemolytic anemia.

Spinal cord compression by extramedullary hemopoietic tissue is a rare complication of hemolytic anemias. This is the first report of this complication in hemolytic anemia caused by pyruvate-kinase deficiency. Indium scan, computed tomography (CT) scan, and myelography were helpful in diagnosis. Surgery and radiotherapy were followed by complete recovery during a follow-up period of 12 months.