The initial experience and response of vascular surgeons in Michigan during the COVID-19 pandemic.

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.

Reopening Endoscopy after the COVID-19 Outbreak: Indications from a High Incidence Scenario.

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Reflections from London's Level-1 Major Trauma Centres during the COVID crisis.

Emergence of the Covid-19 pandemic resulted in dramatic changes in global healthcare provision. Resources were redirected across all healthcare sectors to support the treatment of viral pneumonia with resultant effects on other essential services. We describe the impact of this on the provision of major trauma care in a major capital city.

[National organization of forensic medicine in France]. / Organisation nationale de la médecine légale en France.

Forensic medicine has long been characterized, in France, by diverse medical practices, which affected its recognition and development. A change was needed, Harmonization procedure includes the development of professional guidelines and allows forensic medicine to look at itself. However, the implementation of the recommendations is still far from complete. A national reform came into effect on 15 January 2011 and has defined a national reform of forensic medicine which includes funding by global budgets instead of fee-for-service. This reform allows easier organization and identification of forensic medicine units. One year later, tangible results are mixed. Forensic medicine is now more clearly identified but properly defined funding criteria are still lacking.

[Improving productivity by implementing RIS and PACS throughout the clinic: a case study]. / Produktivitätsverbesserung durch klinikweite RIS und PACS: eine Fallstudie.

PROBLEM: How are improvements in productivity in connection with RIS/PACS to be defined? What do they cost? To limit the problem to the relevant topics, we first describe the objectives of a radiology department and the identified bottlenecks in the workflow. How to define and assess the improvements is discussed. METHODS: The case in question for this study is the RIS/PACS project at the "Klinikum der Universität München, Campus Grosshadern". The goals of the project and its present status are reviewed. The project is not yet completed, so this is a "midterm" report. RESULTS AND DISCUSSION: We describe the status of the achieved and not yet achieved goals and of the eliminated bottlenecks. On the plus side, for example, nearly 100% of all digitally generated images (except mammogramms) are digitally archived. They are accessible to the same percentage in radiology via PACS and in the hospital via the webbased intranet image distribution system when needed. In some radiology areas, such as multislice CT, already the reporting can no longer be performed without softcopy image interpretation. However, the full elimination of hardcopy images is still not reality, since the distribution to DICOM viewers for selected requesters with demands for almost reporting quality, high cost image displays is still in the testphase. To reduce film costs, images are being printed on a high resolution paper printer in addition to the intranet distribution during this transition period. On the negative side, due to a lack of job positions in the transcription rooms, about 40% of the reports are still being handwritten by radiologists. Furthermore, the dictated and transcribed reports are usually still not available early enough in the RIS and thereby in the intranet report distribution of the hospital. Here only a speech recognition system can remedy the situation. As soon as this problem is solved and the image distribution to the DICOM viewers works routinely, the reports and the images will be accessible within minutes to maximally within some hours after the examination. CONCLUSION: The goals reached so far suffered delays due to unforeseen problems and pitfalls. Altogether, a quieter operation and workflow in radiology has already been achieved, due to less inquiries from the requestors for unfinished examinations, images and/or image copies.

Organizaçäo da sociedade: mobilizaçäo da comunidade e parcerias / Society organization community: mobilization and partnership

O autor comenta o atual momento de recomposicao das entidades civis brasileiras apos o periodo da ditadura militar e como o Instituto da Crianca do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (ICr) vem...

Propuesta conceptual de la restructuración de la dirección general de epidemiología / Conceptual proposal of the restructuring of the general direction of epidemiology

El objetivo del documento es definir nuevas funciones, atribuciones y responsabilidades a nivel nacional, departamental y distrital de la DGE y las otras Direcciones en relación a la epidemiolog1a, definir compotencias intrainstitucionales e interinstitucionales, contar con un organigrama de funcionamiento acorde con un Ministerio de Salud en el marco de la descentralización y la epidemiología del siglo XXI.

Service-line management/bottom-line management.

To survive in the sturm und drang of health care administration, hospitals and health care systems will have to restructure themselves in ways that emphasize their specific clinical strengths, control their costs, and manage the delivery and outcomes of care. Structuring the organization along clinical lines of service (e.g., oncology, cardiology, rehabilitation) cedes total bottom-line authority for all aspects of that service to the service, or product, line manager. This article discusses the qualifications, compensation, and responsibilities of service-line managers in well-integrated health care systems and describes how they and managed care organizations view each other. It also suggests which organizations will, and will not, benefit from restructuring along service lines.

Multiple changes, multiple opportunities in the ambulatory surgery department.

As one facility that was restructured and purchased, the Ambulatory Surgery Department moved through changes at a very rapid pace. The waves of change began with preoperative testing requirements and expansion of the nurse's role in accurate and appropriate testing decisions. Cross-training for radiology, pain management, infusion services, and oncology services were also incorporated. As the department became a multi-faceted area of patient care, nursing staff met the challenge of change and grew both educationally and professionally. This article identifies areas of departmental and professional opportunity and outlines the development of protocols to meet each challenge.

Reengineering a cardiovascular surgery service.

BACKGROUND: Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance. OTHER INITIATIVES: Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate. CONCLUSION: For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.

Re-engineering: managing radical change.

Faced with both a move to a new facility and the need for radical, cost-saving organizational change, the Ontario Cancer Institute/Princess Margaret Hospital turned to the principles of re-engineering. With the help of a consulting firm, the organization overhauled sufficiently to save $7.5 million, enough to finance the move, the transition and even the expansion of some services.

Improving patient care, cutting hospital costs. A process improvement system.

Today's healthcare managers all find themselves confronted with the dilemma of finding ways to reduce costs while simultaneously improving the quality of patient care. Working with management consultants, cross-functional teams at Good Samaritan Hospital carried out a four-step process to reduce the average length of stay for knee and hip replacement surgery from twelve to seven days. The improvements are saving the hospital an estimated $800,000 a year.

Product line management. Formalizing clinical product lines as part of patient focused restructuring.

Patient Focused Care is entirely consistent with clinical Product Line Management. In fact, as with Patient Focused Care and CQI/TQM, these two initiatives are better together than apart. To take advantage of this opportunity, you may have to modify your existing mechanism for Product Line Management. But the added benefits of more successful Product Line Management will make any modifications a temporary distraction. Down goes the perceived hurdle.