Aerodigestive Programs Enhance Outcomes in Pediatric Patients.

The early efforts of pediatric airway surgeons, gastroenterologists, and pulmonologists to optimize surgical outcomes involved evaluating multiple organ systems for diseases negatively affecting surgery. This resulted in coordinated clinics with multiple services, ancillary testing, and endoscopic procedures, known as aerodigestive programs. These programs have nationally increased the value of care, with multidisciplinary experts delivering organized and efficient care to children with complex needs. This article describes the origin and value of aerodigestive programs within the modern health care landscape, serving as a primer for providers and administrators investigating how to facilitate aerodigestive or similar programs.

Nonclinical outcomes of hospital-based palliative care.

Evidence-based outcomes are commonly used in making decisions about clinical care. For healthcare executives, evidence-based outcomes also can be useful in making decisions about hospital services. Finkler and Ward (2003) suggest a model whereby cost measurement, cost control, and value assessment can be used as nonclinical, evidence-based outcome measures to provide decision support and to guide management decisions. The Finkler and Ward framework is used to understand the financial implications of establishing an inpatient palliative care unit (PCU). A longitudinal study was conducted to examine the nonclinical outcomes associated with opening and operating an inpatient PCU at a large academic medical center during the first four years of the unit's operation. First, the cost of providing inpatient palliative care was measured. Results indicated that the cost per day to care for patients hospitalized in the last 20 days leading up to their death was significantly less on the PCU than on intensive care units and non-PCUs. Average daily total charges exceeded reimbursement on the ICU and non-PCUs, but the cost on the PCU for the same population was equal to or below the average daily total charges. Second, ways to control costs when operating an inpatient PCU were identified and measured. Evidence from one organization suggests that costs can effectively be controlled by admitting patients directly to the PCU and by appropriate use of hospital resources, including staff, ancillary services, and pharmaceuticals. Third, the study assessed the value to the institution of operating an inpatient PCU. Results indicated that the inpatient PCU yielded a cost savings of nearly 1 million dollars by the third year of operations. This study highlights the nonclinical outcomes of one institution's inpatient PCU and provides guidelines for healthcare executives and managers to use in making decisions about adopting such programs.

Provision of information for cancer patients: an appraisal and review.

This article is based on an appraisal of Cancer Information and Support Services in Britain supported by the UK-based charity Macmillan Cancer Relief. Commissioned in 2002, the appraisal formed part of a wider review aimed at extending knowledge about Cancer Information and Support Services. It was also designed to ensure that the Macmillan Cancer Information and Support Service Model continues to reflect the needs of people whose lives are affected by cancer. The individual services reviewed for the appraisal vary widely in terms of resources, staffing and organizational structure, but many common themes emerge. The importance of outreach and networking are highlighted, along with the problem of isolation. Many post-holders saw a need to include a hospital base, while the role played by volunteers is widely acknowledged. A key aim of the review was to start to identify the factors that contribute to the success of a service, and a number of these emerge from the study. The creation of a culture that enables such a service to thrive appears to be as important as securing financial and other resources. The contribution made by Macmillan is explored, and ways in which the organization can support the dissemination of knowledge are put forward.

Atuação neuropsicológica em centro de neurologia pediátrica: um projeto de extensão universitária / Neuropsychologycal intervention in pediatric neurology centre: a project of extension's university

O presente artigo tem como objetivo relatar uma experiência profissional na área da Psicologia Hospitalar com um enfoque neuropsicológico, que ocorre através de um projeto de extensão universitária. Tal projeto intitulado Atuação neuropsicológica em Centro de Neurologia Pediátrica, consiste na implantação do serviço de neuropsicologia pelo Laboratório de Neuropsicologia do Departamento de Psicologia da UFPR dentro do Centro de Neuropediatria do Hospital de Clínicas da UFPR (CENEP-HC). O principal objetivo do projeto é proporcionar à população atendida neste centro médico, um serviço de neuropsicologia de qualidade, bem como desenvolver e divulgar trabalhos desenvolvidos na área de neuropsicologia. O trabalho desenvolve-se através da avaliação e intervenção neuropsicológica de pacientes portadores de diversos comprometimentos neuropsicológicos, provenientes de diversas etiologias. Tais procedimentos têm como propósito auxiliar na avaliação diagnóstica dos pacientes, possibilitar um atendimento neuropsicológico e encaminhar corretamente pacientes para outros profissionais. Tais objetivos são alcançados através de visitas ambulatoriais, avaliações e intervenções neuropsicológicas, supervisões semanais, discussões interdisciplinares teórico-práticas dos casos atendidos e encaminhamentos para outros profissionais. Além disso, como resultado do desenvolvimento desse projeto ocorre a elaboração de material de avaliação e intervenção neuropsicológicas apropriadas à população atendida no CENEP-HC

Ancillary services in the health care industry: is Six Sigma reasonable?

Within the naval medical center construct, the disparate disciplines encompassed within ancillary services lend themselves to formal quality analysis and process improvement. This analysis uses the Six Sigma approach. Error rates were investigated and calculated for various processes within ancillary services at Naval Medical Center, San Diego. These were translated into the common metric of defects per million opportunities (DPMO). DPMO rates vary between 21.5 and 420,000. These correspond to Sigma values from 1.7 to approaching 6. Rates vary with biological complexity of the system and the degree of automation available. Some ancillary services translate well into a Six Sigma schema. Systems with high potential patient risk if performed poorly and those amenable to second checking and computer oversight may be candidates for such optimization. This should be undertaken in a local environment conducive to individual error reporting, and in a corporate environment with the will and funding to support the transition.

Organisational governance structures in allied health services: a decade of change.

A ten year review of developments in the organisation and management of allied health services in Australian acute care public hospitals reveals a steady transformation away from a medically managed universal model towards more complex and contested models of governance. This article revisits early observations about the reorganisation of allied health services and presents more recent research findings to guide managerial decision-making about restructuring the diverse disciplines that constitute allied health. A new organisational model "integrated decentralization" is presented as an approach to managing allied health services which accommodates multiple stakeholder demands in the context of New Public Management (NPM) related reforms. The focus on the institutional level is complemented by examining developments in the profile and activity of allied health at the regional, state and national levels to present a more comprehensive picture of change over the decade of the 1990s.

Contribuiçäo à organizaçäo de serviços de transplante de medula óssea e a atuaçäo do enfermeiro / Contribution to the organization of the service of bone marrow transplantion and nurse's performance

Trata-se de um estudo bibliográfico sobre a temática: transplante de medula óssea com ênfase na atuaçäo do enfermeiro, levantada em publicaçöes de enfermagem dos últimos dez anos. As informaçöes, organizadas e sintetizadas permitiram identificar que para a realizaçäo do transplante säo necessários uma infra-estrutura apropriada, recursos humanos especializados e recursos operacionais que viabilizem a assistência. Foi possível identificar também que a atuaçäo do enfermeiro nesse procedimento se dá em todas as fases do processo de assistência ao paciente, de modo peculiar em cada uma delas, preferentemente de forma individualizada e integral, na proporçäo máxima de um enfermeiro para dois pacientes.

Managing capacity and demand in a resource constrained environment: lessons for the NHS?

The purchaser-provider split within the NHS which emerged out of the government's 1990 White Paper, Working for Patients, together with the introduction of the Patients Charter, has imposed new, tighter performance measures on provider units. The internal market has placed clear contractual guarantees on providers in terms of service/care provided. The Patients Charter has set, with little reference to local conditions, required timescales for treatment, i.e. waiting time guarantees for patients. The government is committed to reducing these guaranteed waiting times further. Both these factors have forced provider units to look far more closely at the way they operate, and the way they provide services. The impact of these performance measures has been magnified by the tight budgetary constraints within which provider units are currently expected to operate. Consequently the option of increasing service provision through expanding facilities and staff has effectively been precluded in the majority of instances. Thus provider units have been forced into reappraising the manner in which service provision is structured and the services delivered. While this restructuring of service provision has been most obvious in those services where the internal market has had the more immediate effect - for example, direct access services such as physiotherapy - increasingly, performance measure pressures have forced providers to examine the processes by which they deliver both in-patient and out-patient care. Analyses the difficulties encountered by an NHS Trust in Scotland in managing capacity and demand in a specialist out-patient clinic.

The development of a massage service for cancer patients.

Despite major technological advances in the treatment of cancer, many patients are dissatisfied with conventional biomedical interventions. This is largely because they fail to resolve long term intractable problems such as chronic pain or stress. More emphasis is now being placed on quality of life. This shift in attitude has opened the door for complementary therapies as adjuvants to traditional models of cancer care. Changes within the NHS have facilitated this transition, by the creation of the 'internal market' and the development of central funding to individual clinical directorates. To exploit these opportunities, complementary, therapists must develop new skills and be prepared to adopt NHS standards of assessment to evaluate the efficacy of their work. Standards are a component of 'Quality assurance'. They are observable, achievable and measurable, and contribute towards an acceptable evaluation process. Standards are used by health care purchasers to assess which therapies should be made available to patients within the NHS. This paper describes the development of a massage service that has been integrated into the Hammersmith Oncology Department. The massage standard is seen to be fundamental and essential to the continued development and evaluation of the project.