RESUMEN
PURPOSES: Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. METHODS: This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. RESULTS: Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien-Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. CONCLUSION: Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/tendencias , Planificación Hospitalaria/organización & administración , Planificación Hospitalaria/estadística & datos numéricos , Planificación Hospitalaria/tendencias , Grupo de Atención al Paciente , Servicio de Cirugía en Hospital/estadística & datos numéricos , Servicio de Cirugía en Hospital/tendencias , Heridas y Lesiones/epidemiología , Heridas y Lesiones/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Cirujanos/educación , Cirujanos/provisión & distribución , Heridas y Lesiones/mortalidad , Adulto JovenRESUMEN
BACKGROUND: Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region. METHODS: The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year. RESULTS: The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities. CONCLUSIONS: Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.
Asunto(s)
Disparidades en Atención de Salud/tendencias , Planificación Hospitalaria/tendencias , Tiempo de Internación/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Alta del Paciente/tendencias , Intervención Coronaria Percutánea/tendencias , Bases de Datos Factuales , Humanos , Intervención Coronaria Percutánea/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Reino UnidoRESUMEN
Every year, the American Hospital Association compiles the Environmental Scan to provide hospital leaders with insight and information about market forces that are likely to affect the health care field. One common theme this year is the pace of change.
Asunto(s)
Sector de Atención de Salud/tendencias , American Hospital Association , Biotecnología/tendencias , Sector de Atención de Salud/economía , Sistemas de Información en Hospital/tendencias , Planificación Hospitalaria/tendencias , Humanos , Seguro de Salud/tendencias , Liderazgo , Personal de Hospital/economía , Personal de Hospital/provisión & distribución , Política , Garantía de la Calidad de Atención de Salud/tendencias , Estados UnidosRESUMEN
Markets with too many hospital beds could see trouble as providers seek to control spending and avoid expensive hospitalizations. "You'll need a lot fewer hospitals and hospital beds" because providers will do more to keep patients healthy enough not to need them, says Frank Trembulak, of Geisinger Health System.
Asunto(s)
Atención Ambulatoria/economía , Economía Hospitalaria/tendencias , Hospitalización/economía , Atención Ambulatoria/tendencias , Control de Costos/métodos , Control de Costos/tendencias , Promoción de la Salud/economía , Promoción de la Salud/tendencias , Capacidad de Camas en Hospitales/economía , Capacidad de Camas en Hospitales/estadística & datos numéricos , Planificación Hospitalaria/economía , Planificación Hospitalaria/tendencias , Hospitalización/tendencias , Humanos , Cobertura del Seguro/legislación & jurisprudencia , Medicaid/economía , Medicaid/legislación & jurisprudencia , Evaluación de Necesidades , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/normas , Estados UnidosRESUMEN
Hardly any other part of the healthcare sector is under such a pressure to change as the hospital sector. Hospitals are high-performers in coping with complex changes in modernising patient care, process design, quality, cost-effectiveness and service orientation. But, what really makes value to the patient? Currently, this question is raised with new seriousness. Those hospitals which consequently align their portfolio to value based and 'patient driven' healthcare delivery will succeed by both quality and cost-effectiveness. We receive such messages from the USA. In Germany there are on-going and admonishing pleas since the end of the 1990s not to lose sight of the patients' needs while designing new concepts for healthcare delivery. Future challenges imply not only the renaissance of patient centred care, but also demand for a comprehensive user orientation as a key factor to successful hospital modernisation. This is particularly true of concepts of structured, integrated and regional healthcare delivery. But a consequent alignment of healthcare with value for patients clearly exceeds the focus on integrating hospital and outpatient care. In designing new services of coordinated regional healthcare, hospitals gain strategic options for a single-source healthcare delivery. In terms of business development, user orientation does not only yield important impulses for stronger patient centred care, but also opens up chances for better quality and competitive advantages. Nevertheless, it requires a new understanding of innovation processes which considers value for patients and quality of results and outcome as a relevant scale for measuring effects of change management. Finally, the methods of the assessment of user oriented healthcare delivery are an essential challenge for the evaluation of cooperative healthcare services.
Asunto(s)
Sector de Atención de Salud/tendencias , Administración Hospitalaria/tendencias , Planificación Hospitalaria/tendencias , Satisfacción del Paciente , Mejoramiento de la Calidad/tendencias , Comportamiento del Consumidor , Conducta Cooperativa , Prestación Integrada de Atención de Salud/tendencias , Predicción , Alemania , Reestructuración Hospitalaria , Humanos , Comunicación Interdisciplinaria , Comercialización de los Servicios de Salud/tendencias , Evaluación de Necesidades/tendencias , Grupo de Atención al Paciente/tendencias , Atención Dirigida al Paciente/tendenciasAsunto(s)
Financiación del Capital/tendencias , Planificación Hospitalaria/economía , Inversiones en Salud/economía , Sistemas Multiinstitucionales/economía , Toma de Decisiones en la Organización , Financiación de la Construcción de Edificios/tendencias , Necesidades y Demandas de Servicios de Salud , Planificación Hospitalaria/tendencias , Sistemas Multiinstitucionales/organización & administración , Valorización y Adquisición Práctica/economía , Estados UnidosRESUMEN
The crisis in the financial markets is having a major impact on hospitals' ability to access capital. Providers are seeking longer-term fixed-rate debt rather than shortterm debt. Hospital management teams and their boards need to understand the upside and downside of variable-rate debt and interest rate derivatives.
Asunto(s)
Financiación del Capital/tendencias , Administración Financiera de Hospitales/tendencias , Planificación Hospitalaria/tendencias , Consejo Directivo , Gobierno , Planificación Hospitalaria/economía , Humanos , Renta/tendencias , Seguro de Hospitalización , Inversiones en Salud/tendencias , Liderazgo , Gestión de Riesgos , Estados UnidosRESUMEN
Planning for capital development of public hospitals in Victoria is guided by a multi-stage process with comprehensive data analysis and thorough approval processes at each of the stages. The long development time frames and the limitations in the data available to project service utilisation may negatively impact upon the service planning processes, and in some cases newly developed hospitals have not been sufficiently planned to meet community needs. This paper suggests that service utilisation forecasts derived from administrative databases require a more detailed verification process than currently exists. The process requires consideration of the drivers of demand to document the core assumptions about the future drivers, benchmarks with other jurisdictions, epidemiological, comparative and corporate needs assessment to explain the differences in utilisation rates, and sensitivity analysis. Given the cost of hospital construction and the rate of change in the healthcare sector, it is important that future hospital planning processes do not accept current utilisation trends as valid for future planning without this level of verification.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Planificación Hospitalaria/tendencias , Hospitales Públicos/estadística & datos numéricos , Bases de Datos Factuales , Predicción , Sector de Atención de Salud/estadística & datos numéricos , Sector de Atención de Salud/tendencias , Arquitectura y Construcción de Hospitales , VictoriaRESUMEN
As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the fifth in a 5-part series on applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, the concept of control is explored from a complex systems perspective.
Asunto(s)
Toma de Decisiones , Planificación Hospitalaria/organización & administración , Enfermeras Administradoras/organización & administración , Teoría de Sistemas , Predicción , Planificación Hospitalaria/tendencias , Humanos , Errores Médicos/prevención & control , Errores Médicos/estadística & datos numéricos , Enfermeras Administradoras/tendenciasRESUMEN
The nation's children's hospitals are in the midst of a building boom, moving into dazzling new spaces, adding an array of amenities and boosting research.
Asunto(s)
Arquitectura y Construcción de Hospitales/tendencias , Planificación Hospitalaria/tendencias , Hospitales Pediátricos/provisión & distribución , Niño , Encuestas de Atención de la Salud , Ambiente de Instituciones de Salud , Traslado de Instalaciones de Salud , Necesidades y Demandas de Servicios de Salud/tendencias , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/tendencias , Humanos , Habitaciones de Pacientes , Apoyo a la Investigación como Asunto , Estados UnidosAsunto(s)
Consejo Directivo , Sector de Atención de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Planificación Hospitalaria/tendencias , Liderazgo , Tecnología Biomédica/tendencias , Relaciones Comunidad-Institución/tendencias , Sistemas de Información en Hospital/tendencias , Planificación Hospitalaria/economía , Humanos , Seguro de Salud/tendencias , Política , Garantía de la Calidad de Atención de Salud , Sociedades Hospitalarias/tendencias , Estados UnidosAsunto(s)
Planificación Hospitalaria/economía , Hospitales con Fines de Lucro/provisión & distribución , Hospitales Filantrópicos/provisión & distribución , Sistemas Multiinstitucionales/economía , Competencia Económica/tendencias , Sector de Atención de Salud/tendencias , Instituciones Asociadas de Salud , Planificación Hospitalaria/tendencias , Humanos , Sistemas Multiinstitucionales/tendencias , Crecimiento Demográfico , VirginiaRESUMEN
The continuing influx of new residents has been a boon for hospitals in the Sunshine State, where new state-of-the-art facilities seem to be sprouting next to every palm tree. But questions about Medicare payments, a large uninsured population, and shortages of doctors and other staff pose serious challenges.