scholarly journals Emergency department models of care in Queensland: a multisite cross-sectional study

2019 ◽  
Vol 43 (4) ◽  
pp. 363 ◽  
Author(s):  
Anthony Bell ◽  
Ghasem-Sam Toloo ◽  
Julia Crilly ◽  
John Burke ◽  
Ged Williams ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Public Hospital ◽  
Care Delivery ◽  
Relative Effectiveness ◽  
Geographical Location ◽  
Cross Sectional Study ◽  
Models Of Care ◽  
Complete Analysis ◽  
Sectional Study ◽  
Cross Sectional

Objective The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Methods Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Results Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. Conclusion There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. What is known about the topic? MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. What does this paper add? The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. What are the implications to practitioners? A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.

scholarly journals Processes of care and outcomes for homeless patients hospitalised for cardiovascular conditions at safety-net versus non-safety-net hospitals: cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046959
Author(s):  
Atsushi Miyawaki ◽  
Dhruv Khullar ◽  
Yusuke Tsugawa
Keyword(s):  
Hospital Mortality ◽  
Health Outcomes ◽  
Care Delivery ◽  
Bypass Graft ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Homeless Adults ◽  
To Receive

ObjectivesEvidence suggests that homeless patients experience worse quality of care and poorer health outcomes across a range of medical conditions. It remains unclear, however, whether differences in care delivery at safety-net versus non-safety-net hospitals explain these disparities. We aimed to investigate whether homeless versus non-homeless adults hospitalised for cardiovascular conditions (acute myocardial infarction (AMI) and stroke) experience differences in care delivery and health outcomes at safety-net versus non-safety-net hospitals.DesignCross-sectional study.SettingData including all hospital admissions in four states (Florida, Massachusetts, Maryland, and New York) in 2014.ParticipantsWe analysed 167 105 adults aged 18 years or older hospitalised for cardiovascular conditions (age mean=64.5 years; 75 361 (45.1%) women; 2123 (1.3%) homeless hospitalisations) discharged from 348 hospitals.Outcome measuresRisk-adjusted diagnostic and therapeutic procedure and in-hospital mortality, after adjusting for patient characteristics and state and quarter fixed effects.ResultsAt safety-net hospitals, homeless adults hospitalised for AMI were less likely to receive coronary angiogram (adjusted OR (aOR), 0.42; 95% CI, 0.36 to 0.50; p<0.001), percutaneous coronary intervention (aOR, 0.52; 95% CI, 0.44 to 0.62; p<0.001) and coronary artery bypass graft (aOR, 0.43; 95% CI, 0.26 to 0.71; p<0.01) compared with non-homeless adults. Homeless patients treated for strokes at safety-net hospitals were less likely to receive cerebral arteriography (aOR, 0.23; 95% CI, 0.16 to 0.34; p<0.001), but were as likely to receive thrombolysis therapy. At non-safety-net hospitals, we found no evidence that the probability of receiving these procedures differed between homeless and non-homeless adults hospitalised for AMI or stroke. Finally, there were no differences in in-hospital mortality rates for homeless versus non-homeless patients at either safety-net or non-safety-net hospitals.ConclusionDisparities in receipt of diagnostic and therapeutic procedures for homeless patients with cardiovascular conditions were observed only at safety-net hospitals. However, we found no evidence that these differences influenced in-hospital mortality markedly.

scholarly journals Cross-sectional study of prevalence and risk factors, and a cost-effectiveness evaluation of screening and preventive treatment strategies for latent tuberculosis among migrants in Singapore

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050629
Author(s):  
Vanessa W Lim ◽  
Hwee Lin Wee ◽  
Phoebe Lee ◽  
Yijun Lin ◽  
Yi Roe Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
Length Of Stay ◽  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ltbi Prevalence ◽  
The Cost

ObjectivesWHO recommends that low burden countries consider systematic screening and treatment of latent tuberculosis infection (LTBI) in migrants from high incidence countries. We aimed to determine LTBI prevalence and risk factors and evaluate cost-effectiveness of screening and treating LTBI in migrants to Singapore from a government payer perspective.DesignCross-sectional study and cost-effectiveness analysis.SettingMigrants in Singapore.Participants3618 migrants who were between 20 and 50 years old, have not worked in Singapore previously and stayed in Singapore for less than a year were recruited.Primary and secondary outcome measuresCosts, quality-adjusted life-years (QALYs), threshold length of stay, incremental cost-effectiveness ratios (ICERs), cost per active TB case averted.ResultsOf 3584 migrants surveyed, 20.4% had positive interferon-gamma release assay (IGRA) results, with the highest positivity in Filipinos (33.2%). Higher LTBI prevalence was significantly associated with age, marital status and past TB exposure. The cost-effectiveness model projected an ICER of S$57 116 per QALY and S$12 422 per active TB case averted for screening and treating LTBI with 3 months once weekly isoniazid and rifapentine combination regimen treatment compared with no screening over a 50-year time horizon. ICER was most sensitive to the cohort’s length of stay in Singapore, yearly disease progression rates from LTBI to active TB, followed by the cost of IGRA testing.ConclusionsFor LTBI screening and treatment of migrants to be cost-effective, migrants from high burden countries would have to stay in Singapore for ~50 years. Risk-stratified approaches based on projected length of stay and country of origin and/or age group can be considered.

Hepatitis B prophylaxis in newborns: A cross-sectional study of 7-year attendance in a public hospital of Brazil

2019 ◽  
Vol 47 (9) ◽  
pp. 1107-1111
Author(s):  
Alex S. Jorge ◽  
Barbara S. Horvath ◽  
Claudia Ariati ◽  
Jessica C. Silva ◽  
Lucas B. Lima ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Public Hospital ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

2021 ◽  
Author(s):  
Salman Ahmed ◽  
Suraj Sarvode Mothi ◽  
Thomas Sequist ◽  
Navdeep Tangri ◽  
Roaa M. Khinkar ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Care Delivery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk

scholarly journals Prevalence of Mycoplasma genitalium in men with urethritis in a large public hospital in Brussels, Belgium: An observational, cross-sectional study

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0196217 ◽  
Author(s):  
Agnès Libois ◽  
Marie Hallin ◽  
Tania Crucitti ◽  
Marc Delforge ◽  
Stéphane De Wit
Keyword(s):  
Public Hospital ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Nursing problems in children with hydrocephalus and myelomeningocele

2011 ◽  
Vol 5 (6) ◽  
pp. 1483
Author(s):  
Maria Cláudia Moreira de Alcântara ◽  
Francisca Alexandra Araújo da Silva ◽  
Thereza Maria Magalhães Moreira ◽  
Maria Euridéa de Castro ◽  
Jênifa Cavalcante dos Santos
Keyword(s):  
Public Hospital ◽  
Pediatric Neurosurgery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Multiprofessional Team ◽  
De Re ◽  
Skin Integrity ◽  
Nursing Diagnoses ◽  
Frequent Exposure

ABSTRACTObjective: to identify nursing problems of children with hydrocephalus and myelomeningocele in the use of ventricular shunts. Method: cross-sectional study, quantitative, developed in an internment unit for pediatric neurosurgery in a public hospital. The sample consisted of 60 patients admitted from June to December 2006. The study was submitted to the ethics committee of research on Protocol No. 82/2006. Results: the findings showed that the main problems and nursing diagnoses are related to decreased intracranial adaptive capacity related to increased ICP, risk of impaired skin integrity related to immobility and / or frequent exposure to fecal / urinary secretion and urinary incontinence  related neurogenic bladder. Conclusion: ventricular shunts are important methods to improve survival of children with hydrocephalus. But the care provided and the handling of the devices must be well oriented to families by the multiprofessional team, aiming to reduce the long periods of re-internments. Descriptors: nursing; child health; hydrocephalus; myelomeningocele; drainage.RESUMOObjetivo: identificar problemas de enfermagem de crianças com hidrocefalia e mielomeningocele em uso de derivações ventriculares. Método: estudo transversal, quantitativo, desenvolvido em uma unidade de internação em neurocirurgia pediátrica de um hospital público. A amostra constituiu-se de 60 pacientes internados de junho a dezembro de 2006. O estudo foi submetido ao comitê de ética em pesquisa com protocolo n°82/2006. Resultados: os achados evidenciaram que os principais diagnósticos e problemas de enfermagem relacionam-se à capacidade adaptativa intracraniana diminuída relacionada ao aumento da PIC; risco para integridade da pele prejudicada relacionado à imobilidade e/ou exposição frequente à secreção fecal/urinária e incontinência urinária relacionada à bexiga neurogênica. Conclusão: as derivações ventriculares são métodos importantes para aumentar a sobrevida das crianças com hidrocefalia. Porém os cuidados dispensados quanto ao manuseio dos dispositivos devem ser bem orientados pela equipe multiprofissional às famílias, objetivando reduzir os longos períodos de re-internações. Descritores: enfermagem; saúde da criança; hidrocefalia; mielomeningocele; drenagem.RESUMENObjetivo: identificar problemas de enfermería en niños con hidrocefalía y  mielomeningocele que usan derivaciones ventriculares. Método: estudio transversal, cuantitativo, desarrollado en una unidad de internación en neurocirugía pediátrica de un hospital público. La muestra fue compuesta por 60 pacientes internados entre junio y diciembre de 2006. El estudio fue sometido al comité de ética en investigación con el protocolo n°82/2006. Resultados: los resultados demostraron que los principales diagnósticos y problemas de enfermería están relacionados con la capacidad adaptativa intracraneal disminuida asociada al aumento de la PIC; riesgo para la integridad de la piel perjudicada relacionado a la inmovilidad y/o exposición frecuente a secreción fecal/urinaria e incontinencia urinaria asociada a vejiga neurogénica. Conclusión: las derivaciones ventriculares son métodos importantes para aumentar la sobrevida de los niños con hidrocefalía, sin embargo las familias deben ser bien orientadas  por el equipo multiprofesional sobre los cuidados con el manejo de los dispositivos, con el objetivo de reducir los largos periodos de reinternación. Descriptores: enfermería; salud del niño; hidrocefalía; mielomeningocele; drenaje.

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