Readmission to hospital after stroke

‘Readmission to hospital after stroke’ explores the important area of hospital readmissions after a stroke. The authors examine the importance of hospital readmissions, the worldwide data, the influence of healthcare on readmissions, the current evidence and limitations of the available data, and the reasons for readmissions. The authors also discuss some illustrative case vignettes, how to identify patients at risk of readmissions, predicting risk of readmissions, strategies for prevention, implications for patients and healthcare workers, and the implications of stroke readmissions for health services and healthcare providers. There is a significant resource implication and consequent economic burden from stroke hospitalization, especially if this becomes a recurrent issue. While there is no doubt that readmissions are necessary in a cohort of patients who require urgent and specialized hospital care, a significant proportion of readmissions of stroke survivors may be preventable.

Planning Change in an Organization; MCB Bank Limited, Pakistan

This paper is primarily based on a case study of a leading bank in Pakistan, that is, MCB Bank Ltd. Four established change models have been applied to the bank to find out how a change comes in/ is brought in, managed, and how it affects organizational environment and its stakeholders, particularly customers and employees. The four established change models applied are the change management approach by Ansoff and McDonnell; the change management model by Kurt Lewin; the 7S framework by Thoman J. Peters and Robert H. Waterman; and the change management model developed by Stephanie Elam. The study covers a change management aspect such as strategic intervention technique; a need for change management; resource implication; planning change; strategies in change management; system effectiveness; managing resistance to change; leadership issues; cultural issues; people issues; external environment issues; workable approach to overcome change resistance; appropriate model and implementing the model.

An Opinion Survey on Patient Acceptance of a Two-Day Medication Supply Policy in Emergency Departments

Objective To obtain an idea on patient acceptance of a two-day medication supply policy in emergency departments, an opinion survey was carried out at the Accident & Emergency (A&E) department of North District Hospital. Methods Questionnaire were distributed to 200 ambulatory patients attending the A&E department on 4 April 2000, asking for their opinions on the reasonable duration of medication supply and its possible impact on emergency department misuse. The questionnaires were collected and the data analysed. Results A total of 78 questionnaires (39%) were returned. Forty-nine respondents (62.8%) accepted that dispensing two days of medications from emergency departments reasonable. Ten out of the 27 patients who disagreed on two-day supply (37.0%) considered that a three-day supply would be optimal. More than half of the respondents (52.6%) agreed with the hypothesis that a two-day supply policy would discourage misuse of emergency department service. Conclusion The great majority of patients attending A&E departments supported the prescription of two to three days supply of medication. This policy has important resource implication. However, its possible impact on misuse of emergency department service is controversial. (Hong Kong j.emerg.med. 2002;9:3–9)

Executive Briefing: Sunnybrook's Matrix Organizational Model—Moving Ahead

Traditionally, hospitals have denied the true intricacy of their organization by forcing all reporting relationships into a single structure. To address this complexity, Sunnybrook has developed three independent, yet interrelated, organization dimensions. Three structures—the traditional, the clinical unit and the programmatic dimension —provide a better link of accountability by holding departments responsible for the efficiency of their operations, holding physicians accountable for the resource implication of volume and case mix, and ensuring that the activities of the hospital's departments and clinical units are in line with the hospital's overall mission and programs.