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An evaluation of the care of patients with minor injuries in emergency settings

Accident and Emergency Nursing 2000年第2期8卷 101-109页

作者： Byrne, Geraldine Richardson, Marion Brunsdon, Julie Patel, Asmita Dept. of Adult Nursing and Health Wright Building University of Hertfordshire Hatfield Herts AL10 9AB College Lane United Kingdom Dept. of Post-registration Nursing Wright Building University of Hertfordshire Hatfield Herts AL10 9AB College Lane United Kingdom

This paper describes a study which evaluated three models of emergency care for patients with minor injuries;a traditional Accident and Emergency (A&E) department where patients with minor injuries were seen by senior house officers and nurses working together;a Minor Accident Treatment Service (MATS) unit, located in a main A&E, where patients with minor injuries were seen by Emergency Nurse Practitioners (ENPs) and a nurse-led Minor Injuries Unit (MIU), where patients with minor injuries were also seen by ENPs. Information about waiting times and length of stay was recorded by the researchers and patients were asked to complete a satisfaction questionnaire at the end of their stay. A sample of 181 patients were included in the study (57 in the traditional A&E, 57 in the MATS unit and 67 in the nurse-led MIU). Patients in the traditional A&E waited significantly longer to be seen than patients seen by an ENP, by an average of 40 minutes, and spent an average of 33 minutes longer in the department. ENPs spent an average of 12 minutes longer than doctors undertaking the first consultation where patients' needs were assessed and documented. Patients were very satisfied with care given by all health professionals. Those seen by ENPs were significantly more likely to have been given health advice and information, written instructions on discharge and told who to contact if they needed further advice. They were found to be subsequently significantly less worried about their health than patients seen in the traditional A&E. It is suggested that although ENPs spent longer with patients, this resulted in an improvement in the quality and depth of information and advice provided. © 2000 Harcourt Publishers Ltd.

关键词：效率组织急症护理/标准急诊室医院/人力急诊室医院/标准伦理学大不列颠住院时间模型护理学开业护士护士病人关系护理管理研究病人医疗小组/标准病人满意度/统计学和数值数据试点项目卫生保健质量/统计学和数值数据问卷调查时间安排创伤和损伤/治疗人类

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A multidisciplinary QA program for enteral nutrition in high-risk patients.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1991年第4期13卷 34-39,52页

作者： Danek, M. Booth Memorial Medical Center Flushing NY United States

An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial Medical Center revealed a certain percentage of complications with small bore, weight-tipped feeding tubes inserted through the nares, a multidisciplinary peer review committee (MPRC) was formed to review the enteral nutrition program. After a literature review to determine possible complications, the MPRC identified lung perforations due to tube misplacement, tube feeding aspiration into the lungs leading to possible aspiration pneumonia, and an internal tip separation from the tube product failure. Unconscious incubated patients on ventilators were shown as at high risk for feeding tube misplacement in an initial MPRC patient study. A second study evaluated several different feeding tube products in the medical, respiratory and surgical ICU. The MPRC established a credentialing process for physician assistants, interns and residents in feeding tube placement. The MPRC proceedings were presented to the hospital-wide QA committee for review, endorsement and recommendations on all policy and procedure changes. The conclusions were that a more concerted effort must be made to improve medical management and encourage ongoing education in the administration of enteral feedings to high-risk patients.

关键词：费用效益分析文献工作肠道营养/标准表格和记录管理医院病床数 300至499张重症监护病房/标准纽约市病人医疗小组/标准专家委员会质量保证卫生保健/组织和管理人类

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Outpatient care: The modern chaplains’ new impact in healthcare reform

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Journal of Health Care Chaplaincy 1994年第1期6卷 83-108页

作者： McSherry, Elisabeth Dartmouth Medical School Brockton/West Roxbury VAMC (10B41) West Roxbury VAMC West Roxbury MA 02132 1400 VFW Parkway United States

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关键词：宗教事务科医院/经济学宗教事务科医院/标准费用效益分析卫生保健改革/标准门诊部医院/经济学门诊部医院/人力门诊部医院/标准病人医疗小组/标准质量保证卫生保健/经济学质量保证卫生保健/标准美国人类

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Defining outpatient scopes of practice for allied healthcare practitioners.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第3期20卷 30-33,38页

作者： Wurst, D.E. Western International University Phoenix AZ United States

The definition of scopes of practice for allied healthcare practitioners in outpatient settings is an emerging healthcare topic in this era when technologically advanced procedures are being done and diagnostics, therapies, and care are being given in outpatient settings. The standards of care and practice under which allied health professionals provide care must be defined within an organization in order to provide the high-quality integrated healthcare that is the benchmark of excellence. One way to increase leadership and staff awareness is to provide experts in each allied health discipline the opportunity to define their scopes of practice, as the Joint Commission suggests, based on the rules and regulations that govern those practices.

关键词：卫生保健辅助人员/教育卫生保健辅助人员/立法和法学卫生保健辅助人员/标准门诊医疗/人力门诊医疗/组织和管理门诊医疗/标准亚利桑那证书授予联合开业职业间关系职务说明许可证护理学护理过程护理人员/立法和法学护理人员/标准病人医疗小组/组织和管理病人医疗小组/标准专业业务/标准

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Support for patients with hepatitis C: an exploratory qualitative study of medical specialists' perceptions

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第2期23卷 201-203页

作者： Teague, W Hepworth, J Krug, G Univ Adelaide Dept Gen Practice Adelaide SA 5005 Australia Univ S Australia Sch Commun Studies Adelaide SA 5001 Australia

Objective: To explore the range of meanings about the role of support for patients with hepatitis C by examining medical specialists' perceptions. Method: The study employed a qualitative, open-ended interview design and was conducted in four major teaching hospitals in Adelaide, South Australia. Eight participants (three infectious disease physicians, four gastroenterologists, one hepatologist), selected through purposive sampling, were interviewed about general patient support, their role in support provision, the role of non-medical support and their reasons for not using support services. Results: Main themes included a focus on support as information provision and that patient education is best carried out by a medical specialist. The use of support services was defined as the patient's decision. Participants identified four key periods when patients would benefit from support;during diagnosis, failure to meet treatment criteria, during interferon treatment and following treatment failure. Conclusions: It was concluded that while barriers exist to the establishment of partnerships between specialists and other support services, this study has identified clear points at which future partnerships could be established. Implications: A partnership approach to developing support for patients with hepatitis C offers a systematic framework to facilitate the participation of health professionals and the community in an important area of public health.

关键词：适应心理学医务工作者的态度数据收集肝炎丙型/心理学肝炎丙型/治疗病人医疗小组/标准病人医疗小组/发展趋势心理学卫生保健质量疾病角色社会支持南澳大利亚专业医学人类

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The integration of a QA/RM program in a rural healthcare obstetrical service.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1991年第6期13卷 20-22页

作者： Ament, L.A. Barat College and University of Health Sciences Chicago Medical School North Chicago IL United States

Obstetrical services in a rural healthcare setting have special problems because the number of deliveries per month is below 100, with some facilities averaging fewer than 10 to 15 births per month. Medical resources may include obstetricians, pediatricians, or family practitioners, but not necessarily all three. Because it is not cost-effective to staff an obstetrical unit 24 hours a day when a low census is the norm, staffing patterns may be atypical and creative. The development of an effective credentialing system for both nursing and medical staffs is the first component of a QA/RM plan. Nursing staff play a vital role in modifying potential risk. When nurses do not routinely provide care on a unit, an efficient quality assurance plan is vital. Components of the plan must include staffing patterns and ratios, policies and procedures, and documentation. QA indicators should address both volume and outcome-oriented clinical indicators. Medical follow-up when indicated should also be part of the plan. Ongoing communication among team members and utilization of outside resources can assist in promoting an effective program. Although obstetrics is an area where the potential for risk exposure remains great, it is possible to create an efficient, practical risk management system.

关键词：病人医疗小组/标准质量保证卫生保健/组织和管理危险处理/组织和管理美国妊娠

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A model for multidisciplinary peer review and supervision of behavioral health clinicians

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COMMUNITY MENTAL HEALTH JOURNAL 1999年第4期35卷 361-365页

作者： Gillig, PM Barr, A Wright State Univ Sch Med Dept Psychiat POB 927 Dayton OH 45401 USA

The authors describe a semi-annual program for multidisciplinary peer review and supervision that is in use at two rural adult and child mental health and drug and alcohol service agencies. The program incorporates semiannual chart reviews and face-to-face discussions held with each clinician by a multidisciplinary supervisory group. Several quality improvement issues addressed by this program are described, including improved communication, improved clinical diagnosis, the establishment of service parameters, more appropriate referrals for psychiatric and other medical care, and improved clinician skills. The program represents an inexpensive approach to peer review and supervision that can incorporate university-based consultants, improve quality of care, improve clinicians' skills, and be readily applied by clinical supervisors to most behavioral health settings.

关键词：行为疗法/标准医学审核/方法精神卫生服务/组织和管理精神卫生服务/标准模型组织管理病人医疗小组/标准同行评议卫生保健/方法专业能力/标准乡村卫生服务/组织和管理乡村卫生服务/标准物质滥用治疗中心美国成年人儿童人类

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The malcontent or disruptive physician: some practical problems.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1989年第3期11卷 12-13页

作者： Griffith, R.L. Health Law Section Cantey & Hanger Fort Worth TX

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Quality improvement in a managed care organization from a medical director's perspective: an interview with Bruce Perry. Interview by Douglas Roblin.

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The Joint Commission journal on quality improvement 2000年第10期26卷 601-610页

作者： Perry, B. Research Scientist at Kaiser Permanente Atlanta Member of The Joint Commission Journal on Quality Improvement Editorial Advisory Board

BACKGROUND: In late 1994 the Quality Forum commissioned the Interdisciplinary Prevention Committee [IPC]. One of the IPC's charges was to identify priorities for QI in preventive health services. The IPC established priorities through a review of scientific literature, identification of national and state health initiative priorities, and consideration of what services to establish as priorities and of the practicality of implementing low-cost interventions to achieve specific QI goals. Breast cancer screening was selected as a top-ten priority for guideline development and for focused intervention because of the disease's prevalence, morbidity, and mortality and because of the fact that it is most treatable and curable when it is found early through routine screening. The national HEDIS (Health Plan Employer Data and Information Set;National Committee on Quality Assurance (NCQA), Washington, DC] result of 71%, reported in May 1995, provided our baseline performance measurement. This result fell short of our goal of being in the 90th percentile of performance on each HEDIS effectiveness of care measure. In August 1995 the Quality Forum accepted the IPC's recommendations, which had been endorsed by the department of medicine. These recommendations emphasized the importance of annual clinical breast exam and mammography for women of targeted age groups. In November 1997, a new "Excellence in Quality: HEDIS Improvement Team" began work. Its charge was to undertake analyses of underlying causes of reduced performance and to develop additional steps to improve performance by changes in care delivery processes in 1998. In March 1998 the Quality Forum's executive committee designated breast cancer screening one of the six organizationwide quality priorities for 1998 and designated two "owners" who would be accountable for this performance--the chief and director of radiology. RESULTS: The screening rate increased from 73.8% in 1996 to 84.0% in 1999. National benchmarks [90

关键词：佐治亚健康维护组织/标准卫生服务/标准病人医疗小组/标准病人满意度医生行政负责人/标准预防卫生服务/标准初级卫生保健/标准卫生保健质量/组织和管理安全/标准全面质量管理/组织和管理儿童女(雌)性人类男(雄)性

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