Journal of quality in clinical practice
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In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. ⋯ Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.
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Randomized Controlled Trial Clinical Trial
Outcome evaluation of early discharge of asthmatic children from hospital: a randomized control trial.
The objective of our study was to compare the safety and efficacy of discharging asthmatic children from hospital on three versus four hourly nebulized salbutamol. The setting was a tertiary referral paediatric hospital in Sydney, NSW, Australia. The design was a randomized controlled parallel group study. ⋯ Discharge of asthmatic children from hospital on three hourly nebulized salbutamol is as safe and effective as on four hourly. Parents are generally very satisfied with timing of discharge, irrespective of frequency of nebulization. Earlier discharge benefits both the child and their family, and improves hospital bed utilization.
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Clinical pathways have been introduced in many hospitals with the aims of improving efficiency, reducing costs, and improving the quality and outcomes of care. However, there is a shortage of research evidence regarding the extent to which they do in fact achieve such aims. This paper describes the development and testing of a patient-perceived quality-of-care questionnaire for use in relation to the assessment of clinical pathways. Issues of validity and reliability are addressed and illustrative examples of results for two pilot hospitals are presented.
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A 1 year (1995) retrospective audit of all patients who were discharged or died, with a primary diagnosis of acute myocardial infarction (AMI) was conducted at Auburn Hospital, a level 4 district hospital in Sydney's western suburbs. After their first echocardiogram (ECG), 21 patients of 129 patients who had a primary diagnosis of AMI in the Emergency Department at this time were given thrombolytic therapy. For eight patients there was a time delay of over 60 min to commencement of thrombolytic therapy. ⋯ This study highlights areas of unnecessary delay in patients receiving thrombolytic therapy and shows that these delays can be reduced by the implementation of relatively simple strategies by medical and nursing staff. Time delays from the development of symptoms (usually chest pain) to arrival at triage were recorded when such a time was specified in the clinical notes. The median delay from the development of chest pain to triage was 73 min.
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For nearly 50 years there has been an independent system for monitoring all maternal deaths in the United Kingdom. Validation exercises suggest that about 99% of cases are successfully identified and reviewed. ⋯ Review of particular causes of deaths suggests that the regular stating of the problem areas, developing management guidelines relating to these, and re-auditing practice, almost certainly has improved standards. However, more remains to be done.