Care In Hospital Environment Research Articles

Exploring the barriers and gateways to intersubjectivity in dementia care: A meta-ethnography.

Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline (France et al., 2019).

Experimental investigation of human tenability and sprinkler protection in hospital room fires

SummaryThe effectiveness of sprinklers in protecting hospital patients in the room of fire origin was investigated by 14 experiments with a residential‐grade sprinkler system, and by two free‐burns. The fire load was UL 1626 corner fire. Tenability conditions were evaluated for the UL 1626 corner fire using gas temperature and species concentration measurements, and by calculating the fractional effective dose (FED) and fractional irritant concentration (FIC) with the comprehensive model of Purser and a more simplified method of ISO 13571. In the sprinklered tests, the average FED at 15 minutes was 0.8 ± 1 with 95% confidence, when using the Purser's method, and 0.2 ± 0.2 with ISO 13571. The difference was mainly caused by the assumption in the Purser's method that all NOx gases behave like NO2. Ignoring the NO contributions decreased the Purser's FED values very close to those of ISO 13571. In nonsprinklered tests, the FED and FIC values indicated definite incapacitation and possibly death 3 minutes after ignition. The sprinklers effectively increase the possibility of surviving, but the toxic effects may still be dangerous. In hospital and health care environments, many of the exposed persons may have lower‐than‐average tolerance.

Dignity-Contributing Factors In Clinical Care Settings: A Multisite Qualitative Descriptive Study

<p><strong>Background.</strong> The illness treated in hospital care environment increases the risk for loss of patient’s dignity. Hence, simultaneously preventing risk of losing dignity and maintaining patient dignity is important. Nevertheless, maintaining patient dignity depends on the knowledge of the factors influencing it. The present study aimed to explore the factors associated to dignified care in clinical care settings.</p><p><strong>Method.</strong> The study design was a multisite qualitative descriptive. This study was a multisite study conducted in six general hospitals located in East Java, Indonesia. The participants involved were 40 clinical nurses recruited from 36 medical and surgical wards. Data were analyzed using inductive content analysis.</p><p><strong>Results.</strong> Three main overarching categories contributing dignity care: nurse related factors involving commitment, competency and self-control; patient related factors involving personal traits and perception of care; and organization related factors involving staffing level and tangible resources.</p><p><strong>Conclusion</strong>. The study adds the understanding of factors contributing dignity gathered from healthcare provider viewpoints. These factors could act either as dignity-promoting factor or dignity-threatening factor. Our findings expanded the operationalization of the three areas as potential elements which could act as means to enhance dignity in care.</p>

Continuous Temperature and Humidity Monitoring Using Sensors Within an External Male Incontinence Device over 12 Hours of Wear-time

<h3>Background</h3> Skin maceration and tissue breakdown, with subsequent infection, have been long-standing challenges in hospital and long-term care environments. In this regard, we sought to devise a trial that accurately measures temperature and humidity within the skin-exposed environment of a male anatomy urine collection device. <h3>Methods</h3> A device was engineered to allow air flow and yet allow for male anatomy urine collection without a catheter in order to mitigate skin exposure risks and a novel study design using state-of-the-art sensors within the device generated robust data for 24 adult males continuously over 12 hours period in a simulated clinical setting. Weight, height, age, ingested food and liquids, along with type, frequency and volume of liquid intake, frequency of urination, and volume of urine were all documented. The sensors precisely logged temperature and humidity data from within the skin-exposed environment of the device. <h3>Results</h3> The data yielded a mean temperature of 31.09°C (88°F) [Standard Error-of-the-Mean (SEM) = 0.01; SD = 1.90; range: minimum = 23.80°C and maximum = 35.40°C] and a mean relative humidity of 54.79% [SEM = 0.13; SD = 23.31; range: minimum = 24.70% and maximum = 100.00%]. Mean temperature and relative humidity within the system stabilizes over a12-hour period to produce a skin-exposed environment for male anatomy with a mean temperature of 31.09°C (88°F) and a mean relative humidity of 54.79%. <h3>Conclusions</h3> Study findings demonstrate that an external urine management system designed for male anatomy, after 12-hours of continuous wear, was able to predictably provide a skin-exposed environment for temperature and relative humidity within the device. Since the device is designed to mitigate the risk for tissue maceration and skin breakdown in a relatively enclosed environment, this novel methodology yields evidence to support continuous wear-time in the clinical setting.

Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial.

BackgroundChildren with autism spectrum disorder (ASD) frequently demonstrate aggression and externalizing behaviors in the acute care hospital environment. Pediatric acute care nursing staff are often not trained in managing aggression and, in particular, lack confidence in preventing and managing externalizing behaviors in children with ASD. High-fidelity simulation exercises will be used in this study to provide deliberate practice for acute care pediatric nursing staff in the management of aggressive and externalizing behaviors.ObjectiveThe purpose of this study is to conduct a pilot and feasibility cluster randomized controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalizing behaviors of children with ASD in the hospital setting.MethodsThis study has a mixed design, with between-group and within-participant comparisons to explore the acceptability and feasibility of delivering a large-scale cluster RCT. The trial process, including recruitment, completion rates, contamination, and completion of outcome measures, will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism, with or without intellectual disability, who displays aggressive and externalizing behaviors and the resulting change in confidence in managing clinical aggression. Two pediatric wards of similar size and patient complexity will be selected to participate in the study; they will be randomized to receive either simulation-based education plus web-based educational materials or the web-based educational materials only. Change in confidence will be assessed using pre- and posttraining surveys for bedside nursing staff exposed to the training and the control group who will receive the web-based training materials. Knowledge retention 3 months posttraining, as well as continued confidence and exposure to clinical aggression, will be assessed via surveys. Changes in confidence and competence will be compared statistically with the chi-square test using before-and-after data to compare the proportion of those who have high confidence between the two arms at baseline and at follow-up. The simulation-based education will be recorded with trained assessors reviewing participants’ abilities to de-escalate aggressive behaviors using a validated tool. This data will be analyzed using mean values and SDs to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected during each shift for the duration of the study to assess the number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed, with both datasets analyzed using descriptive statistics.ResultsThis study gained ethical approval from The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) on November 1, 2019 (HREC reference number: 56684). Data collection was completed in February 2020. Data analysis is due to commence with results anticipated by August 2020.ConclusionsWe hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care pediatric nurses. We anticipate that the intervention ward will have increased confidence in managing clinical aggression in children with ASD immediately and up to 3 months posttraining.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976; http://www.ANZCTR.org.au/ACTRN12620000139976.aspxInternational Registered Report Identifier (IRRID)DERR1-10.2196/18105

Experiences and views of different key stakeholders on the feasibility of treating cancer-related fatigue

BackgroundAlthough cancer-related fatigue (CRF) has gained increased attention in the past decade, therapy remains a challenge. Treatment programs are more likely to be effective if the needs and interests of the persons involved are well represented. This can be achieved by stakeholder engagement.In this paper, different key stakeholders’ experiences and views on the feasibility of treating CRF in the context of supportive care in hospital environments are analyzed.MethodIn a qualitative study with the aim of developing an integrative treatment program for CRF, a total of 22 stakeholders (6 medical oncologists, 5 nurses, 9 patients, 1 patient family member, 1 representative of the Swiss Cancer League) were interviewed either in a face-to-face (n = 12) or focus group setting (n = 2). For data analyses, the method of qualitative content analysis was used.ResultsThe stakeholders referred to different contextual factors when talking about the feasibility of treating CRF in the context of supportive care in hospital environments. These included: assessment, reporting and information; treatability; attitude; infrastructure, time-management, costs and affordability; and integrative approach.ConclusionsKey factors of a feasible treatment approach to CRF are a coherent, cost effective integrative treatment program facilitated by an interdisciplinary team of health care providers. Furthermore, the treatment approach should be patient orientated, adopting an individualized approach. The major challenges of making the integrative treatment program feasible for CRF are resources and interprofessional collaboration.

First detection of vanB phenotype-vanA genotype vancomycin-resistant enterococci in Egypt.

Enterococci have emerged in last two decades as serious hospital acquired pathogens particularly vancomycin resistant strains (VRE). The study aimed to identify the prevalence of enterococcal isolation from hospital infections and colonization as well as determine vancomycin resistance phenotypes and genotypes. Sixty enterococcus isolates were isolated from patients, health care workers and hospital environment, identified and tested for antimicrobial susceptibility. Enterococcus species were identified by Real-time PCR and vancomycin resistance was assessed by agar dilution method and Real-time PCR. out of 300 samples (20%) were enterococci (53.3% were E. faecium, 31.7% E. faecalis and 10% other enterococci). Among of them 40/60 (66, 6%) were isolated from infections and 33.3% were isolated from colonization. multiple drug resistance was reported in (100%) of isolates, while (95%) and (45%) of isolates were resistant to vancomycin and ticoplanin respectively. VanA phenotype, vanA genotype was identified in (47.4%) of isolates, while vanB phenotype, vanA genotype was identified in (33.3%) of vancomycin resistant isolates. VanB phenotype-vanA genotype was identified in (33.3%) of vancomycin resistant enterococcal isolates. To our knowledge it is the first identified incidence of such strains in Egypt and Africa.

Extended spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak reveals incubators as pathogen reservoir in neonatal care center

In the context of a 3-month extended-spectrum beta-lactamase-producing Klebsiella pneumonia (ESBL-KP) outbreak in a neonatal care center (NCC), hygiene practices and hospital environment were investigated. ESBL-KP strains isolated from patients and environment were compared by molecular typing. The density of incidence of multi-drug-resistant bacteria (MDRB) was calculated from January 2014 to September 2016. The 3-month ESBL-KP outbreak involved 19 patients. Clinical strains from the 19 patients displayed the same molecular profile between them, and with a strain isolated from an incubator after cleaning. Furthermore, 52.4% of incubator mattresses were positive for diverse pathogens. Hygiene practices were acceptable except for external practitioners and parents. In addition to classical infection control (IC) measures, the replacement of mattresses and the improvement of incubators disinfection stopped the outbreak. The protocol of disinfection was revised and microbiological control was implemented. A significant decrease of MDRB incidence was concomitant (p value = 0.03219) but 3months later, MDRB incidence increased again.Conclusion: This investigation highlighted incubators and mattresses as critical materials associated to infectious risk in NCC. NCC and IC teams should implement efficient protocol for incubators disinfection and monitoring. What is Known: • Environment in neonatal intensive care units is often suspected as reservoir for Enterobacteriaceae outbreaks but is scarcely investigated. • Incubators and mattresses offer wet and warm conditions suitable for pathogens multiplication, but microbiological survey is not performed routinely for assessing bacterial contamination. What is New: • Incubators and mattresses serve as reservoir for pathogens and relay in outbreak. • An infection control protocol associating efficient disinfection and microbiology analysis is proposed.

Using survival analysis to predict septic shock onset in ICU patients

PurposeTo determine the efficacy of survival analysis for predicting septic shock onset in ICU patients. Materials and MethodsWe performed a retrospective analysis on ICU cases from Mercy Hospital St. Louis from 2012 to 2016. As part of the procedure for inclusion in the Apache Outcomes database, each case is reviewed by critical care clinicians to identify septic shock patients as well as the time of septic shock onset. We used survival analysis to predict septic shock onset in these cases and employed lagging to compensate for uncertainties in septic shock onset time. ResultsSurvival analysis was highly effective at predicting septic shock onset, producing AUC values of >0.87. The methodology was robust to lag times as well as the specific method of survival analysis used. ConclusionsThis methodology has the potential to be implemented in the ICU for real time prediction and can be used as a building block to expand the approach to other hospital wards or care environments.

Secure Monitoring of Patients With Wandering Behavior in Hospital Environments

Today there is considerable interest for making use of the latest technological advancements for several healthcare applications. However, there are several challenges for making use of different technologies for healthcare applications. In particular, there is a need to ensure that the healthcare related services receive priority during events, such as legitimate failures of devices, congestion, and attacks in the networks. In this paper, we discuss some of the requirements for making use of technology for healthcare applications and propose techniques for secure monitoring of patients with wandering behavior in a hospital or elderly care environment. One of the aims of our work is to use technology for secure monitoring of patients with wandering behavior to keep them away from danger, or detect if the behavior of the patient violates the policies of the hospital, or even violates privacy policies of other patients. Our approach makes use of software defined networking (SDN), Wireless LAN (WLAN), and wearable devices for the patients. Our approach incurs low cost since WLAN is widely deployed. However, there are some challenges for making use of WLAN for monitoring dementia patients, since it is primarily used for accessing the Internet and its open nature is vulnerable to different types of security attacks. Hence we make use of SDN to solve some of these challenges and provide priority for the monitoring services. We have developed a security application for an SDN controller that can be used to enforce fine granular policies for communication between the hosts, real time location tracking of the patients, and deal with attacks on the hospital networks. The policy-based security enforcement helps to differentiate healthcare related traffic from other traffic and provide priority to the healthcare traffic. The real time location tracking detects wandering by patients and if necessary can raise alarms to the staff. The attack detection component makes use of attack signatures and behavior-based intrusion detection to deal with attacks on hospital networks. We will also present the prototype implementation of our model using ONOS SDN controller and OpenFlow Access Points.

Learning from the development of Integrated Care Projects in Dementia

Introduction: Due to demographical shifts and potential high demand for care, increased attention and leadership around dementia care within acute hospital services is anticipated. This is of particular concern due to potential barriers to timely patient flow associated with this cohort of vulnerable service users. This paper aims to report on scope and nature of service delivery reform needed to achieve integration in dementia care within the acute hospital sector. Methods: Three acute hospital sites are included in the analysis, with data collected pre-implementation of the ICP. An audit of hospital organisation/environment and case notes was conducted. Ethical approval was secured from the Faculty of Health Sciences Research Ethics Committees in Trinity College Dublin and relevant hospital Ethics Committees. Results: There was a high level of commitment and enthusiasm amongst service providers for dementia care and the development of an ICP. Data revealed the high demand for dementia-sensitive care and a number of gaps in service provision including absence of formalised dementia care pathways, inconsistent inreach/outreach arrangements between hospital and community, lack of standardisation in documentation and assessment and absence of formal system to alert personnel of dementia diagnosis. Gaps at an environmental and ward level such as reduced staffing levels were noted. The physical limitation of hospital as a suitable care environment for PwD was also highlighted. Areas for improvement to be addressed included colour schemes to allow PwD to find their way around the ward and clear marking of key areas. Pressure on resources and the need for active management of patients were highlighted as potential barriers to dementia care. A number of obstacles to optimal and timely patient flow were detected. The need for a central record was one of the most important aspects of early learning. Difficulties within the journey of care were highlighted including, for example, difficulties in assessment, delays in resolving capacity issues, high level of movement of patients within the hospital, and insufficiency in suitable community care provision. Discussion: Findings highlight the significant and wide reaching reforms needed in all aspects of service delivery so the hospital care environment may be optimised to meet the needs of PwD. Such reform necessitates a coherent dementia strategy within hospitals so the environment, care processes and staff are appropriately responsive to the needs of PwD. Considerable investment of time and resources is needed to fully understand the systems and processes that underpin the quality of integration in dementia care. The implementation of the proposed ICP is a lengthy and onerous process and there is significant change yet to be implemented within the three sites. These findings will inform the respective development and implementation process. Conclusion: The findings outlined here provide an important comparison for assessment post-implementation of the ICP across all sites. There is significant early learning from the data, both on a national and international level, in relation to the development and implementation of ICPs in an acute hospital setting, with critical barriers to same highlighted.

Hospital transfusion medicine committees – problems and pitfalls

Hospital Transfusion Medicine Committees (TMCs) are multidisciplinary committees that provide oversight of a variety of clinical activities as they pertain to transfusion medicine and patient care in hospital environments. Across the globe, there are many different standards that provide guidance on the goals, structure and function of hospital transfusion medicine committees but these are not always implemented in the same manner. This review will highlight some of these standards and undertake a high‐level review of the similarities and differences. Awareness of common barriers to success for TMCs will allow strategies to be developed locally to ensure that the TMC functions in the most effective manner to provide high‐quality transfusion medicine care to patients.

Abstract TP366: Improving Transitions of Care with a Daily Rounding Tool

Background: Patients who experience acute stroke often have complex discharge planning needs that impact transitions of care. The hectic acute care hospital environment is not always conducive to addressing these needs in a standardized fashion. Purpose: To improve communication among team members and identify potential post-acute needs early in the hospital stay. Ultimately we hoped to have a positive impact the readmission rate and the patient experience. Methods: We designed a structure for daily rounds, identifying who would attend, setting clear expectations, and having a consistent schedule. We piloted a paper based check list that would serve as a guide to the dialogue during daily rounds to ensure that the team addressed key issues in a step wise, standardized fashion. This process also included the patients and families and their goals of care. Results: Readmissions were reduced from 15.4% to 10.9%. HCAHPS scores improved, specifically "Discharge Information" from 70% to 94% and "Communication with Nurses" from 46% to 83%. Conclusions: For a patient population with complex discharge needs, transitions of care can be improved by implementing a daily rounding checklist. This could positively impact the readmission rate and the patient experience.

Distracted Practice: A Concept Analysis.

Distracted practice is a growing concern for all healthcare professionals working in today's complex, technology-rich, acute care hospital environment. Distractions are a threat to patient safety, frequently cited as a contributing factor when reporting an adverse event. The number of new technologies introduced to the healthcare environment has significantly increased the number of distractions. Shrinking resources and the resultant time pressure placed on all practitioners has added to the list of human factors known to be contributing to potential errors. Delivering safe, quality care in this environment has now become a daily challenge for all members of the healthcare team. Distracted practice was found to have no consistent definition in the healthcare literature. Walker and Avant's method of concept analysis was used to develop a preliminary definition and model of distracted practice. This analysis includes a definition, characteristics, antecedents, and consequences of distracted practice. More research is needed to fully understand this critical human experience of distracted practice. With additional knowledge we will be able to raise awareness and create interventions to reduce its occurrence among members of the healthcare team. This will positively contribute to the team's efforts to keep all our patients safe while in the hospital. D'Esmond.

Antibacterial Effects of Extracts of Pinus sylvestris and Picea abies against Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Streptococcus pneumoniae

Pine heartwood, sapwood, and spruce extracts were tested against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis (VRE), Escherichia coli O157:H7, and Streptococcus pneumoniae. The bacterial strains were cultured in a broth with and without the wood extracts. Also, the antibacterial effect of the extracts was studied by performing the antimicrobial sensitivity test method on agar plates. Both pine extracts had a clear antibacterial effect on MRSA, VRE, and S. pneumoniae. Only pine sapwood extract had an effect on E. coli and it was weaker than on other strains. Spruce showed a clear antibacterial effect on S. pneumoniae and a weaker effect on MRSA and VRE. The results suggest that these wood species have potential as surface materials in hospital and day care environments.

Abstract 228: Heart Failure Self-management: Engaging Social Networks in Symptom Evaluation

Aims: The aim of this project was to describe patient perceptions of seeking lay advice in symptom evaluation prior to hospitalization for acute decompensated heart failure. Methods: Semi-structured interviews were conducted with 90 patients hospitalized for acute decompensated heart failure. Frequencies and Chi-square tests were used to characterize patient perceptions of lay consultations for symptom evaluation before hospitalization. Results: Seventy-five (83.3%) patients consulted persons in their social networks about symptoms before hospitalization. Forty-six (52.3%) patients received symptom attributions from their lay consultants, and most often lay consultants identified cardiac causes for patients’ symptoms (n=35, 76.1%). Sixty-six (76.7%) patients received advice about what to do for symptoms; most often that advice was to seek medical care (n=55, 83.3%). Lay consultants who identified causes for patients’ symptoms more often gave advice on what to do about symptoms than those consultants who did not provide symptom attributions (95.7% vs. 75.0%, p&lt;.0008). Overall, women consulted with adult children about their symptoms significantly more often than men (48.0% vs. 8%, p≤.0001). Among patients who were married, women (vs. men) more frequently consulted with adult children about symptoms (50% vs. 6.45%, p=.001). No other gender differences were found. Conclusions: Heart failure self-management is complex, and this study is a first step toward understanding how patients, with contributions from their lay consultants evaluate and manage their symptoms beyond the walls of acute care hospital environments. Findings have implications for designing community-based self-care interventions and effectively reducing re-hospitalizations.

Prevalence of Aspergillus Infections in Patients in a Tertiary Care Hospital in Navi Mumbai

The aim of this study was to determine the prevalence of Aspergillus infections among the patients attending at tertiary care hospital and Hospital environment in Navi Mumbai, India, from January 2014 to December 2014. Total 1785 samples were included in this study for prevalence of Aspergillus species. Out of which 251(14.06%) were positive for Aspergillus infection. Species wise distribution of Aspergillus, maximum numbers were A. niger 142 (56.57%), followed by A. fumigatus 62 (24.70%), A. flavus 35 (13.94%), A. brasiliensis 9 (3.59%) and A. terrus 3 (1.20%). Aspergillus infection prevalence in male patients was 3-fold higher than in female patients. Most infection occurred in age group 51 and above years.

Bacteriocin Typing of Staphylococcus Aureus Isolated from Different Sources in Ibb City , Yemen

A total of 207 specimens were collected from different sources including patients, health care staff and hospital environment in Ibb city, Yemen. The study used the bacteriocin produced from active producer strains in typing of Staphylococcus aureus. Depending on the morphological, cultural and biochemical characteristics, 54 (26.09%) isolates of Staphylococcus aureus were identified. An antibiotic sensitivity test was done for the bacterial isolates, and the results showed that there were multiple resistant antibiotics. The Staphylococcin production of these isolates has been detected by using wells assay. Fifty one isolates were Staphylococcin producer. Four isolates (staph19, staph25, staph28 and staph43) were chosen as good Staphylococcin producers, and used locally as indicators in bacteriocin typing. Depending on S. aureus typing, the isolates fell into (9) groups. The most numerous group was characterized by susceptibility to all four staphylococcin and comprised 61.11% isolates of S. aureus, while the lowest numerous were found in three groups with a ratio of 1.85%; the remaining groups had little percentages ranging from 3.70% to 11.11%. We observed that about (94.44%) of the isolates were bacteriocin producers, and among them, four isolates had a strong bacteriocin production. Based on typing, most isolates had one pattern.

The quality movement in hospital care

The purpose is to introduce the demand for the quality movement practice in hospital care. We show both the need and application of quality monitoring, especially the need monitoring activities having auto correlated data flows of which there are many in the hospital environment. The goal is to control the flow of quality care data in the dynamic behavior of these systems of acre in hospitals. These monitoring systems are designed to control and improve changes in the hospital care environment.

The Practices and Countermeasures of Appointment Registration in an Oral Speciality Hospital

AbstractThe appointment system in clinics is a service to facilitate the patients’ convenience. The problems existing in the practice of appointment registration, carried out by oral speciality hospitals, include: the intense disparity between supply and demand of oral medical centers, the long cycle of patient engagement; the high rate of appointments broken by outpatients, etc. In view of these problems, this paper proposes that medical organizations actively search for effective solutions, to boost the practice of clinical appointment registration, under the normal conditions of hospital operation and care environment, such as putting more efforts into the spot dissemination and guidance; buffering the disparity between supply and demand appropriately; arranging reasonable appointment cycles, and controlling the rate of appointment-breakage.