Indications For Hospitalization Research Articles

Complications of Hyperemesis Gravidarum; A Disease of Both Mother and Fetus, Review Article

Hyperemesis Gravidarum (HG) is the most severe form of nausea and vomiting during pregnancy and is characterized by severe intractable nausea and vomiting that lead to many maternal and fetal consequences. HG is mainly diagnosed clinically; most of the physicians diagnose it by its typical clinical picture and exclusion of other causes of nausea and vomiting in the pregnant woman. Nausea and vomiting are a disease of high prevalence among pregnant women and it is a common experience affecting 50-90% of all women. It is the most common indication for hospitalization during the first half of pregnancy. HG occurs in only about 0.5-2% of cases but actually, when it occurs it may be associated with morbidity of both mother and fetus. Adequate replacement therapy and weight gain may prevent most of the maternal and fetal consequences. Pregnant women with HG may suffer marked psychosocial burden. Moreover, the condition may be complicated by electrolyte imbalances, nutritional deficiencies, and Wernicke’s encephalopathy. Other complications include thrombosis, esophageal trauma, cerebral vascular spasm, others are related to TPN and central venous lines. Besides, recurrence of HG in subsequent pregnancies may occur. Offspring of pregnant women with HG may suffer long-term conditions which include high serum cortisol, decreasing insulin sensitivity, high risk of mood and psychiatric problems. Studies showed no significant increase in the incidence of congenital anomalies among these neonates versus the control group. Regarding cancer, the large Scandinavian study found no association between HG and incidence of 12 types of childhood malignancies, only increased the incidence of lymphoma and testicular tumor was found which need further studies to confirm this causal relation. Besides, higher incidence of preterm labor, placental abruption, preeclampsia and small for gestational age were found in these patients. Further studies are needed to determine long-term maternal complications and to study long-term effect of HG on the mental and physiological status of offspring of HG mothers during adulthood.

Analysis of the NASH Efficiency Indicators in Brazilian Federal University Hospitals via Business Intelligence

The hospital area is constantly in need of care and attention. Because of its urgencies, it has vulnerabilities and risks that hinder the quality of hospital management. Technological management tools are effective in improving processes and strategic administration because they provide information reliability. The aim of this work is to propose to the Brazilian’s Federal University Hospitals (BFUHs) and to the Brazilian Hospital Services Company (BHSC) the use of an open source Business Intelligence (BI) tool, Pentaho, to analyze the efficiency of Hospital Indicators (HIs) and to support the clinical decision-making. This paper describes BI and Pentaho, as well as the main points of the efficiency documentations established by the National Agency of Supplementary Health (NASH), with emphasis on the HIs: Hospital Occupancy Rates (HORs) and Averages Length of Stay (ALSs). The Pentaho does the data extraction and the transformation, as well as loading them into the Data Warehouse (DW), all based on a relational database from BHSC. After that, dimensional cubes are created for the generation of graphic panels in dashboards. Most BHSC hospitals are not yet adequately using their operational beds and neither managing correctly the average length of hospitals patients stay, being outside the goals established by NASH. Several steps are taken to achieve efficient hospital administration. However, the joint working of Information and Communication Technologies (ICTs) solutions with the health area and its standards provides a major step towards efficient hospital management.

Relating Outcomes to Processes of Care: The Maryland Hospital Association’s Quality Indicator Project (QI Project®)

The Maryland Hospital Association's Quality Indicator Project (QI Project) is a program of indicator development and application that has grown from 7 hospitals in 1987 to more than 700 hospitals today. Expert panels help to create sets of indicators that describe events involved in a specific sequence of patient care. Each hospital collects data elements for the 21 indicators on a quarterly basis using specifically designed data-collection software. Indicator data are adjusted for case complexity, risk of adverse outcomes, and patient group characteristics. A report is developed that states the rate of occurrence of each indicator and how the hospital's indicator rate compares to other hospitals in the database. Hospitals then use this information to determine if specific processes in their delivery of care yield results that deviate from those of other hospitals. The QI Project promotes regional sharing of information about specific hospital initiatives that might benefit other participants. It also provides a model to use in interpreting what the indicator data reveal about hospital performance. QI Project is testing process indicators for patient-level and service-level data to supplement current aggregate-level trend and profile analysis. Indicator data are shared solely with participating systems, but changes in the confidentiality policy are being studied. Reliability assessment surveys are periodically conducted. Case studies portray improvement of processes prompted by indicator data for unscheduled admission following ambulatory surgery, for surgical wound infections, and for reducing emergency room waiting times. The chief contribution of the QI Project and similar projects may not be that they identify all issues of quality, but rather that they may help develop a generation of hospital professionals who will be better able to quantify, evaluate, and improve health care quality.