Hospital Accommodation Research Articles

“Ebilities” tourism: an exploratory discussion of the travel needs and motivations of the mobility-disabled

With the 1990 passage of the Americans with Disabilities Act (ADA) and the earlier Air Carrier Access Act, US marketers began to pay some attention to one of the most important but overlooked of all market segments. This article discusses the importance to the travel and tourism industry of the US disabled market, concentrating on the mobility-challenged travelers, which number 36 million (Murphy & Baig, 1997). Post-ADA literature regarding marketing to the disabled is reviewed and results are reported of a focus group with one support group attended by wheelchair-bound members and survey respondents attending an Abilities Expo. Data are also collected from general tourists, eleven percent of whom indicated that they have a physical disability. Survey respondents reveal that word-of-mouth, the Internet and travel guides serve as the most important sources of information when planning travel. The main special interests they pursue while vacationing involve nature activities, often participating in sports. A temporary disability or “slowing down” does not stop their enjoyment of travel, especially nature travel. Tourism operators, especially those involved with heritage and nature activities, should consider appealing to the mobility challenged, as they do not shy away from travel. They are, however, careful in planning their travel and are impressed by “personal inspection” of hospitality facilities and accommodation.

Retention of Key Employees in the Oilfield Service Sector

Abstract Prior to 1994 Core Laboratories offered its employees little in the way of company benefits. The company moved from being part of a multinational to an independently owned organization in 1994. At this time, there was recognition that if the newly created company was to be successful in a competitive environment then retention of its key employees was essential. A series of concrete measures were introduced in October 1994. This included health, long term disability and dental benefits and a profit share component to all employees. In addition, for key employees, discretionary bonuses for non-management employees, management incentive plans and stock options were introduced. This paper discusses the benefit and incentive plans, its cost and the impact it has had on the company's employees. Introduction Core Laboratories (Core) was formed in 1936 in Dallas Texas. In 1949, the company created its first international office-in Edmonton, Canada. During the next five decades the company expanded its overseas locations and now operates in more than 50 countries and has over 100 facilities worldwide. In 1984, the company was purchased by a multinational organization. Ten years later, in 1994, a management buy out of the company took place. In September 1995, the company became publicly traded. Prior to 1994, the company adopted local country benefit plans as stipulated by the Government of the day. The company at this time viewed the lack of or minimal benefits plan as a cost saving venture. The parent company did not take into account the affect on morale, employee retention and loyalty that these limited plans provided. The change of ownership in 1994 presented the opportunity for Core to re-assess its benefits package and introduce an incentive plan for its worldwide employees. Benefits In some countries of the world, health and dental services are provided free of charge while others provide limited or no benefits to its employees. It was these latter categories that Core wished to address. The benefits introduced to Core's worldwide employees were based upon modified Canadian and United States plans. Basic health care and hospital accommodations for the employee and dependents were introduced to all regions. This was compulsory for all employees. Core and the employee share the cost. Additional extended health care was introduced, on a voluntary basis, to cover items such as home nursing care, physiotherapy, etc. Both employer and employee again share the cost. Dental coverage was introduced at the same time and covers basic and major dentistry as well as preventative treatment. Two compulsory insurance plans were implemented. The first is life insurance, with all premiums paid by the employer. A voluntary life insurance is offered for further coverage for the employee and dependents. The second, a split cost between employer and employee is the long-term disability insurance. In the event of disability, 60﹪ of an individual's base salary is paid until they either return to employment or reach retirement age. The short-term disabilityis covered by internal procedures and is dependent upon length of service.

Hospital Length of Stay on a Diabetes Cluster Unit

To determine whether the length of hospital stay for patients with either a primary or a secondary diagnosis of diabetes mellitus can be reduced by use of a diabetes cluster unit. For a period of 12 months, we compared the length of hospital stay for 462 patients with diabetes who were admitted to a diabetes cluster unit and for 1,855 patients with diabetes who were admitted to the other medical and surgical units during the same period. Statistical analysis was done by comparing the calculated average length of stay for patients with primary and secondary diagnoses of diabetes admitted to both types of hospital accommodations and comparing these values with the expected lengths of hospital stay based on the New York Group Standard. The mean length of hospital stay for patients who were admitted to the diabetes unit for a primary diagnosis of diabetes was 5.8 days shorter than for those admitted to regular medical and surgical units (7.6 days or 1% below the expected duration versus 13.4 days or 70% longer than the expected duration, respectively; P<0.0002). For a secondary diagnosis of diabetes, patients in the diabetes unit had an average length of stay of 15.5 days (35% longer than the expected duration) in comparison with 17 days (45% longer than expected) for patients on the other medical and surgical units (no significant difference). For hospitalization of patients with diabetes, geographic clustering seems to reduce the length of stay for patients with a primary diagnosis of diabetes mellitus.

The cost consequences of changing the hospital-community balance: the mental health residential care study.

Altering the balance of provision between hospital and community care is a key and often contentious component of mental health care policy in many countries. Implementation of this policy in the UK has been slowed by the apparent shortage of suitable community accommodation for people with long-term needs for care and support. Among the consequences could be the silting up of hospital beds by people who could be supported more appropriately elsewhere, in turn denying in-patient treatment to people with acute psychiatric problems and unnecessarily pushing up health service expenditure. Using data collected in a survey of hospital and residential accommodation services and their residents in eight areas of England and Wales, the cost components of today's balance of care were explored. Comprehensive costs were calculated and their associations with resident characteristics examined using multiple regression analyses. On a like-with-like basis, the costs of hospital in-patient treatment for inappropriately placed patients greatly exceeded the costs of community-based care. Further reduction of hospital beds, however, is not the panacea for an appropriate balance of mental health care, given the unknown but potentially considerable extent of unmet demand, as well as the impact of previous in-patient bed reductions apparent in the services surveyed. Rather, service providers and purchasers should focus on developing community-based care (including increased provision of 24-hour nursed beds) by ensuring that resources released through earlier closure programmes have been redeployed for their intended use and by accessing additional pump-priming or bridging resources.

Daycare assessment and hypertensive disorders of pregnancy

Hypertension is a common problem occuring in around 12–15% of all pregnancies. It remains one of the major causes of maternal death. Because of its perceived risk and the difficulty in deciding who has a problem and who does not, obstetricians often admit a patient found to be hypertensive to hospital for closer observation. This “play safe” approach can cause much inconvenience to the patient and her existing family. The result of this policy is that pregnancy hypertension is responsible for around 25% of all antenatal admissions. It is a major burden on health service resources in terms of manpower and hospital accommodation. Inpatient management may vary between different hospitals but the cornerstone is to keep the patient in hospital in order to allow serial monitoring of blood presure. Strict bedrest has been suggested to have therapeutic value but this has never been substantiated. As some of these patients will progress to more severe forms of the disease, it is important that there is early recognition of any signs of progression.

I sold my soul for a rotten hole.

We read the report about nursing students paying exorbitant rents for hospital accommodation (Anger over 'totally unacceptable' rent levels, News, November 17).

Paediatric inter-facility transport: the parents' perspective.

A telephone survey was conducted to evaluate the impact on families of inter-facility paediatric transport to a tertiary care centre. The 54 families who responded were almost unanimous in their appreciation of the transport service and the expertise of the attendants. However, many experienced problems, including finances, child care, travel arrangements and accommodation. Most problems were encountered by those who did not accompany the child in the transport vehicle, lived at a distance so that they could not commute and did not use hospital accommodation. Further research is suggested to assess the extent of the problems families face and to determine appropriate solutions.

Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy

To compare operative laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women. Non-randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on-call medical team. Provincial undergraduate teaching hospital. 87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy between 1 March 1988 and 31 August 1989. Salpingotomy, salpingectomy, salpingo-oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy. Operative outcome, duration of surgery, intra- and post-operative complications, post-operative hospital stay, return to normal domestic activities, return to work, changes in plasma beta-hCG concentrations, health and social service costs. 60 women were treated by videopelviscopy on 65 occasions and the other 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post-operative hospital stay (1.7 vs 5.2 days), faster return to domestic activities (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P less than 0.001 for all). In economic terms, successful videopelviscopy was associated with a reduction in hospital accommodation costs by 69% (248 pounds vs 808 pounds), drug costs by 52% (8.38 pounds vs 17.57 pounds) and statutory sickness payment by 51% (130.25 pounds vs 266.51 pounds), that is an overall saving to the health and social services of 701.47 pounds or 50% per ectopic pregnancy (P less than 0.001). Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.

Postpartum Mothers' Preferences for Nighttime Care of the Neonate

This study, conducted in response to issues raised during implementation of a dyad care delivery system, investigated preferences of postpartum mothers for nighttime care of the neonate. For dyad as well as traditional care subjects, the availability of individual care options emerged as a theme in both personal preference and preference based on available hospital accommodation. Significant differences existed between dyad and traditional care subjects on second choices for nighttime care and on environmental variables.

Cost of Continuing-care Facilities in the Evaluation of Experimental National Health Service Nursing Homes

In this paper the costing method and results from the UK evaluation of National Health Service (NHS) nursing-home and continuing-care hospital accommodation for elderly people are presented. Results demonstrate that, in deciding on the relative efficiency of NHS nursing-home and hospital accommodation, it should be possible to provide NHS nursing-home care at a cost which is no greater than its hospital counterpart. Cost implications of future developments should be monitored in the possible event that they are set up differently from the NHS nursing homes discussed in this paper. Despite being more costly than private-sector nursing-home accommodation, NHS nursing homes cater for a less able group of people, although some overlap exists. The implications of such results are discussed in the light of the UK Government's recent proposals to reform both the NHS and community care.

Double poll tax charge could be abolished.

The double poll tax charge on property- owning nurses who rent hospital accommodation could be abolished, following a precedent-setting appeal last week.

Medicare Down Under: Bureaucracy Triumphant

Sunshine, beaches, the Harbour Bridge, the Opera House, theatre, art, music, oysters, beer, football, horse racing, and a favourable exchange rate—Sydney seems a tourist's paradise. We local physicians aren't sure that it's a paradise for us. Had this letter been written in the mid-1960s, it would have described a variety of health services that met the needs of all Australians and that remunerated physicians adequately. A letter in the mid-1970s would have described a new scheme that made little difference to health services, but considerably decreased general practitioners' incomes. This letter records the latest scheme, which has seriously damaged the delivery of health services and eroded the incomes of all physicians. Medicare, financed by a compulsory levy on income, started in 1983. It covers all charges at state hospitals and medical services at physicians' offices. Additional insurance for private hospital accommodation charges is permitted. But private insurance for physicians' fees

Selection for long-term hospital care.

A formalized system for selecting patients requiring long-term hospital accommodation is described and our first two years' experience presented. Fifty patients were considered by the panel of whom 25 were designated as being suitable to be transferred to a long-term bed. Alternative solutions were considered more appropriate for the remaining 25; only 0.95% of all admissions to the unit finally required long-term hospital care.

THE FIRST AMERICAN PLEA FOR A PERMANENT HOSPITAL FOR SICK CHILDREN (1852)

In 1852, James Stewart (1799-1864), under the pen name "Phiopedos," originated a plan for the establishment of a children's hospital in New York City. When the institution was opened on March 1, 1854, under the name of the New York Nursery and Child's Hospital, it was the only hospital on this continent devoted to children. (There had been a hospital devoted exclusively to sick children in Boston as early as 1846, but financial difficulties forced it to close after a few years.) "Philopedos" wrote1: It must be evident to all who will reflect upon the large amount of sickness there is among the children of the poor in our city [New York], that hospital accommodations for them are among its most urgent wants. In the dwellings of the very poor there is almost always .. absence of everything necessary for the ordinary relief of the sick, and especially of the unremitting attention that is needed by them. The necessity of constant occupation to obtain the means of existence, precludes the possibility ...of devoting any time to the requirements of the sick; and it is from this want of attendance, next to want of pure air, that children suffer most. For those who have the necessary comforts for the sick, or who have the time that they may bestow upon their families, when they most require it, dispensary attendance is sufficient for their wants in sickness; but when it is known that many children are absolutely destitute of all these—indespensable as they are—the necessity of proving well-ventilated accomodations is evident; a place where all the wants of the sick [child] may be supplied, and especially when personal care must form an essential pant of the arrangement;—a need only to be supplied by the establishment of a well-organized hospital....

Residential needs in hospital and the community for mentally handicapped people.

Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper "Better Services for the Mentally Handicapped" will be sufficient.

Improvements Needed to Hospital Accommodation for the Mentally Handicapped

Improvements Needed to Hospital Accommodation for the Mentally Handicapped

Planning of psycho-geriatric care. Report of a joint working party of geriatric physicians and psychiatrists.

Three Psychiatrists and three Geriatric Physicians working in a Regional Hospital Board area have investigated the problem of Psycho-Geriatric care. They have made suggestions with regard to areas of clinical responsibility based on needs and behaviour rather than precise academic diagnoses. They have investigated psychiatric and geriatric resources available in their areas, and They have made recommendations with regard to the total numbers of beds needed, but have not made precise recommendations about the numbers required for residential hostels, geriatric units or psychiatric hospital accommodation respectively.

13. Social aspects of rehabilitation: The hospital problem

IN hospital, patients are grouped according to their needs and not according to the cause of their disability. This is in order to make maximum use of the facilities that they require, both in terms of equipment and in human skills. The broad divisions within the hospital service are for patients suffering from acute illness, subdivided according to various specialties; old people and the younger chronic sick who require long-term hospital care, the mentally ill, and the mentally subnormal. People suffering from the aftereffects of head injury may require accommodation with the facilities of any of these groups. Numerically, although growing rapidly, the problem is still comparatively small: there are in hospital at the present time about 20 cases in the Birmingham region, from a population of 5 million people. There seems little justification for regarding them as a special group, or for providing special hospital accommodation in one place for them because wherever this were to be placed, it would create enormous difficulties for relatives who wished to visit them. At present, responsibility for many categories of handicapped people is divided between the hospital service and the local health or welfare authority, and according to the present regulations, once a patient no longer requires the particular facilities that a hospital can provide, and is able to live at home or in a hostel, he becomes the responsibility of the welfare authority. This is a purely artificial distinction but it may have serious repercussions because financial responsibility is divided. It may be impossible to decide in individual cases where the responsibility lies, and this may lead to dispute between the authorities concerned, each of whom have a vested interest in trying to get the other authority

COST AND COMPLEXITY OF MEDICINE

The cost and complexity of medicine are habitually exaggerated. Many of the most successful measures are simply achieved without hospital admission. More accommodation and ancillary staff are needed for those with senile dementia and mental illness. Otherwise, there is probably enough hospital accommodation, though the quality of much of it should be improved. We probably need more G.P.S but we do not need more of most kinds of specialist. The overvalued specialties include geriatrics, psychiatry, and physical medicine. Excessive investigation in hospitals is common; many outpatient visits are unnecessary; and nearly all routine medical checks are of insignificant value, and many cause needless anxiety.

DELAYED IN HOSPITAL

A survey in the hospitals of the Leeds and Otley area of patients who would ordinarily have been discharged but were still in hospital seven days later revealed a waste of beds, skill, and money. Routine registers relating to the discharge of patients, greater use of hostels, and a greater awareness of the increasing pressure of geriatric cases on hospital accommodation would help to overcome the present waste.