Internal Wards Research Articles

Content validity and internal reliability of Slovene version of Medication Administration Error Survey

Introduction: In Slovenia there is a lack of valid and reliable instruments for measuring medication administration errors. The aim of research is to determine the content validity and internal reliability of the Slovenian version of the ''Medication Administration Error Survey''. Methods: We used the translation and back translation tested the questionnaire for its content validity on the basis of an agreement of eight experts. Content validity was quantified by the content validity index and a modified Cohen kappa index. A cross-sectional design, with a convenience sample of 91 caregivers working in internal or surgical wards in two health care institutions, was used to test the internal consistency by calculating Cronbach's α and corrected item-total correlations. Results: 64 items showed an excellent content validity index, ranging from 0.875 to 1.000, and modified kappa index over 0.740. Two items had a content validity index 0.750 and modified kappa index 0.560. The average content validity index for three main parts of the questionnaire ranged from 0.940 to 0.959. Cronbach's α for these three parts ranged from 0.832 to 0.989. The corrected item-total correlations reached a required criterion for all items, except one. Discussion and conclusion: Instrument has an acceptable content validity and internal reliability, however, due to some methodological shortcomings results should be interpreted with caution. Further psychometric testing is needed.

A Comparison of Hospital Stressors and their Related Factors: From the Perspective of the Cardiac and Internal Wards’ Patients

Background: Stress is one of the human being’s predicaments in the current century which has extended its effects on various aspects of peoples’ lives. These unpleasant effects have indeed afflicted the patients even more and can aggravate their health status. Therefore, this study was conducted to examine the stressors inherent in the cardiac ward and internal ward of hospitals. Methods and materials: This cross-sectional study was carried out in Sistaan-va-Baluchestaan province, Zahedaan city in 2013 and all of the patients hospitalized in the cardiac and internal wards of the Khaatam Hospital and Imam Ali Hospital were taken as the population. Available sampling was used to extract a sample of 368 patients. Data was gathered by handing out a questionnaire produced by the researcher and the descriptive statistics, Chi-square, and ANOVA tests were used to analyze the data. Results: Analyses indicate that the mean of stressors in the internal and cardiac wards are 60.36 and 44.90 respectively which are statistically significant. The mean of stressors’ scores has a significant relationship with background factors such as level of education, hospitalization history, marital status, religion, and sex but did not render any significant relationship with other variables. Conclusion: Since stress may lead to the deterioration of the patients’ illness it is expected that the authorities detect the least stressors in hospitals and take action to moderate them. In this regard non-specialist units are in greater need for attention.

The association of serum procalcitonin and high-sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with respiratory symptoms: retrospective cohort study.

BackgroundSerum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms.MethodsWith a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney’s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker’s association with pneumonia diagnosis.ResultsFour hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5–179.0, vs 22.5 mg/dl, IQR 6.9–84.4, p < 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12–0.87, vs 0.15 ng/ml, IQR 0.10–0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72–0.79, p < 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels >61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35–5.48, p < 0.0001).ConclusionIn elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

Approaches for optimizing medical aid in acute ischemic stroke patients, hospitalized in UMHAT „Saint Marina` - Varna

In Bulgaria generally, treatment of acute ischemic strokes is done at the neurology wards and in smaller hospitals - in internal diseases wards, at intensive care wards in state regional hospitals; at ischemic stroke units and intensive care wards for treatment of neurological diseases at university hospitals. Between 2009 and 2013 in Varna, at the Neurology Clinic of UMHAT- St. Marina , a prospective research was carried out in view of optimizing the treatment of acute ischemic stroke (AIS) patients hospitalized at the clinic. After a stage-by-stage introduction into everyday clinical practice of innovative treatment methods, including intravenous thrombolysis and endovascular therapy of AIS patients, as well as organizational restructuring in view of optimizing the care for such patients, improvement in some of the quality indicators was observed.

Factors affecting the quality of hospital hotel services from the patients and their companions' point of view: A national study in Iran.

Background:The hospitality design of a hospital is a complex process that depends on careful planning, systematic thinking, and consideration of various factors. This study aimed to determine the viewpoints of patients and their relatives on factors affecting hospital hotel services in Iran in 2015. The results of this study can be used to design a suitable model for the assessment and improvement of hospitality service quality.Materials and Methods:In this cross-sectional descriptive study, 10 hospitals of Iran were included. The subjects of the study included 480 patients and their companions from different internal and surgical wards. Simple random sampling method was performed at the hospitals, where patients were selected through stratified sampling based on hospital wards, and in each ward, through systematic sampling based on the bed numbers. A researcher-made questionnaire was used as the study tool which was developed through reviewing the literature and opinions of experts. Its internal reliability was determined based on Cronbach's alpha coefficient (α =0.85).Results:In reviewing the eleven aspects of hospital hotel services regarding the patients’ and their companions’ viewpoint, services related to all aspects, whether human, economic, operational, personnel identification, safety, health care services, physical, clinical welfare, cultural, patient guidance, or public welfare services, received mean scores of higher than three (out of five).Conclusion:The present study showed that in the patients’ and their companions’ viewpoint, factors affecting hospital hotel services in the country are very important. The tool used in this study can be a criterion for assessing the status of the hotel services of the country's major hospitals, so accordingly, the assessment and improvement of the existing conditions can be possible.

Iranian patients' perspective of patients' rights: a qualitative study.

There is an increasing emphasis on "protecting patient rights", which has a great influence on the patient's well-being. This study aimed to explore patients' perspectives of patients' rights in the hospitals of Kurdistan University of Medical Sciences in Iran. This qualitative study used the content analysis method. The data were collected through in-depth interviews, conducted in Persian at the internal and surgical wards from 2012 to 2013. Consequently, interviews continued to be conducted on 20 patients, using content analysis, until data saturation. The findings highlighted aspects of patients' rights and five themes emerged from the interviews: having one's dignity respected, receiving care of the requisite quality, being shown financial consideration, receiving adequate information, and having a desirable and pleasant environment. The patients believed that for their rights to be upheld, it is necessary that together with the provision of enough facilities and equipment, they need to be respected and offered ideal healthcare services. This could be achieved by removing barriers and facilitating procedures.

Design and operation of strategic inventory control system for drug delivery in healthcare industry

Several factors such as the raise in healthcare expenditures impose growing pressures to improve efficiency in healthcare industry Industrial engineering and operations research can be effectively used at this aim. This paper examines the optimization of a hospital’s inventory costs where the central pharmacy of the hospital assumes a role of central decision maker for drugs’ purchasing and their distribution to internal wards. Inventory control strategies integrating combinatorial based mechanisms and classical inventory control has been developed in order to optimize inventory costs of drugs logistics. The developed work includes into the decisional model also a partial decisional independence of wards and the special requirements of drugs delivery. Results and tests of the model’s implementation on real data are reported to evaluate the goodness of offered tool and to discuss of potential real application.

The Graz Malnutrition Screening (GMS): a new hospital screening tool for malnutrition

Despite the significant impact of malnutrition in hospitalised patients, it is often not identified by clinical staff in daily practice. To improve nutritional support in hospitals, standardised routine nutritional screening is essential. The Graz Malnutrition Screening (GMS) tool was developed for the purpose of malnutrition risk screening in a large hospital setting involving different departments. It was the aim of the present study to validate the GMS against Nutritional Risk Screening (NRS) and Mini Nutritional Assessment-short form (MNA-sf) in a randomised blinded manner. A total of 404 randomly selected patients admitted to the internal, surgical and orthopaedic wards of the University Hospital Graz were screened in a blinded manner by different raters. Concurrent validity was determined by comparing the GMS with the NRS and in older patients (70+ years) with the MNA-sf additionally. According to GMS, 31·9 or 28·5% of the admitted patients were categorised as at 'risk of malnutrition' (depending on the rater). According to the reference standard of NRS, 24·5% of the patients suffered from malnutrition. Pearson's r values of 0·78 compared with the NRS and 0·84 compared with the MNA showed strong positive correlations. Results of accuracy (0·85), sensitivity (0·94), specificity (0·77), positive predictive value (0·76) and negative predictive value (0·95) of GMS were also very high. Cohen's κ for internal consistency of the GMS was 0·82. GMS proves to be a valid and reliable instrument for the detection of malnutrition in adult patients in acute-care hospitals.

Clinical features and characteristics of Clostridium difficile PCR-ribotype 176 infection: results from a 1-year university hospital internal ward study.

BackgroundClostridium difficile infection (CDI) is a major cause of antibiotic-associated diarrhoea. Given an increasing CDI incidence and global spread of epidemic ribotypes, a 1-year study was performed to analyse the molecular characteristics of C. difficile isolates and associated clinical outcomes from patients diagnosed with CDI in the Internal Medicine department at University Hospital Motol, Prague from February 2013 to February 2014.ResultsA total of 85 unformed stool samples were analysed and CDI was laboratory confirmed in 30 patients (6.8 CDI cases per 10,000 patient bed days and 50.6 CDI cases per 10,000 admissions). The CDI recurrence rate within 3 months of treatment discontinuation was 13.3% (4/30). Mortality within 3 months after first CDI episode was 26.7% (8/30), with CDI the cause of death in two cases. 51.9% of C. difficile isolates belonged to PCR-ribotype 176. MLVA of ribotype 176 isolates revealed two clonal complexes formed by 10/14 isolates. ATLAS scores and Horn’s index were higher in patients with ribotype 176 infections than with non-ribotype 176 infections.ConclusionThis study highlights the clinical relevance of C. difficile PCR-ribotype 176 and its capacity to spread within a healthcare facility.

Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts

AbstractIntroduction: Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care.The goal of the present study was to compare the time being devoted to professional – nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran.Methods: A descriptive- comparative study was conducted on 30 nurses (27 female, and 3 male) working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses’ activities,using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers’ agreement (The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test.Results: The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities (41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities). Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities (41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities).Conclusion: Nurses working in both 8 and 12 hours shift spend most of their times for professional activities (direct and indirect healthcare) and devote less time to nonprofessional activities (administrative and personal affairs), and these activities are independent of their shift durationKeywords: Working shift, Nurse, Direct nursing care, Indirect nursing care, Teaching hospital REFERENCES Admi H Tzischinslcy O Epstein R et al (2008). Shift work in nursing: Is it really a risk factor for Nurses health and patients safety?. Nursing Economics. 26 (4)250-256 Farquharson B (2013). How much time do nurses actually spend on patient care? An analysis of real-time data across medical and surgical wards. Avaible at: https://www.rcn.org.uk/__data/assets/pdf_ file/0019/512146/2013_RCN_research_3.1.3.pdf French L (1977). The Personal Management Process.6rd ed. Boston: Houghton Mifflin Co. Hagerty B, Spengler C.(1985). Work sampling analyzing nursing staff productivity. The Journal of Nursing Administration. 5(9) 13-20. Heslop L Power R Cranwell K (2014) Building workforce capacity for complex care coordination: A function analysis of workflow activity. Heslopet al. Human Resources for Health2014,12:52. Avaiable at:http://www. human-resources-health.com/content/12/1/52 Josten DC (2003).The effects of extended work days on fatigue, health, performance and satisfaction in Nursing. Journal of Advanced Nursing.44(6) 643-652. Kabiri F (1992) [ How nurses relate themselves to patients in the internal and cardiology wards of Tehran university]. M.S Thesis. Faculty of Nursing and Midwifery Shahid Beheshti University of Medical Sciences. (Persian). Liang Y, Chen W, Lee J & Huang L (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study BMC Health Services Research 2012, 12:44 Medical Dictionnary (2014). Avaible At: http://medical-dictionary.thefreedictionary.com/indirect+care. Accessed time: 9/24/2014. Puente LM, Rabbino H (2003). Creating value with strategic resources. Avaiable At:http://www.iseesystems. com/community/connector/Zine/SeptOct03/luz.html. Accessed time: 9/24/2014. Rogers AE, Hwang WY, Scott LS, Aiken LH, Dinges DF(2004). The Working Hours of Hospital Staff Nurses And Patient Safety. Avaiable at:http://content.healthaffairs.org/content/23/4/202.full. Accessed time 9/24/2014. Rostamipoor A(1986).[ Assessment of nurses non professional activities in Tehran hospitals ] M.S Thesis. Tarbiat Modarress university.(Persian). Shams Azad M (1995).[ Comparison of nurses’ productive hours in various wards of educational hospital in Tehran. M.S thesis. Shahid Beheshti University of Medical Sciences. (Persian). Safari M (2002).[ Impact of touching group discussion technique to nurses on the quality of care for myocardial patients]. M.S thesis. Tarbiat Modarress University. [Persian]. 1393 راهب ،84 هرامش ،24 هرود / 50 ناراکمه و یسیئر ناروپ Telles SCR, & Castilho V.(2007). Staff cost in indirect nursing care at an intensive care unit. Rev Latino-am Enfermagem. 15(5) 1005-9 Thompson P (2009). Health care financial management. Health Management Journal.63(1) 76-82. Westbrook JI Duffield C Li L & Creswick NJ (2011) How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals, BMC Health Services Research 11:319. Avaible at: http://www.biomedcentral.com/1472-6963/11/319 Williams M (1977).Quanification of direct nursing care activities. Journal of Nursing Adminstration. 7(8)15-8, 49-51.

Dietary supplement consumption among cardiac patients admitted to internal medicine and cardiac wards

Dietary supplements may have adverse effects and potentially interact with conventional medications. They are perceived as "natural" products, free of side effects with no need for medical consultation. Little is known about consumption of dietary supplements by patients with cardiac diseases. The objective of this study was to investigate dietary supplement consumption among cardiac patients admitted to internal and cardiology wards. Potential drug-dietary supplement interactions were also assessed. During a period of 6 months, patients with cardiac disease hospitalized in the Internal Medicine and Cardiology Wards at Assaf Harofeh Medical Center were evaluated regarding their dietary supplement consumption. A literature survey examining possible drug-supplement interaction was performed. Out of 149 cardiac patients, 45% were dietary supplement consumers. Patients ad-mitted to the Internal Medicine Wards consumed more dietary supplements than those admit-ted to the Cardiology Division. Dietary supplement consumption was associated with older age (OR = 1.05, p = 0.022), female gender (OR = 2.94, p = 0.014) and routine physical activity (OR = 3.15, p = 0.007). Diabetes mellitus (OR = 2.68, p = 0.020), hematological diseases (OR = 13.29, p = 0.022), and the use of anti-diabetic medications (OR = 4.28, p = 0.001) were independently associated with dietary supplement intake. Sixteen potential moderate interactions between prescribed medications and dietary supplements were found. Consumption of dietary supplements is common among cardiac patients. It is more common in those admitted to Internal Medicine Departments than in those admitted to the Cardiology Wards. Due to the risk of various drug-supplement interactions consumed by patients with cardiac diseases, there is a need to increase awareness and knowledge among medical staff regarding the intake of dietary supplements.

Thromboembolic disease and chronic obstructive pulmonary disease

Venous thromboembolism is still a leading cause of mortality and morbidity for hospitalised patients. While the awareness of the risk for thromboembolic complications for surgical patients is high, and effective prophylactic treatment is normally and systematically prescribed, the situation is very different regarding patients admitted in a internal medical ward. Only recently the usefulness of prophylactic treatment was recognised also for medical patients. A thromboembolic event can be a life threatening complication especially for people affected by chronic obstructive pulmonary disease (COPD) that represents a significant part of medical hospitalised patients. Moreover symptoms and signs related to the chronic pulmonary disease can be confusing factors that may delay a timely and correct diagnosis of a thromboembolic complication.

Assessment of nutritional status and feeding methods in patients with inflammatory bowel disease

Aim. The aim of this study was to evaluate diet of patients with IBD, their nutritional status and potential differences as compared to diet of healthy persons.Material and methods. The examination included the patients of Internal, Metabolic Diseases and Dietetics Ward and Gastroenterology, Internal Diseases and Human Nutrition Ward of Heliodor Święcicki Clinic in the Poznan University of Medical Sciences in Poznan. The criterion allowing participation into the study involved a diagnosed ulcerative or Crohn’s disease, basing on histopathology and radiological examination. The study was conducted on 50 patients, 25 women and 25 men. The control of group included 50 persons, 30 women and 20 men, potentially healthy and occupationally active. In the study the authors' own questionnaire was used, which contained questions related to diet and evaluating conditions of nutrition, based on the results of anthropometric measurements and selected biochemical parameters.Results. The study documented that IBD affected diet, which proved to be distinct from that of potentially healthy person. Course of the disease reduced some laboratory parameters in serum: decreased levels of total protein were detected in 40% patients, reduced levels of albumin in 28% patients and of haemoglobin in 72% patients with IBD. Most of patients introduced some modifications and dietary restrictions to reduce the symptoms and prolong remission. Presentation of such attitudes, indicates a need for an effective multidirectional education, which should affect a conscious decision making about the diet. The Body Mass Index and evaluation of nutrition demonstrated that IBD predisposed development of malnutrition: as compared to the control group, 28% of the patients manifested underweight.

Acute Ebola virus disease patient treatment and health-related quality of life in health care professionals: A controlled study

ObjectiveThis study aimed to identify predictors of health-related quality of life (HrQoL) and to investigate infection-related concerns in health professionals during the acute treatment episode for one Ebola virus disease (EVD) patient in tertiary care. MethodsIn a cross-sectional controlled study, validated self-report questionnaires were completed by three groups of health care professionals: (1) staff from standard internal medicine inpatient wards of a tertiary care center, (2) staff from the isolation unit of the same center responsible for Ebola patient treatment, and (3) staff from a research laboratory with contact to the Ebola virus and other highly infectious pathogens. Outcomes were HrQoL (SF-12), infection-related concerns, global health status, fatigue (FACIT), depression (PHQ-9), anxiety (GAD-7), and somatic symptoms (SSS-8). ResultsComparisons between groups (n1=42, n2=32, n3=12) yielded no significant differences in HrQoL, subjective risk of infection, and most other psychosocial variables. However, the Ebola patient treatment group experienced significantly higher levels of social isolation than both other groups. The best predictors of poor physical and mental HrQoL were perceived lack of knowledge about the Ebola virus disease (physical: B=−1.2, p=0.05; mental: B=−1.3, p=0.03) and fatigue (physical: B=−0.3, p=0.02; mental: B=−0.53, p<0.001). ConclusionEbola patient treatment in tertiary care does not seem to be associated with lower HrQoL and enhanced subjective risk of infection, but seems to yield feelings of social isolation in health-care professionals.

Colonization of methicillin resistant staphylococcus aureus (MRSA) strains in patients of internal ward in Imam Reza hospital in Bojnurd

Colonization of methicillin resistant staphylococcus aureus (MRSA) strains in patients of internal ward in Imam Reza hospital in Bojnurd

Physician experience and outcomes among patients admitted to general internal medicine teaching wards.

Physician scores on examinations decline with time after graduation. However, whether this translates into declining quality of care is unknown. Our objective was to determine how physician experience is associated with negative outcomes for patients admitted to hospital. We conducted a retrospective cohort study involving all patients admitted to general internal medicine wards over a 2-year period at all 7 teaching hospitals in Alberta, Canada. We used files from the Alberta College of Physicians and Surgeons to determine the number of years since medical school graduation for each patient's most responsible physician. Our primary outcome was the composite of in-hospital death, or readmission or death within 30 days postdischarge. We identified 10 046 patients who were cared for by 149 physicians. Patient characteristics were similar across physician experience strata, as were primary outcome rates (17.4% for patients whose care was managed by physicians in the highest quartile of experience, compared with 18.8% in those receiving care from the least experienced physicians; adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.72-1.06). Outcomes were similar between experience quartiles when further stratified by physician volume, most responsible diagnosis or complexity of the patient's condition. Although we found substantial variability in length of stay between individual physicians, there were no significant differences between physician experience quartiles (mean adjusted for patient covariates and accounting for intraphysician clustering: 7.90 [95% CI 7.39-8.42] d for most experienced quartile; 7.63 [95% CI 7.13-8.14] d for least experienced quartile). For patients admitted to general internal medicine teaching wards, we saw no negative association between physician experience and outcomes commonly used as proxies for quality of inpatient care.

Quality of bedside teaching in internal wards of Qaem and Imam Reza hospitals in Mashhad.

Background:Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals.Methods:This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis.Results:In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals.Conclusion:The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds.

Biochemical Testing After Pheochromocytoma Removal: How Early?

Pheochromocytomas are catecholamine-producing tumors with typical clinical presentation. Tumor resection is considered as an appropriate treatment strategy. Due to its unpredictable clinical behavior, biochemical testing is mandatory to confirm the success of tumor removal after surgery. The aim of the study was to investigate the feasibility of a shorter interval of postoperative testing (earlier than the recommended 2-4 weeks according to recently published Guidelines). We investigated 81 patients with pheochromocytoma before and after surgery. Postoperative examination was performed of stable subjects after their transport from the surgical to the internal ward (7.1±2.2 days after surgery). Plasma metanephrines were used for the diagnosis of pheochromocytoma and confirmation of successful tumor removal. All subjects with pheochromocytoma had markedly elevated plasma metanephrines before surgery. No correlation between postoperative interval (the shortest being 3 days) and plasma metanephrine levels was found. Postoperative plasma metanephrine levels did not differ significantly from those taken at the one-year follow-up. In conclusion, we have shown that early postoperative diagnostic workup of subjects with pheochromocytoma is possible and may thus simplify early postoperative management of this clinical condition.

Opening of a Respiratory Intermediate Care Unit in a General Hospital: Impact on Mortality and Other Outcomes

Background: Respiratory intermediate care units (RICUs) are specialized areas aimed at optimizing the cost-benefit ratio of care. No data exist about the impact of opening a RICU on hospital outcomes. Objectives: We wondered if opening a RICU may improve the outcomes of patients with acute respiratory failure (ARF), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), or community-acquired pneumonia (CAP). Methods: We analyzed the discharge abstracts of 2,372 admissions to the RICU and internal medicine units (IMUs) for ARF, AECOPD, and CAP. The IMUs at the Hospital of Trieste comprise emergency and internal wards. In order to investigate the determinants of outcomes, a matched case-control study was performed using clinical records. Results: The in-hospital mortality rate was lower in the RICU vs. IMUs (5.4 vs. 19.1%, p = 0.0001). Statistical differences did not change when comparing the RICU with the emergency and internal wards. After adjusting for potential confounders, the risk of death for patients with CAP, AECOPD, or ARF was significantly higher in the IMUs than in the RICU (OR 6.90, 3.19, and 6.7, respectively, p < 0.04). Both the frequency of transfer to the ICU (6 vs. 12%, p = 0.0001, OR 0.38) and the hospital stay (9.3 vs. 12.1 days, p = 0.0001) were reduced in patients admitted to the RICU compared to those admitted to non-RICUs. Significant differences were found in care management concerning chest physiotherapy, mechanical ventilation, antibiotics, and corticosteroids. Conclusions: The opening of a RICU may be advantageous to reduce in-hospital mortality, the need for ICU admission, and the hospital stay of patients with AECOPD, CAP, and ARF. Better use of care resources contributed to better patient management in the RICU.

On Patient Flow in Hospitals: A Data-Based Queueing-Science Perspective

Hospitals are complex systems with essential societal benefits and huge mounting costs. These costs are exacerbated by inefficiencies in hospital processes, which are often manifested by congestion and long delays in patient care. Thus, a queueing-network view of patient flow in hospitals is natural for studying and improving its performance. The goal of our research is to explore patient flow data through the lens of a queueing scientist. The means is exploratory data analysis (EDA) in a large Israeli hospital, which reveals important features that are not readily explainable by existing models. Questions raised by our EDA include: Can a simple (parsimonious) queueing model usefully capture the complex operational reality of the Emergency Department (ED)? What time scales and operational regimes are relevant for modeling patient length of stay in the Internal Wards (IWs)? How do protocols of patient transfer between the ED and the IWs influence patient delay, workload division and fairness? EDA also underscores the importance of an integrative view of hospital units by, for example, relating ED bottlenecks to IW physician protocols. The significance of such questions and our related findings raise the need for novel queueing models and theory, which we present here as research opportunities. Hospital data, and specifically patient flow data at the level of the individual patient, is increasingly collected but is typically confidential and/or proprietary. We have been fortunate to partner with a hospital that allowed us to open up its data for everyone to access. This enables reproducibility of our findings, through a user-friendly platform that is accessible via the Technion SEELab.