Hospital Planning Research Articles

IMproving PArticipation of patients in Clinical Trials--rationale and design of IMPACT.

BackgroundOne of the most commonly reported problems of randomised trials is that recruitment is usually slower than expected. Trials will cost more and take longer, thus delaying the use of the results in clinical practice, and incomplete samples imply decreased statistical power and usefulness of its results. We aim to identify barriers and facilitators for successful patient recruitment at the level of the patient, the doctor and the hospital organization as well as the organization and design of trials over a broad range of studies.Methods/designWe will perform two cohort studies and a case-control study in the Netherlands. The first cohort study will report on a series of multicenter trials performed in a nationwide network of clinical trials in obstetrics and gynaecology. A questionnaire will be sent to all clinicians recruiting for these trials to identify determinants - aggregated at centre level - for the recruitment rate. In a case control-study nested in this cohort we will interview patients who refused or consented participation to identify factors associated with patients' consent or refusal. In a second cohort study, we will study trials that were prospectively registered in the Netherlands Trial Register. Using a questionnaire survey we will assess whether issues on hospital organization, trial organization, planning and trial design were associated with successful recruitment, i.e. 80% of the predefined number of patients recruited within the planned time.DiscussionThis study will provide insight in barriers and facilitators for successful patient recruitment in trials. The results will be used to provide recommendations and a checklist for individual trialists to identify potential pitfalls for recruitment and judge the feasibility prior to the start of the study. Identified barriers and motivators coupled to evidence-based interventions can improve recruitment of patients in clinical trials.

Planned implementations of ePrescribing systems in NHS hospitals in England: a questionnaire study

ObjectivesTo describe the plans of English NHS hospitals to implement ePrescribing systems.Design and settingQuestionnaire-based survey of attendees of the National ePrescribing Forum.ParticipantsA piloted questionnaire was distributed to all NHS and non-NHS hospital-based attendees. The questionnaire enquired about any completed or planned implementation of ePrescribing systems, the specific systems of interest, and functionality they offered.Main outcome measuresEstimate of the number of NHS Trusts planning to implement ePrescribing systems.ResultsNinety-one of the 166 questionnaires distributed to NHS hospital-based staff were completed and returned. Of those, six were incomplete, resulting in a total usable response rate of 51% (n = 85). Eighty-two percent (n = 46) of the 56 Trusts represented at the Forum were either ‘thinking of implementing’ or ‘currently implementing’ an ePrescribing system, such as Ascribe (13%, n = 7) and JAC (20%, n = 11). Forty percent (n = 22) of respondents specified other systems, including those procured by NHS Connecting for Health e.g. RiO, Lorenzo and Cerner. Knowledge support, decision support and computerized links to other elements of patients’ individual care records were the functionalities of greatest interest.ConclusionThere is considerable reported interest and activity in implementing ePrescribing systems in hospitals across England. Whether such developments have the desired impact on improving the safety of prescribing is however, yet to be determined.

"A Little Extra Persuasion”: Gender and Craft Unionism in West Virginia’s Glass Industry, 1900–1950s

"A Little Extra Persuasion”: Gender and Craft Unionism in West Virginia’s Glass Industry, 1900–1950s Virginia C. Young On January 22, 1947, a meeting was conducted between the plant management of Fostoria Glass in Moundsville, West Virginia, and the respective factory committees of two of the plant’s labor unions. Local 10 had, for more than fifty years, represented the facility’s skilled male glassworkers who worked in the “hot metal” end of the plant and made the glassware. Local 507, organized in 1936, represented the unskilled and semi-skilled miscellaneous workers, both male and female, who worked in the “cold metal” section of the facility and performed various finishing tasks on the glass. Both Local 10 and 507 were affiliated with the American Flint Glass Workers Union (AFGWU).1 Near the end of the meeting, after resolving several issues, plant management announced plans for a new plant hospital to be “properly equipped with modern first aid equipment and staffed by a competent nurse.” The proposed location for this new plant hospital was the Factory #1 Girls’ Toilet, which had been built during World War II for the numerous women who transferred to the hot metal furnace room to replace enlisted male workers. The hospital, management explained, would benefit all of Fostoria’s employees, but it would also necessitate the transfer of fourteen women who had thus far chosen to remain in hot metal. Additionally, management announced that it counted on Local 507 to provide “a little extra persuasion,” if necessary, to convince any woman who objected to the transfer.2 A glimpse into the experiences of women at Moundsville’s Fostoria Glass provides a valuable standpoint from which to consider the impact of gender in the unionized workplace. First, Fostoria’s story places the glass industry, which has recently begun to receive more attention from historians, alongside other industries as a significant economic force and employer of women.3 Second, pre- and postwar events that transformed gender relations in factories nationwide also had an impact on Fostoria’s [End Page 35] shop floor, thus linking West Virginia’s manufacturing economy to larger national trends. Finally, Fostoria Glass allows us to better understand how prewar conditions affected postwar gender dynamics when we ask why those fourteen women who remained in their hot metal positions needed “a little extra persuasion” to relinquish their jobs. World War II was not the first instance of expanded opportunities for women at Fostoria. For example, despite initially hiring women in the 1890s to perform a very narrow set of tasks, Fostoria quickly expanded women’s jobs in cold metal. Eventually men and women performed many of those same jobs, which blurred the lines meant to distinguish between them. When Local 507 was formed in 1936, those same miscellaneous workers became AFGWU members, finally giving women a share of the union pie and a seemingly equal standing in the eyes of their union brothers. Further, while their role within Local 507 was uncertain at first, their numbers were such that women became an increasingly active group within the union. Thus, the glass ceiling at Fostoria experienced periodic “cracks” in the years prior to World War II and provided women in the plant with a cumulative inclusion into the predominantly male world of craft unionism. Through Fostoria Glass we see how those cracks made it progressively harder to justify and maintain gender divisions in the years after World War II. Over the past few decades scholars have successfully made gender, just like considerations of race and class, a necessary component of our historical understanding of labor unionism and the industrial workplace. Even as they have informed us of the pervasive practice of occupational sex-typing used to segregate women and stymie their opportunities on the shop floor, so too have they debated the impact World War II had on women’s labor activism and the move to end such discriminatory practices. 4 Discussions surrounding whether the war brought permanent or passing change have not discounted the ways in which many women expressed their dissatisfaction with the gendered order long before World War II. However, the prewar years are largely seen as a precursor to the real...

Make Room for Daddy: The Journey from the Waiting Room to the Birthing Room by Judith Walzer Leavitt (review)

Reviewed by: Make Room for Daddy: The Journey from the Waiting Room to the Birthing Room by Judith Walzer Leavitt Jessica Weiss Make Room for Daddy: The Journey from the Waiting Room to the Birthing Room. By Judith Walzer Leavitt. Chapel Hill: University of North Carolina Press. 2009. Judith Walzer Leavitt traces men’s migration from birth’s periphery to a central role in childbirth. Mid-20th century nuclear family togetherness shaped men’s increasing involvement in childbirth. Although men and women demanded that husbands accompany their wives in labor and, having won that right, to delivery, the initial impulse was not egalitarian—traditional gender roles followed men into the maternity ward. American medicalization of childbirth and cultural investment in hospital birth buttressed opposition to fathers’ presence. Some contrarian doctors drew on powerful sexual stereotypes, concerned with the future attraction of men to their wives and their own authority, remaining convinced that men did not belong at births into the 1970s. Hospital design slowed men’s transition from the waiting room to the delivery room, constituting physical and logistical barriers that patient demand in a competitive healthcare marketplace overcame. Room size hindered male presence in labor; in delivery, windowed rooms defied modesty conventions. This transformation occurred despite such obstacles, Walzer concludes, because “support of the nuclear family and respect for medicine,” not revolutionary militance, ushered men into birthing rooms. Bringing dad into childbirth posed no challenge to doctors’ authority, masculine roles in the nuclear family, nor to the medicalization of child birth; rather fathers’ coaching accommodated all three while promoting paternal attachment. As men left behind the “stork clubs,” literally and metaphorically, they remained at the head of the (delivery) table, and have more recently demanded attention for their unique needs in the transformative experience of childbirth. Making Room shows the continuity in opposition to and arguments for fatherly presence at birth, leading to some repetition. Yet, faithful to her sources, Walzer depicts this gradual change in detail; thus, readers are treated to disturbing examples of male bonding over the delivery table between doctors and dads and to the emotionally resonant voices of men denied access to the birth of their children and of wives who endured alone, as well as the elation of couples who partnered through birth. Privileged men began the move in the forties and fifties, starting with isolated hospitals, physicians, and expectant dads. The natural childbirth movement augmented these efforts; feminism added power to demands for partner attendance. The white middle class found access first; working class, African-American, and Southern couples had the least access to the fatherly participation. Walzer uncovers ‘fathers’ books’, poignant journals where men scribbled their fears and joys about their children’s births during the waiting room era, revealing their vulnerability, and expressing discontent with their isolation from their wives. Surveying sources ranging from oral histories, sitcoms, and medical literature to hospital plans, Walzer charts men’s increasing role and expanded voice, alongside of the voices of birthing women, creating a social, cultural, and spatial history of birth. Fathers’ participation invited family members, same-sex partners and other attendants to accompany laboring women, as families accommodated the hospital [End Page 212] birth, and hospitals competed with new alternatives. Attuned to the emotions and power relations of hospital births, Making Room, contributes mightily to the history of American childbirth, medicine, and families. Jessica Weiss California State University, East Bay Copyright © 2011 Mid-America American Studies Association

Hospital capacity planning: from measuring stocks to modelling flows

The metric of "bed numbers" is commonly used in hospital planning, but it fails to capture key aspects of how hospital services are delivered. Drawing on a study of innovative hospital projects in Europe, we argue that hospital capacity planning should not be based on beds, but rather on the ability to deliver processes. We propose using approaches that are based on manufacturing theory such as "lean thinking" that focuses on the value that different processes add for the primary customer, i.e. the patient. We argue that it is beneficial to look at the hospital, not from the perspective of beds or specialties, but rather from the path taken by the patients who are treated in them, the respective processes delivered by health professionals and the facilities appropriate to those processes. Systematized care pathways seem to offer one avenue for achieving these goals. However, they need to be underpinned by a better understanding of the flows of patients, work and goods within a hospital, the bottlenecks that occur, and translation of this understanding into new capacity planning tools.

Teaching hospital planning: a case study and the need for reform

Academic teaching hospitals and their networks can best serve patients and other stakeholders by achieving critical mass and scope of clinical services, teaching and research. Successful hospital reconfigurations are associated with a convincing case and majority clinician buy-in. The inscrutable political decision to relocate services away from a major teaching hospital campus and into a merged Queensland Children's Hospital was determined without broad stakeholder consultation or a transparent and accountable business case. This compromised process poses a significant and enduring risk to patient care and Queensland's paediatric, perinatal, adolescent and obstetric academic teaching hospital services. As the proposed major stakeholder in Australia's public hospitals and medical workforce training, the federal government should review this decision using an effective methodology incorporating relevant criteria. National guidelines are needed to ensure best practice in the future planning and auditing of major health care projects. The medical profession is responsible for ensuring that health care policy complies with reliable evidence and good practice.

Basic study on architectural planning of psychiatric hospital

This paper considers the main problems of the current mental health facilities in China from the standpoint of architects on the background that mental disorder has become a serious threat to human health. In order to effectively learn from the developed countries, this paper reviews the brief history of the world’s mental health and the main phases of the evolution of psychiatric hospitals, analyzes the actual situation of mental health facilities abroad based on a large amount of data, compares the roles of public and private psychiatric hospitals from the viewpoint of government supervision, and investigates the functions and positions of psychiatric hospitals and the psychiatry divisions of general hospitals in the medical system. At last, this paper discusses the necessity of the systemization of mental health facilities, the role of psychiatric hospitals in this facility system and the developing approaches of psychiatric hospitals in China.

Impact on Hospital Functions Following the 2010 Chilean Earthquake

The objective of this study was to assess the impact of the 2010 Chilean earthquake on hospital functions and services. Hospitals functioning in a post-disaster environment must provide emergency medical care related to the event, in addition to providing standard community health services. This study focused on damage to both structural and nonstructural components, as well as to utility services. Site visits were made to every hospital in a single province (Bio-Bio). Engineers conducted damage assessments while interviews of hospital administrators were conducted. The survey was requested by the Chilean Ministry of Health (MOH) to assess the impact of the earthquake on hospital operations and facility responses to those effects. Other important regional and hospital data were gathered from hospital administrators and the MOH. Seven government hospitals were surveyed. All hospitals in the region lost communications, municipal electrical power and water for several days. All reported some physical damage although only one suffered significant structural damage. All lost some functional capacity as a result of the earthquake. The loss of telephones and cellular service was identified as the most difficult problem by administrators. An average of 3 physical areas per hospital lost some degree of functional capacity following the earthquake. Even in an earthquake-prone and very well-prepared country such as Chile hospital functions were widely disrupted by the event. The loss of hospital functions can occur even with minimal damage to the physical structure. The loss of communications can impede or halt response efforts at all levels. Hospitals should be prepared to self-sustain following a disaster for 2-3 days regardless of the level of structural damage. Understanding the details of these impacts is essential to hospital preparedness and plans for continuing services after a disaster.

Early Feeding and Shortened Hospital Stay after Colostomy Takedown in Patients with Imperforate Anus

Objective: This study reviewed 15 years of experience with 94 patients to identify an optimal feeding protocol and hospitalization plan for patients with imperforate anus who underwent colostomy takedown. Methods: The authors treated 145 patients with imperforate anus from June 1988 to August 2003. Among them, 94 underwent a 3-stage operation (colostomy, posterior sagittal anorectoplasty, and colostomy takedown). Traditionally, patients started feeding on the 2(superscript nd) or 3(superscript rd) postoperative day (POD) and went home on the 5(superscript th) or 6(superscript th) POD (n=10). In 1991, the authors adopted a protocol in which patients received feeding on the 1(superscript st) POD and were discharged on the 2(superscript nd) POD (n=21). Then, in 1994, a more aggressive protocol permitted feeding 6 hours after colostomy takedown. However, one patient suffered an anastomotic leak, which subsided three days later after abstinence from feeding. Thus the 1(superscript st) POD feeding protocol was resumed in 1995 and 59 more patients were added to the 1991 program. Results: Of the 80 patients following the 1991 protocol, feeding started at 20.2 hours (range 17.4-41.5), and the mean postoperative hospital stay was 1.9 days (range 1.7-3.2). Three patients encountered minor complications but recovered after conservative treatment. Of the 4 patients following the 1994 protocol, one suffered anastomotic leakage. Conclusion: Our 1(superscript st) POD feeding and 2(superscript nd) POD discharge plan is safe and efficient for patients with imperforate anus who undergo colostomy takedown.

The Rudd hospital plan — many pitfalls to avoid on the way to a better health system

The Rudd hospital plan — many pitfalls to avoid on the way to a better health system

Psychological Effects of Patient Surge in Large-Scale Emergencies: A Quality Improvement Tool for Hospital and Clinic Capacity Planning and Response

Although information is available to guide hospitals and clinics on the medical aspects of disaster surge, there is little guidance on how to manage the expected surge of persons needing psychological assessment and response after a catastrophic event. This neglected area of disaster medicine is addressed by presenting a novel and practical quality improvement tool for hospitals and clinics to use in planning for and responding to the psychological consequences of catastrophic events that create a surge of psychological casualties presenting for health care. Industrial quality improvement processes, already widely adopted in the healthcare sector, translate well when applied to disaster medicine and public health preparedness. This paper describes the development of the tool, presents data on facility preparedness from 31 hospitals and clinics in Los Angeles County, and discusses how the tool can be used as a benchmark for targeting improvement. The tool can serve to increase facility awareness of which components of disaster preparedness and response must be addressed through hospitals' and clinics' existing quality improvement programs. It also can provide information for periodic assessment and evaluation of progress over time.

Editorial Comments—Psychological Effects of Patient Surge in Large-Scale Emergencies: A Quality Improvement Tool for Hospital and Clinic Capacity Planning and Response

Editorial Comments—Psychological Effects of Patient Surge in Large-Scale Emergencies: A Quality Improvement Tool for Hospital and Clinic Capacity Planning and Response

Queuing analysis for outpatient and inpatient services: a case study

PurposeThe purpose of this paper is to carry out queuing analysis to analyse patient load in outpatient and inpatient services to facilitate more realistic resource planning.Design/methodology/approachThe paper adopts an analytical approach based on real life data (e.g. not a priori or an academic one where data are mingled to fit a theoretical stance) in accordance with the service level prescribed by the hospital administration. A service level is usually specified in terms of admissible range of queuing characteristics, such as mean patient waiting time, reduction of inordinate delays, incidences of minimum delays, average queue length, etc. which the management of a health organisation may decide to aim and control.FindingsQueuing analysis reported in this case study provides a basis for estimating medical staff size and number of beds, which are two very important resources for outpatient and inpatient services in a large hospital, and all other hospital resources in one way or another depend on them.Research limitations/implicationsThe study challenges and aims to replace thumb‐rule approaches, which can be very conveniently carried out with efficient computer aids available at present for any hospital. Queuing analysis provides valuable insights into a hospital system, though it may not be the best approach as several underlying assumptions may not always hold true. In hospitals, for example, there can be several interacting queues, many of which could be cyclic with interaction among them. Accordingly, treatment of each queue individually, independent of others may not be a valid assumption.Practical implicationsMedical staff (doctors) and beds are very basic hospital resources, which largely depend on the hospital load in terms of arrival rates of patients in outpatient and inpatient services. When hospitals are adequately staffed and equipped in terms of beds and other key resources, it is unlikely that patients will turn away to other hospitals for treatment and there will be all round satisfaction with the hospital performance.Originality/valueThe authors do not claim the findings to be novel or unique but rather more well‐documented and comprehensive in coverage than available in existing literature. The practice‐based themes such as this well‐documented case study may evoke global interest as a multiplier effect for using such methodologies for resource planning in hospitals.

Basic study on architectural planning of psychiatric hospital

Basic study on architectural planning of psychiatric hospital

Hospital Group Preparation for the 2008 Democratic National Convention

There is little academic documentation of regional hospital planning in preparation for mass gathering events and national political conventions. As the lead planning group for the local medical branch during the 2008 Democratic National Convention (DNC), the Denver Health Paramedic Division brought together twenty six hospitals within the region to develop an operational plan to ensure an effective response in the event that hospital resources were strained or overwhelmed during the 2008 DNC.The effectiveness and long-term impact of hospital planning for the DNC was assessed by analyzing bed availability data gathered during the event and from a post-event survey of participating hospitals.Survey results indicate that overall hospital emergency preparedness improved significantly because of planning for the DNC and bed availability analysis indicates that there was a significantly greater amount of surge capacity available during the DNC than previously documented.Planning for future national political conventions will benefit from the early development of relationships between hospitals and the establishment of baseline bed availability data to aid in surge capacity planning.

Resultados del primer año de funcionamiento del plan de resucitación cardiopulmonar del Hospital Juan Ramón Jiménez (Huelva)

Objective To present the results of the first year of the functioning of a Cardiopulmonary Resuscitation (CPR) Hospital Plan and to describe the characteristics of the patients with cardiopulmonary arrest (CPA) in hospital units with no monitoring facilities (HU). Design An observational, prospective study in a cohort of patients who presented CPA during a one-year period. Setting HU of a general hospital and as province reference. Patients and methods Patients admitted to an HU from May 2007 to May 2008 with CPA and treated according to a specific hospital CPA Program, organized in order to: (a) decentralize the CPR through the training of the nurse as the first responder capable of performing immediate CPR and early defibrillation (DF) (less than 4 min), (b) a specific phone number as hospital alarm of CPR and (c) maintenance of the CPR maneuvers by an early intervention Resuscitation Team (RT) (less than 8 min). Main variables of interest Characteristics of patients, CPA episode and results according to the «Utstein style». Results A total of 73 patients were included with activation of the CPA alarm, 8 of which were false alarms, with an average age of 70 years and 60% men. A total of 65% occurred in the medical area in patients with heart or respiratory failure, sepsis or septic shock. Initial heart rhythm of the patients attended was asystolic in 74% of the patients, ventricular fibrillation in 18% and electromechanical dissociation in 8%. The first attending person was the nurse in 79% of cases, CPR was always initiated in less than 1 min, DF in less than 2 min (92%) and RT in less than 8 min (96%). Fifty-five percent survived and 35% of the reanimated patients were discharged live from the hospital, 78% with good neurological outcomes. Conclusions The CPR “Juan Ramón Jiménez” Hospital Program is an applicable and effective initiative in our setting.

Florence Nightingale: nurse and public health pioneer

August 2010 marks the centenary of the death of Florence Nightingale, who must be, without doubt, the most famous name in nursing. Most people, even those in the health professions, think of her as 'The Lady with the Lamp'; the heroine of the Crimean War, who tended the sick and wounded soldiers at Scutari. Important though this was, her main contribution, which continued long after Crimea, was in the organization of nursing training, in hospital planning, public and military health, and in effective collection of medical statistics.

Health Care Infrastructure Post-Katrina: Disaster Planning to Return Health Care Workers to Their Home Communities

Health Care Infrastructure Post-Katrina: Disaster Planning to Return Health Care Workers to Their Home Communities

Health Care Infrastructure Post-Katrina: Disaster Planning to Return Health Care Workers to Their Home Communities

One of the greatest challenges of restoring the New Orleans health care infrastructure since the post-Katrina disaster has been shortages of health care providers. Many providers had prolonged displacements or did not return to their practices, depleting the city of valuable resources. This Open Forum chronicles the displacement of Louisiana State University's Department of Psychiatry and discusses barriers to returning health care providers to their communities expeditiously. Predisaster planning and policy changes are proposed to facilitate a quicker return and decrease the attrition of health care providers after future disasters. A community's predisaster plans should include a mechanism to allow funds to follow patients instead of hospitals, to provide bridge funding that pays local health care providers to work as first responders and serve uninsured patients while these providers rebuild their practices, and to provide funds to quickly expand services and usable space in undamaged clinics and hospitals and to shore up reparable structures.

Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident

In many hospitals, intensive care units (ICUs) operate at or above capacity on a daily basis. Multiple casualty incidents will create a sudden need for additional ICU beds and hospital planning for disaster response must anticipate the need for rapid ICU expansion. In this article, the authors describe the management of 6 patients who were burned in Guam and successfully transported a distance of 7,268 miles to San Antonio, TX, for tertiary burn center care. The mission required creation of a temporary burn ICU at Tripler Army Medical Center in Hawaii, approximately midway between the referring hospital and the receiving burn center. A method of creating a temporary burn center is described. Lessons learned, including the need to standardize equipment, and to cross-train and cross-credential medical personnel, are applicable to both military and civilian mass casualty management.