Small General Hospital Research Articles

Reasons for laparosopic cholecystectomy conversion in a small general hospital

Background: Laparoscopic cholecystectomy is one of the most common procedures in abdominal surgery. This procedure is the gold standard for the treatment of symptomatic cholelithiasis and acute cholecystitis. However, thedifficulty and possibility of safely performing laparoscopic cholecystectomy vary considerably due to the variety of local findings and the course of the procedure. If it is not possible to complete the procedure safely by laparoscopy, due to intraoperative complications or to avoid the occurrence of complications, it is necessary to convert laparoscopic cholecystectomy to open cholecystectomy.Methods: We performed retrospective research on cases of cholecystectomy performed on all patients at the Dr. Mustafa Beganović General Hospital in Gračanica from 2014 to 2020, which were started by laparoscopy and finished using laparoscopy or converted to open cholecystectomy. Results: There were 888 cases that started as laparoscopic cholecystectomy. In 43, or 5.39% of cases laparoscopic cholecystectomy was converted to open cholecystectomy. The most common reasons for conversion from LC to OC were adhesions, the inability to identify anatomical structures, and inflammation.Conclusion: The number of conversions in our sample is in accordance with the data from the relevant research and at the same time the incidence of bile duct injuries is very low.

The Effect of Shared Leadership, Self-efficacy and Perceived Patient Safety Culture on the Patient Safety Management Activities of Nurses in Small and Medium-sized General Hospitals

The Effect of Shared Leadership, Self-efficacy and Perceived Patient Safety Culture on the Patient Safety Management Activities of Nurses in Small and Medium-sized General Hospitals

The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

PurposeTo describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospitalMethodsWe describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR.ResultsWe performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009).ConclusionA structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.

언어폭력을 경험한 응급실 간호사의 이직의도에 미치는 영향요인

The purpose of this study was to identify the factors that influence turnover intentions of emergency nurses who have experienced verbal abuse. The subjects for this study consisted of 158 nurses work at small and medium-sized hospitals and general hospital. The collected data were analyzed according to frequency, percentage, mean and standard deviation, t-test, one way ANOVA, Scheffé test, Pearson Correlation Coefficient and Multiple regression. The research found that the factors that effects of emergency nurses’ turnover intentions were emotional labor(β=.291, p<.001), age(β=-.251, p=.042) and nursing satisfaction(β=.185, p=.012). The explained variance for turnover intention was 24.3%(F=11.102, p<.001). In conclusion, in order to decrease the turnover intention of emergency nurses, various efforts are needed, to prevent situations in emotional labor. And in order to reduce emotional labor, diverse efforts are needed to avoid verbal abuse situation systematically. Institutional measures should be made to improve the working environment and treatment of emergency nurses and reduce turnover intention.

Treatment difficulties during COVID 19 pandemic in a patient with giant renal tumor. A small town general hospital perspective

Introduction: We present an unusual case of papillary renal cell carcinoma, which is a rare subtype of kidney malignancy. Objective: The present case report emphasizes a voluminous left renal tumoral mass causing bowel obstruction and necessity of emergency surgical intervention. Presentation of case: A 74 year old patient with a history of multiple severe cardiovascular conditions, presented in the emergency room accusing abdominal distension and pain, nausea, vomiting and lack of intestinal transit for about 72 hours. Based on the symptomatology, physical examination and imagistic explorations a clinical diagnosis of bowel obstruction was arisen, caused by a voluminous tumor with compression of the large vessels and invasion of the left colon. Given the severity of the cardiovascular comorbidities and the complexity of the case, the possibility of patient’s transfer to a university hospital was arisen, which was not practicable due to the COVID 19 pandemic. During surgical intervention en-bloc resection of the left kidney and tumoral mass was practiced. Histopathologic examination identified the tumoral mass as type I papillary carcinoma of the left kidney. The postoperative evolution was unfavorable, due to the severe cardiovascular comorbidities, on maximal vasoactive support the patient remained hemodynamically unstable, showed progressive myocardial infarction with the persistence of arrhythmias and severely reduced ejection fraction which led to his unfortunate death. Conclusion: Careful patient selection is needed to ensure a favorable risk-benefit ratio. Also a thorough multidisciplinary evaluation of patient and the possible therapeutic options is necessary, in order to create an optimal and individualized treatment plan

A Propensity Score-Matched Analysis to Assess the Outcomes in Pre- and Post-Fast-Track Hip and Knee Elective Prosthesis Patients.

Fast-track surgery is a multimodal evidence-based approach to perioperative care aimed at reducing complications and recovery time. We compared a fast-track protocol to standard care in the setting of a small Italian general hospital. Propensity score estimation before and after the study was performed to compare pre-fast-track (pre-FT; January 2013–March 2014) and fast-track (FT; January 2016–December 2016) patients undergoing elective hip and knee replacement surgery with a three-year follow-up (up to January 2020). The primary endpoints were the mean hemoglobin drop, mean predischarge hemoglobin, transfusion and reinfusion rates, pain, ambulation day, hospital length of stay (LOS), and discharge to home/outpatient care or rehabilitation hospital center. The secondary endpoints were the adherence measures to the FT protocol, namely, tourniquet and surgical times, use of drains and catheters, type of anesthesia administered, and complications within three years. The risk difference (RD) and the adjusted odds ratio (aOR) were calculated for each outcome. After the propensity score estimation, we analyzed 59 patients in the pre-FT and 122 in the FT categories. The FT patients, with respect to the pre-FT patients, ameliorated their mean hemoglobin drop from 3.7 to 3.1 g/dl (p < 0.01) and improved their predischarge mean hemoglobin (10.5 g/dL versus 11.0 g/dL; p = 0.01). Furthermore, the aOR of being transfused was reduced by 81% (p < 0,01); the RD of being reinfused was reduced by 63% (p < 0.01); the aOR of having low pain on the first day was increased by more than six times (p < 0.01); the RD of ambulating the first day increased by 91% (p < 0.01); the aOR of admission to a rehabilitation hospital center was reduced by 98% (p < 0.01); the aOR of home discharge increased by 42 times (p < 0.01); the median LOS, tourniquet and surgical times, and use of catheters and drains significantly decreased. Patients with complications at 1 month were 43.1% and 38.2%, respectively, of pre-FT and FT patients (p = 0.63). Complications at 6, 12, 24, and 36 months were significantly lower for the FT patients. This study showed that the uptake of enhanced recovery practices was successful and resulted in the improvement of clinical and organizational outcomes. The fast-track concept and related programs may optimize perioperative care and streamline surgical and rehabilitation care paths.

Relationships among Non-Nursing Tasks, Nursing Care Left Undone, Nurse Outcomes and Medical Errors in Integrated Nursing Care Wards in Small and Medium-Sized General Hospitals

This study aimed to identify the degree of non-nursing tasks and nursing care left undone in integrated nursing care wards, and examine their relationships with nurses' burnout, job satisfaction, turnover intentions, and medical errors. A cross-sectional questionnaire survey was conducted. Data were collected using self-report questionnaires from 346 nurses working in 20 wards of seven small and medium-sized general hospitals, and analyzed using multiple regression and multiple logistic regression analysis with the SPSS WIN 25.0 program. The mean score for non-nursing tasks was 7.32±1.71, and that for nursing care left undone was 4.42 ± 3.67. An increase in non-nursing tasks (β = .12, p = .021) and nursing care left undone (β = .18, p < .001) led to an increase in nurses' burnout (F = 6.26, p < .001). As nursing care left undone (β = .13, p = .018) increased, their turnover intentions also (F = 3.96, p < .001) increased, and more medical errors occurred (odds ratio 1.08, 95% confidence interval 1.02~1.15). Non-nursing tasks and nursing care left undone are positively associated with nurses' burnout, turnover intentions, and the occurrence of medical errors. Therefore, it is important to reduce non-nursing tasks and nursing care left undone in order to deliver high quality nursing care and in turn increase patient safety.

PB1798 EFFICACY AND TOLERABILITY OF R‐MINICHOP IMMUNOCHEMOTHERAPY IN ELDERLY PATIENTS WITH HIGH GRADE NON‐HODGKIN LYMPHOMA: REAL WORLD EXPERIENCE AT A RURAL UK HOSPITAL.

Background:The increasing incidence of high grade Non‐Hodgkin Lymphoma in aging populations places a significant burden on healthcare systems. Co‐morbidity, frailty, and reduced organ and physiological reserve contribute to treatment‐related complications. R‐miniCHOP is emerging as the standard of care for these patient with good efficacy and tolerability in clinical trial settings. We reviewed our single centre experience of delivering R‐miniCHOP therapy to elderly patients with high grade lymphoma over a 5 year period in a rural British hospital.Aims:We sought to assess the clinical efficacy and tolerability of attenuated immunochemotherapy (R‐miniCHOP) in elderly patients with high grade lymphoma in a ‘real‐world’ setting with medium term follow up of up to 7 years.Methods:We conducted a retrospective case review of patients who presented to our haematology service with aggressive non‐Hodgkin lymphoma and received R‐miniCHOP attenuated immunochemotherapy as outpatient therapy between 2012 and 2017. Patients received rituximab (375 mg/m2), cyclophosphamide (400 mg/m2), doxorubicin (25 mg/m2) and vincristine (1 mg/m2) on day 1 of each cycle, and prednisolone (40 mg/m2) on days 1‐5. We examined baseline patient characteristics, ECOG performance status, Ann Arbor stage, serum lactate dehydrogenase (LDH) concentration and International Prognostic Index (IPI) at diagnosis. Furthermore, we undertook a review of interim or post chemo disease response by PET/CT imaging and determined renal, cardiac, hepatic and bone marrow toxicities in all patients with follow up until January 2019. A route cause analysis was undertaken for all patients who had died during the follow‐up period.Results:We identified 23 patients treated with R‐miniCHOP between 2012 and 2017. Median age at diagnosis was 82 years (range 74‐88) and 52% were female. Diffuse large B‐cell lymphoma (DLBL) was the most common diagnosis (74%). Mean serum [LDH] at diagnosis was 320U/L (range 162‐1202U/L). Ann Arbor staging and IPI are detailed in Table 1 but patients of all IPI stage were represented in our cohort. The mean number of immunochemotherapy cycles administered was 4 (range 1‐8) and only 3 patients required dose/regimen modifications. Fatigue (52%), peripheral neuropathy (26%), and alopecia (22%) were the most commonly identified toxicities. Two patients (9%) experienced significant cardiotoxicity with echocardiographic evidence of reduced left ventricular ejection fraction. There were no intensive care admissions or deaths related to neutropenic sepsis. Overall, 30% of patients experienced a partial treatment response and a further 39% were in clinical remission at the time of reporting. Ten patients (43%) died over the follow up period, with 5 deaths attributable to disease progression, 1 died of GI bleeding which may have been associated with chemotherapy and the other 4 died of alternative unrelated causes.Summary/Conclusion:In our single centre experience at a small rural general hospital, attenuated immunochemotherapy proves an efficacious and generally well‐tolerated treatment regimen for elderly patients with high grade non‐Hodgkin lymphoma and can provide lasting remissions for a substantial number of patients in this age group. These data are broadly in line with a previous phase 2 study of R‐miniCHOP in patients aged over 80 years with DLBL and support the continued use of this regimen in elderly patients with high grade NHL receiving treatment in a variety of settings. (Peyrade et al., Lancet Oncology 2013).image

Healthcare reimbursement costs of children with type 1 diabetes in the Netherlands, a observational nationwide study (Young Dudes-4)

BackgroundType 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children. Studies on costs related to T1DM are scarce and focused primarily on the costs directly related to diabetes. We aimed to investigate both the overall healthcare costs and the more specific costs related to the management of diabetes.MethodsThis is a retrospective and observational, nationwide cohort study of all Dutch children (aged 0–18 years) with T1DM. Data were collected from the national registry for healthcare reimbursement, in which all Dutch insurance companies combine their reimbursement data. In the Netherlands for all Dutch citizens health care is covered by law and all children are treated by hospital-based paediatricians.ResultsWe analysed 6710 children distributed over 81 hospitals: 475 children in 6 university hospitals and 6235 children in 75 general hospitals. Total reimbursement for all children with T1DM over the period 2009 to 2011 was € 167,494,732 corresponding to an annual mean of € 55,831,577 of total costs and € 8326 euros per child. When comparing small (between 26 and 54 patients), medium (57–84 patients) and large (88–248 patients) general hospitals, costs per patient were highest in the hospitals with the highest number of T1DM patients. The costs for devices, secondary care and pharmaceutics had most impact on total expenditures. Over the study period, there was a slight decrease in per person costs.ConclusionThe overall health expenditure of a child with T1DM is more than € 8000 per patient per annum. Given the move towards more device-intensive multidisciplinary care for these patients, the costs of treating T1DM in children are likely to increase further in the coming years.

Predicting caregiver burden in general veterinary clients: Contribution of companion animal clinical signs and problem behaviors

Caregiver burden, found in many clients with a chronically or terminally ill companion animal, has been linked to poorer psychosocial function in the client and greater utilization of non-billable veterinary services. To reduce client caregiver burden, its determinants must first be identified. This study examined if companion animal clinical signs and problem behaviors predict veterinary client burden within broader client- and patient-based risk factor models. Data were collected in two phases. Phase 1 included 238 companion animal owners, including those with a sick companion animal (n=119) and matched healthy controls (n=119) recruited online. Phase 2 was comprised of 602 small animal general veterinary hospital clients (n=95 with a sick dog or cat). Participants completed cross-sectional online assessments of caregiver burden, psychosocial resources (social support, active coping, self-mastery), and an item pool of companion animal clinical signs and problem behaviors.Several signs/behaviors correlated with burden, most prominently: weakness, appearing sad/depressed or anxious, appearing to have pain/discomfort, change in personality, frequent urination, and excessive sleeping/lethargy. Within patient-based risk factors, caregiver burden was predicted by frequency of the companion animal’s signs/behaviors (P<.01). Within client-based factors, potentially modifiable factors of client reaction to the animal’s signs/behaviors (P=.01), and client sense of control (P<.04) predicted burden. Understanding burden may enhance veterinarian-client communication, and is important due to potential downstream effects of client burden, such as higher workload for the veterinarian. Supporting the client’s sense of control may help alleviate burden when amelioration of the companion animal’s presentation is not feasible.

Stroke networks and telemedicine: An Italian national survey.

Stroke is the leading cause of disability and death. Nowadays, clinical benefits of stroke units and thrombolysis in ischemic stroke are evidence-based. Also the benefit of endovascular treatment for acute ischemic stroke has been established. Telemedicine has been used to improve access to care by allowing a neurologist at a remote location to interact with the patient and their family members. Prior studies have shown that the use of telemedicine for acute ischemic stroke is not only safe and effective, but it also increases the utilization of tPA, improving patient outcomes. This study aimed to investigate the diffusion of telemedicine in Italian stroke networks with an online questionnaire to assess: type of stroke care setting, Volume of thrombolysis- thrombectomy/year, access to stroke care between different hospitals, the presence of imaging sharing protocols within the network or patients dispatchment screening; type of network solutions. We have interviewed 24 Italian neurologists, working in large urban areas, from north southward, including Italian islands. In particular, these neurologists represented 14 different regions and 20 countries. A majority of neurologists replying to the survey (47.83%) worked in large general hospitals or smaller general hospitals (26%) and a smaller number of physicians (17.3%) were committed in University Hospital or (8.7%) independent foundation hospitals. The 60.87% of stroke networks involved in the survey had a low thrombolysis/year volume while the 30.43% had a thrombolysis/year volume above 100. According to the survey a local stroke network was established in 87.50% of cases. In the 45.83% of cases, the hospitals care is not homogeneous within the network. A network for the consultation of neuroimaging between hospitals is available in 33.33% of cases. Whitin those describing an active network for Teleconsult the 57.14% used personal devices, while only the 25 % use professional teleconference system, and in 25% of cases used medical devices. Our findings demonstrated a relevant diffusion of Teleconsult in Italian stroke networks. The systems adopted are mostly individual solutions not integrated in protocolled pathways. These findings may encourage a systematization of Telemedicine medical curricula to increase larger access to neurological consults.

Hospitalization Experience of Patients Admitted to Nursing Care Integrated Service Wards in Small and Medium-size General Hospitals

Purpose: This study was conducted to identify meaning and essential structure of the hospitalization of patients in nursing care integrated service wards of small and medium-size general hospitals. Methods: Experiential data were collected through in-depth interviews with 10 patients who had been hospitalized in nursing care integrated service wards of medium general hospitals. The main question was ‘Could you describe your hospitalization experience in nursing care integrated service wards of medium general hospitals?’, and collected data were analyzed using Colaizzi’s Phenomenological Research Method. Results: Four categories obtained were ‘Realize the system that is not established yet’, ‘Secure care services which are less of a psychological and financial burden’, ‘Thanks for care providers’, and ‘Confident of the hopeful system to desire to reuse in the future.’ Conclusion: Patients in nursing care integrated service wards of small and medium-size general hospitals were satisfied with the reduction of mental and financial burden caused by nursing and were thankful to nursing staff, who put a lot of efforts into nursing. But, at the same time, they were confused and inconvenienced by the services that were not yet completely established. To improve this situation, it is thought that institutional complements including development of a service standardization manual would be helpful.

Mediating Effects of Person-environment Fit between Calling and Job Satisfaction of Nurses in Small and Medium Size General Hospitals

Mediating Effects of Person-environment Fit between Calling and Job Satisfaction of Nurses in Small and Medium Size General Hospitals

Adherence to guidelines regarding total hip replacement for fractured neck of femur.

Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 - December 2013) were collected retrospectively from Scarborough Hospital's hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.

Effects of surgical volumes on the survival of endometrial carcinoma

ABSTRACT Objective This study aims to assess whether surgical volume is related to survival among women with endometrial carcinoma. Methods For this population-based retrospective study, all women diagnosed with endometrial carcinoma between January 2005 and December 2010 were included as registered in the Netherlands Cancer Registry. Hospitals were divided into type of hospital: small general, large general, and oncological referral hospitals and into surgical volume: low ( Results Of 9133 women, 2596 (24.4%) were surgically treated in low volume hospitals, 3530 (38.7%) in medium volume hospitals and 3007 (32.9%) in high volume hospitals. In the Netherlands, low risk endometrial cancer is typically treated with simple hysterectomy and bilateral salpingo-oophorectomy whilst lymphadenectomy is only performed in high-risk endometrial cancer. Hospitals with high volumes treated relatively more women with high-risk and advanced stage tumors. After corrections for age, stage, histology, grade and type of hospital, no differences in relative survival were found by hospital volume in the total group or in the women with high-risk endometrial cancer, nor in women treated with complex surgery for endometrial cancer. Conclusions In this large population based study, no relation between surgical volumes and relative survival of endometrial cancer was observed. Based on this study, we conclude that at this moment there is insufficient evidence that concentration of care for women with endometrial cancer would lead to improved survival.

Percutaneous injuries among healthcare workers at a general hospital

Objectives: Percutaneous injuries (PCIs) remain a common incident among healthcare workers (HCWs) despite the introduction of safety programs. The aim of this study was to assess the PCIs, required precautions, and applications after the injuries among healthcare workers in a small general hospital. Materials and methods: We assessed the occurrence of PCIs at a General Hospital (EGH) from January 2007 to November 2010. During this period, all injury cases among HCWs were reported to the Infection Control Committee (ICC) using percutaneous injury notification form. The injury notification forms were evaluated retrospectively. Results: Totally 275 health personnel were working in our hospital, 36 healthy workers have been exposed to PCIs during this period. The incidence of PCIs was 2,9/10000 in 2007, 3,1/10000 in 2008, 3,8/10000 in 2009 and 3,9/10000 patient-days in 2010. Injured staff were recorded as, 16 nurses (44%), 12 cleaning staffs (34%), and eight (22%) doctors. The device leading to damage was most frequently the needle-channel. Ten sources (27%) were detected positive for hepatitis B virus (HBV), four (11%) for hepatitis C virus (HCV), and two (5%) for Crimean-Congo hemorrhagic fever virus (CCHFV). No case of seroconversion has been recognized for any of the above mentioned infections. Conclusions: Percutaneous injuries remain to occur among HCWs. Since some the sources were infected, the health personnel are endangered for infections due to PCIs. The health personnel should presume that all patients are infected, and thus should work following universal precautions to avoid complications about the PCIs.

Models of care involving district hospitals: a rapid review to inform the Australian rural and remote context.

Distnct hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function or models of care of district hospitals in rural and remote Australia. The aim of the present study was to identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context. A systematic, rapid review was conducted of published peer-reviewed and grey literature using CINAHL, Medline, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included 'rural', 'small general and district hospitals', 'rural health services organisation & administration', 'medically underserved area', 'specific conditions, interventions, monitoring and evaluation', 'regional, rural and remote communities', 'NSW', 'Australia' and 'other OECD countries' between 2002 and 2013. Models of teaching and education, multipurpose services centres, recruitment and/or retention were excluded. The search yielded 1626 articles and reports. Following removal of duplicates, initial screening and full text screening, 24 data sources remained: 21 peer-reviewed publications and three from the grey literature. Identified models of care related specifically to maternal and child health, end-of-life care, cancer care services, Aboriginal health, mental health, surgery and emergency care. District hospitals play an important role in the delivery of care, particularly at key times in a person's life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services.

Factors affecting electronic medical record system adoption in small korean hospitals.

ObjectivesThe objective of this paper is to investigate the factors affecting adoption of an Electronic Medical Record (EMR) system in small Korean hospitals.MethodsThis study used survey data on adoption of EMR systems; data included that from various hospital organizational structures. The survey was conducted from April 10 to August 3, 2009. The response rate was 33.5% and the total number of small general hospitals was 144. Data were analyzed using the generalized estimating equation method to adjust for environmental clustering effects.ResultsThe adoption rate of EMR systems was 40.2% for all responding small hospitals. The study results indicate that IT infrastructure (OR, 1.48; 95% CI, 1.23 to 1.80) and organic hospital structure (OR, 1.86; 95% CI, 1.07 to 3.23) rather than mechanistic hospital structure or the number of hospitals within a county (OR, 1.08; 95% CI, 1.01 to 1.17) were critical factors for EMR adoption after controlling for various hospital covariates.ConclusionsThis study found that several managerial features of hospitals and one environmental factor were related to the adoption of EMR systems in small Korean hospitals. Considering that health information technology produces many positive health outcomes and that an 'adoption gap' regarding information technology exists in small clinical settings, healthcare policy makers should understand which organizational and environmental factors affect adoption of EMR systems and take action to financially support small hospitals during this transition.

Cuidado a pessoas com dependência química em hospital geral na ótica da equipe de enfermagem

Aim: to identify the professional’s conception of nursing about the care to substance-dependent people admitted to a general hospital. Method: descriptive study, qualitative that involved eighteen professionals from nursing to a small general hospital. In searching for dates was used the interview part structured. The analysis of the dates followed to the thematic analysis. Results: after analyzing the data, a theme emerged that focuses on the care to the individual dependent of psychoactive substances in the general hospital. Conclusion: there is a worry from the nursing in accomplished the right interventions to the demands from the patient in a qualify way in the expectation that the person could get better and return to their routine.

An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: Specialty versus small general hospitals

In 2011, the Korean government designated hospitals with certain structural characteristics as specialty hospitals. This study compared the inpatient charges and length of stay of patients with joint diseases treated at these specialty hospitals with those of patients treated at small general hospitals. In addition, the study investigated whether the designation of certain hospitals as specialty hospitals had an effect on inpatient charges and length of stay. Multi-level models were used to perform regression analyses on inpatient claims data (N=268,809) for 2010–2012 because of the hierarchical structure of the data. The inpatient charge at specialty hospitals was 19% greater than that at small general hospitals, but the length of stay was 21% shorter. After adjusting for patient and hospital level confounders, specialty hospitals had a higher inpatient charge (34.6%) and a reduced length of stay (31.7%). However, the effect of specialty hospital designation on inpatient charge (2.7% higher) and length of stay (2.3% longer) was relatively smaller. Among the patient characteristics, female gender, age, and severity of illness were positively associated with inpatient charge and length of stay. In terms of location, hospitals in metropolitan area had higher inpatient charges (5.5%), but much shorter length of stay (−14%). Several structural factors, such as occupancy rate, bed size, number of outpatients and nurses were positively associated with both inpatient charges and length of stay. However, number of specialists was positively associated with inpatient charges, but negatively associated with length of stay. In sum, this study found that specialty hospitals treating joint diseases tend to incur higher charges but produce shorter length of stay, compared to their counterparts. Specialty hospitals’ overcharging behaviors, although shorter length of stay, suggest that policy makers could introduce bundled payments for the joint procedures. To promote a successful specialty hospital system, a broader discussion and investigation that includes quality measures as well as real cost of care should be initiated.