Specialized Care Facilities Research Articles

Environmental and developmental neonatology

Abstract Many foetuses that are born prematurely would be expected to die since their organismic adaptations do not fit the extrauterine environment. Modern medical technology is now providing external life-support systems to enable increasing numbers of such babies to live, but we have yet to establish how best to provide for the preterm babies' psychological and biobehavioural wellbeing. A new subdiscipline, environmental and developmental neonatology, which is concerned with the study of newborn special care facilities and their impact on the medical and developmental status of sick infants, is trying to bridge this knowledge gap. It is argued that there is not a good fit between the neonatal intensive care unit (NICU) environment and the infant's behaviour organization. Evidence from psychophysiological studies of the adverse effects of handling of preterm infants, noise and light exposure and the lack of contingent infant-controlled social interaction in nurseries on the infant is reviewed. Short-ter...

Total Population Estimate of Newborn Special-Care Bed Needs

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and the low birth rate of a population is intimately related to the bed needs.

Organisation of special and intensive care facilities for babies.

Organisation of special and intensive care facilities for babies.

Improvements in Burn Care

The improvement in burn care, as reflected in increased survival of burn patients, that has occurred over the past 15 years is well documented in the article by Feller et al (p 2074) elsewhere in this issue. Their report refutes emphatically the skepticism of other authors recorded in publications (in some of which reliance has been placed on retrospective, nonphysician estimation of burn size) impugning burn unit and burn center cost/benefit ratios and care effectiveness. The data presented confirm generally improved survival and shortened hospital stay during three successive periods of six, four, and four years, respectively, in more than 37,000 burn patients treated in burn care facilities participating in the National Burn Information Exchange Data Collection Program. In addition to the direct patient care benefits of special burn care facilities noted by the authors, such institutions, by permitting concentration of experience, provide a necessary training ground for those who

Are burn units the best places to treat burn patients?

In 1973 a survey was done in Florida to identify needs throughout the state’s eight regions for improvement in burn patient care [l]. It was found that no specific regional needs existed and, furthermore, that gross mortality rates in Florida seemed, at worst, to be the same as elsewhere in the country. In a sense, therefore, this satisfied the initial purpose of the survey. The question arose, however, as to whether or not results might not be equally bad (rather than equally good) all over the country and therefore subject to improvement by upgrading the facilities for burn care. In reviewing the literature, there was no difficulty in finding uniform agreement among leading authorities that special burn care facilities, such as burn units, burn programs, or bum centers, represent the way in which optimal management can be provided and optimal results can be obtained. Unfortunately, not a single reference was found comparing outcomes of bum patients treated in institutions with such special care facilities to those of patients treated in institutions without such facilities. Since the Florida Burn Survey contained a substantial pool of clinical and institutional data, it was decided to use this information to provide at

Training of Personnel–Pediatrics

The educational programs that have been developed in newborn special care facilities have two purposes: first, they teach personnel the manual skills that are necessary to manage the sick newborn infant; second, they provide personnel with a better understanding of neonatal pathophysiology so that they can begin to recognize the subtle responses of the sick neonate. With these skills and knowledge, the nursery staff assumes a more active role in the team's effort to preserve a child's life.

An algorithm for the design of patient monitoring systems

Specialized care facilities must be extended to the small hospital if equality of medical care is to be available to all. The sophisticated patient monitoring systems, essential to the efficient operation of these facilities, are not cost effective for this class of hospital. This paper presents an algorithm for the cost-effective design of computerized monitoring systems. The algorithm takes into account the requirements of the medical staff, as well as the patient loading statistics for the hospital. It thus provides a means of adjusting the monitoring system to the specific needs of a given hospital.

Childbirth, American Style

In June 1971, the House of Delegates of the American Medical Association adopted a statement on "Centralized Community or Regionalized Perinatal Intensive Care." This statement was the product of two years of study and discussion by the Committee on Maternal and Child Care. Its recommendations may be summarized as follows: "Concentration of high-risk infant care programs in hospitals specially staffed and equipped to provide optimal care is a proven life-saving mechanism for infants at risk." Every community should direct attention "to the development and operation of such centralized special care facilities." Goals should include early identification of highrisk infants, transfer of an infant to a more appropriately equipped facility when indicated, and planning for an adequate transport system. The implementation of "regionalized perinatal programs is a responsibility of physicians, government and the public" and inclusion of training programs for the necessary medical and allied personnel is encouraged.

Editorial: The burn-prone society

The care of a severely burned patient imposes a remarkable requirement on the supporting community for nurses, physicians, allied health personnel, special care facilities, and laboratory back-up as well as a large share of hospital beddays. Many hospitals that receive burn cases only occasionally have, quite wisely, adopted the policy of early transfer to units more suitably equipped by facilities and experience. Once the early respiratory threat has abated, and the early fluid therapy is judged satisfactory for transport, the patient is safely transportable. Far better to transport the patient to a burn center early in his course, rather than "hanging on" until sepsis and failure of skin grafting forces transfer. Wherever definitive treatment is given, the patient faces long months of intense physical suffering with the outcome long in doubt. Although many details of care have been improved in the past 25 years and rehabilitation accelerated for survivors, there

The Burn-Prone Society

The care of a severely burned patient imposes a remarkable requirement the supporting community for nurses, physicians, allied health personnel, special care facilities, and laboratory back-up as well as a large share of hospital beddays. Many hospitals that receive burn cases only occasionally have, quite wisely, adopted the policy of early transfer to units more suitably equipped by facilities and experience. Once the early respiratory threat has abated, and the early fluid therapy is judged satisfactory for transport, the patient is safely transportable. Far better to transport the patient to a burn center early in his course, rather than hanging on until sepsis and failure of skin grafting forces transfer. Wherever definitive treatment is given, the patient faces long months of intense physical suffering with the outcome long in doubt. Although many details of care have been improved in the past 25 years and rehabilitation accelerated for survivors, there

Study of Patient Admission Policies for Specialized Care Facilities

Specialized patient care facilities such as coronary care units, intensive care units, renal dialysis units, and cancer radiation therapy units usually constitute scarce resources in a health care delivery system. When patients "compete" for these facilities, decisions on patient selection are made. It is not infrequent to hear the motto of "treating high-risk patients first." A quantitative model implied by the motto is presented. It is assumed that patient classes could be established in terms of the relative effectiveness to be expected from treatments in the facility. For each patient class, arrivals are assumed to be Poisson. The state of the system at a decision point corresponds to the number of patients of each class already in the facility as well as the class of the arriving patient. If the objective is to optimize the overall system effectiveness, and exponentiality assumptions are made about the length-of-stay distributions, then the problem can be formulated in a Markov renewal program. To illustrate the approach, alternative admission policies for a four-bed coronary care unit are studied. There it is shown that the average overall mortality rate can be reduced when a relatively discriminating admission policy is used at a high occupancy level. Simulation runs are also made to evaluate the effects of the exponential approximations.

Suicide in Gothenburg. Demographic and social factors and availment of care of the suicide cases in 1968, with some views on prevention.

The relative importance of suicide as a cause of death, especially among younger persons, underlines the urgency of preventive measures. This study covers the fatal cases in a Swedish city of 450 000 inhabitants in 1968, 71 men and 30 women. Loneliness is closely associated with suicide, with high rates among divorced and widowed and among the elderly. “Sick-listing” is common in the material during the years preceding the suicide. Incomes are not lower than for the population in general, but half of the men are in debt at the time of death. In the critical phase, care had been given in only few cases. This is valid for psychiatric out-and inpatient care, all medical care leading to “sick-listing”, and for social care. Preventive measures must be encouraged at all levels. The needs of old people must be met, including psychiatric care, early cases must be detected and special care facilities must be created.

Classification of Burn-Care Facilities in the United States

The concept of specialized care facilities for the burned patient is relatively new. The first "burn units" were established in 1947 at the Medical College of Virginia, and at the Army Surgical Research Unit in San Antonio, Tex. These units were organized to provide, within their walls, almost all of the resources required for these severely injured patients. Additional units were established in the next two decades. In 1969, a survey of the short-term general and children's hospitals in the United States was completed, to determine the availability of facilities for the care of the burned patients. Only 32 such facilities could be identified. In addition to the hospitals that provide special facilities for burned patients, 46 others are identified with improved care. These facilities and special programs are not alike, and a classification of them is provided to differentiate the levels of care provided. Of the 6,062 hospitals initially

A Ventilation Unit for Special Intensive Care of Patients With Respiratory Failure

Experience from an annual census of 859 patients in an intensive care unit has lead to the development of a special ventilation care facility. The average length of stay for patients with respiratory failure in the general unit has been 9.7 days, as compared with 2.2 and 4.6 days for individuals with other surgical and medical problems, respectively. The complicated multiple-system responses to ventilatory failure, particularly of the chronic chest disease patient, demand specialized equipment and experience at all levels of intensive care which are best served by a unit devoted exclusively to this type problem. It is anticipated that this will become as much a pattern of operation in all first-rate hospitals as have the general intensive care and coronary care units.