灾难及突发事件住院信息管理系统研究现状及趋势

信息工作是决策的依据和先导,如何准确、及时、高效地收集、整理、分析灾难及突发事件信息、伤病员基本信息、救治信息等,已成为医院管理信息学的研究热点问题,也是医院在灾难和突发事件大量伤员信息管理中面临的难点问题。本文就灾难及突发事件住院信息管理系统研究现状及趋势进行综述。     

灾难及突发事件住院信息管理系统建设构想

本文系统地介绍了灾难及突发事件住院信息管理系统的建设构想。从研发目的、意义、系统功能需求、结构和特点,五个方面进行了详细的阐述,旨在为相关的医院信息化、卫勤管理、医疗服务工作提供思路,为下一步研发应用该系统做准备,促进灾害和突发事件医疗信息化建设。     

灾难及突发事件住院信息管理系统建设构想

本文系统地介绍了灾难及突发事件住院信息管理系统的建设构想。从研发目的、意义、系统功能需求、结构和特点,五个方面进行了详细的阐述,旨在为相关的医院信息化、卫勤管理、医疗服务工作提供思路,为下一步研发应用该系统做准备,促进灾害和突发事件医疗信息化建设。     

灾难及突发事件住院信息管理系统的开发与实现

本文从系统设计目标、功能设计、结构设计等几个方面论述了灾难及突发事件住院信息管理系统的开发与实现。该系统由六大模块构成,实现了从预约管理、住院信息管理、床位管理、伤情评分、感染监测、查询统计到打印输出的灾害及突发时间住院伤病员信息全过程管理。应用本系统可规范灾害及突发事件医疗救援保障流程,大大提高了住院伤病员信息管理水平和工作效率。     

灾难及突发事件住院信息管理系统的开发与实现

本文从系统设计目标、功能设计、结构设计等几个方面论述了灾难及突发事件住院信息管理系统的开发与实现。该系统由六大模块构成,实现了从预约管理、住院信息管理、床位管理、伤情评分、感染监测、查询统计到打印输出的灾害及突发时间住院伤病员信息全过程管理。应用本系统可规范灾害及突发事件医疗救援保障流程,大大提高了住院伤病员信息管理水平和工作效率。     

三级医院急诊科护士灾害护理能力现状及影响因素分析

目的调查国内三级医院急诊科护士灾害护理能力现状及其影响因素。方法采用一般情况资料表、临床护士灾害护理能力评估量表对12个省市、18家三级医院的418名急诊科护士进行问卷调查,并对回收问卷数据进行统计分析。结果急诊护士灾害护理能力总体评分为(114.55±7.70)分,最高分和最低分别为159、93分。得分较高的灾害护理能力层面集中在灾难现场护理协作、心肺复苏、紧急转运、外伤处理、预检分诊、分级救护等;能力欠缺的护理层面主要集中在灾难基础及医学知识、灾害心理护理知识与技能、大规模人群感染控制、脆弱人群护理、灾难护理管理等。学历、年龄、工作年限、灾害救援经历是影响急诊护士灾害护理能力的独立因素。结论三级医院急诊护士灾难护理能力整体处于中等偏下水平,应通过多种形式开展灾害救援知识与护理技能培训,不断提升急诊护士对灾难护理的认知及技能水平,以增强其应对灾害的紧急救援与护理能力。     

全媒体时代医院舆情管理危机的应对措施

随着科学技术的快速发展,各类新媒体的出现让部分医疗事件有了更高的关注度。近年来医疗纠纷日益严重,在全媒体时代的背景下,医院舆情危机频繁发生,对医院声誉和医患关系产生较大的不良影响。如何正确的引导网络舆情、降低医院舆情危机带来的不利影响成为急需解决的问题。本研究就全媒体时代医院舆情管理危机展开探讨,从医院舆情管理现状、医院舆情管理所存在的问题及相关的应对措施这三个方面入手,旨在为医院管理者在全媒体背景下控制医院舆情、化解医院突发事件、改善医患关系提供参考。     

灾害脆弱性分析在医院应急管理中的应用研究

目的 开展灾害脆弱性分析,指导医院应急管理质量持续改进。方法 通过凯撒模型的风险评估矩阵对医院面临的各种潜在危害加以识别,进行风险评估和排序,明确应对重点。结果 通过灾害脆弱性分析,了解医院目前对突发事件的承受能力,确定医院需要优先应对的突发风险事件,提出加强医院应急管理的具体措施,取得良好的管理效果。结论 灾害脆弱性分析是医院识别风险和降低风险的重要依据,是将突发事件对人民群众的生命威胁和伤害降到最低程度的重要手段和保证。     

医院信息战略管理的探索与思考

医院信息战略管理是随着信息技术在医院的应用与发展、信息资源战略地位的凸显、网络经济以及知识经济的兴起而出现的一个新的信息实践和研究模式。通过分析信息技术在医院中的实施情况,指出信息战略实施的成功与医院的流程再造、组织结构重组、医院总体战略等有着密切关系。     

医院临床信息模型建立的研究

长期以来,信息的标准化问题一直是我国医院信息化发展的瓶颈。医院信息化建设需要解决的核心问题是医疗信息资源共享,而医疗信息共享的水平和程度从根本上说依赖于统一的标准,特别是临床信息标准。建立一个好的临床信息模型是卫生信息的一项重要工作,就医院临床信息模型进行了研究。     

Computerised tomography of acute traumatic intracranial haematoma: reliability of neurosurgeons' interpretations.

Two neurosurgeons concerned with the emergency management of patients with head injury correctly diagnosed the presence or absence of an acute intracranial haematoma in 97 scans that were presented to them without knowledge of the patients'' clinical details. There were no false-positives or false-negatives, although identification of the type of haematoma was not always possible. The impact of the EMI scan on patient management demands new approaches to the care of head injuries.     

Planning for psychiatric emergencies.

Hospital emergency services have been used increasingly in recent years. This has resulted in questions as to the true nature of patients'' complaints and the appropriateness of this type of care. Since the increase in the number of psychiatric emergency patients has paralleled that for patients at other types of emergency clinics a study was conducted at the Clarke Institute of Psychiatry, Toronto, to examine the situation prior to the inception in 1977 of a crisis intervention unit. It was found that most patients had both psychiatric and social difficulties, and it was considered that planning should concentrate on strategies for efficient management of the clinical problems.     

Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.

Information about patients in ambulance service records has been linked to that in the patients'' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.     

Variability of intensive care admission decisions for the very elderly

Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients'' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83–91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients'' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients'' outcome remains unclear.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00912600","term_id":"NCT00912600"}}NCT00912600     

Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Background

Universal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan''s health-care system, which is mainly publicly funded.

Methods

We chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients'' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients'' clinical status.

Results

We found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71).

Conclusions

Under Japan''s current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.     

Improving care: a study of orthopaedic outpatient referrals.

OBJECTIVE--To identify aspects of outpatient referral in which general practitioners'', consultants'', and patients'' satisfaction could be improved. DESIGN--Questionnaire survey of general practitioners, consultant orthopaedic surgeons, and patients referred to an orthopaedic clinic. SETTING--Orthopaedic clinic, Doncaster Royal Infirmary. SUBJECTS--628 consecutive patients booked into the orthopaedic clinic. MAIN OUTCOME MEASURES--Views of the general practitioners as recorded both when the referral letter was received and again after the patient had been seen, views of the consultants as recorded at the time of the clinic attendance, and views of the patients as recorded immediately after the clinic visit and some time later. RESULTS--Consultants rated 213 of 449 referrals (42.7%) as possibly or definitely inappropriate, though 373 of 451 patients (82.7%) reported that they were helped by seeing the consultant. Targets for possible improvement included information to general practitioners about available services, communication between general practitioners and consultants, and administrative arrangements in clinics. Long waiting times were a problem, and it seemed that these might be reduced if general practitioners could provide more advice on non-surgical management. Some general practitioners stated that they would value easier telephone access to consultants for management advice. It was considered that an alternative source of management advice on musculoskeletal problems might enable more effective use to be made of specialist orthopaedic resources. Conclusion--A survey of patients'' and doctors'' views of referrals may be used to identify aspects in which the delivery of care could be made more efficient. Developing agreed referral guidelines might help general practitioners to make more effective use of hospital services.