Nurses Home

This home was located south of the Homeopathic Hospital where N. University runs into the University Museums. It was used as a Nurses Home, 1899-1900, for the Homeopathic Hospital administration, 1900-1922; and as the Interns Home, 1922-1929.

Η διαχείριση αλλαγών στην υγεία

Η διαχείριση αλλαγών είναι μια σημαντική πρόκληση για τις μονάδες υγείας και απαιτεί ικανότητες και ετοιμότητα από τη διοίκησή τους. Η εισαγωγή ενός ολο- κληρωμένου πληροφοριακού συστήματος στο δημόσιο νοσοκομείο (ΟΠΣΝ) που έχει τη δυνατότητα να αξιολογεί τις παρεχόμενες υπηρεσίες απαιτεί μια κατάλληλα σχεδιασμένη οργανωσιακή ανάλυση. Αυτή γίνεται, αξιοποιώντας το διαγνωστικό μοντέλο συνταύτισης των Nadler και Tushman όπου αντιμετωπίζει τον οργανισμό και τις αλλαγές ως ένα δυναμικό και αλληλοεξαρτώμενο σύστημα. Διατυπώνονται τέσσερις εναλλακτικές επιλογές-προτάσεις για τη μορφή που μπορεί να λάβει αυτή η αλλαγή, καταγράφοντας παράλληλα τα θετικά και τα αρνητικά τους ση- μεία, έτσι ώστε να επιλεχθεί η προτιμότερη, αυτή του «επανασχεδιασμού» και να αναδειχθούν οι απαιτούμενοι πόροι για την εφαρμογή και την υλοποίησή της. Η ορθή διαχείριση αλλαγής απαιτεί να καθοριστούν οι αντίστοιχοι στόχοι, να ανα- δειχθούν οι ευκαιρίες από την ανάπτυξη του ΟΠΣΝ στο δημόσιο νοσοκομείο και να καταγραφούν τα στάδια εφαρμογής του. Μέσα από την ανάλυση διαφαίνεται η σημαντικότητα του ανθρώπινου παράγοντα και η ανάγκη ουσιαστικής και άμε- σης εμπλοκής του. Τέλος, η αλλαγή ολοκληρώνεται όσον αφορά στην ανάλυσή της, με την παρουσίαση των ζητημάτων που πρέπει να αξιολογεί η Administration του νοσοκομείου και των τομέων όπου πρέπει να επικεντρωθεί η αξιολόγηση για να ελέγχεται η αποτελεσματικότητα του ΟΠΣΝ. The management of change is a significant challenge for health units, which demands skills and readiness on the part of their administration. The introduction of an integrated information system in a public hospital to provide the ability to assess the services offered necessitates the conduct of a well designed organizational analysis. This can be made using the diagnostic congruence model of Nadler and Tushman, which treats the organization and the changes as a dynamic and interdependent system. Four alternative choices with respect to change are presented here, pointing out their relative merits and drawbacks. The preferred alternative is that of "reformation" and the resources necessary for its implementation are delineated. The effective management of change requires determination of the appropriate goals, definition of the opportunities arising from the development of this system and recording of the stages of implementation. Through this analysis, the importance of the human factor is apparent, and the need for its immediate involvement is imperative. Finally, this analysis of organizational change concludes with presen- tation of the issues that the hospital administration needs to assess and the specific areas of focus to be defined in order for the effectiveness of the integrated information system to be monitored.

Heart failure following cancer therapy in patients with hematological malignancies aged 18 years and under : a linked health data analysis (1996-2009)

Introduction: The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not.

Methods: Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF).

Results: Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) (Figure 1).

Conclusions: This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this population.

Characteristics of patients with haematological and breast cancer (1996-2009) who died of heart failure-related causes after cancer therapy

Aims To describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF-related causes (IAHF) and those with no index admission for HF who died of HF-related causes (NIAHF) were compared.

Methods and results We performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF-related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post-cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62–78] for IAHF and 66 years (IQR 56–74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2–9) compared with NIAHF patients (median = 6, IQR 2–12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF-related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94–1.29, P = 0.225).

Conclusions The profile of IAHF patients who died of HF-related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF-related causes before hospital admission for HF-related causes—a group that may have been undiagnosed or undertreated until death.

Recueil de pièces sur l'origine et l'administration de la « Confrarie et hospital du Sainet-Esperit, fondé en Grève, à Paris, » en 1537.

On y remarque un inventaire de reliques (fol. 209), des copies de requêtes et des recettes médicales (fol. 222).

Self-administration of medication in hospital: patients' perspectives

Background. Little information is available about patients' perspectives on self- or nurse-related administration of medication.

Aim. The aim of the study was to determine patients' perspectives about self-medication in the acute care setting.

Methods. A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002.

Findings. Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting.

Conclusions. In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.

Veterans Administration Hospital

Dedicated October 18, 1953. This is a general Medical and Surgical Hospital with 488 beds. It is a Residency hospital, cooperating with the Deans Committee, University of Michigan, for the treatment of veterans of our armed force. Color by Lucy Gridley

Veterans Administration Hospital

Opened October 1953. This is a general Medical and Surgical Hospital with 486 beds. It is affiliated with the University of Michigan Medical School for treatment of Veterans of our Armed Forces

Evaluation of contextual influences on the medication administration practice of paediatric nurses

Aim. This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice. Background. Medication administration is a complex aspect of paediatric nursing and an important component of day-to-day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance. Method. A cross-sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%. Result. Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0·001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0·001), including choosing between following policy and acting in the best interests of the child (P = 0·002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0·01). Less experienced nurses reported greater confidence with computer literacy (P < 0·001). Conclusions. Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.

Factors influencing paediatric nurses' responses to medication administration

Objective: To evaluate the importance of contextual and policy factors on nurses’ judgment about medication administration practice.---------- Design: A questionnaire survey of responses to a number of factorial vignettes in June 2004. These vignettes considered a combination of seven contextual and policy factors that were thought to influence nurses’ judgments relating to medication administration.---------- Participants: 185 (67% of eligible) clinical paediatric nursing staff returned completed questionnaires.--------- Setting: A tertiary paediatric hospital in Brisbane, Australia.---------- Results: Double checking the patient, double checking the drug and checking the legality of the prescription were the three strongest predictors of nurses’ actions regarding medication administration.--------- Conclusions: Policy factors and not contextual factors drive nurses’ judgment in response to hypothetical scenarios.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Demand for public hospital emergency department services in Australia : 2000–2001 to 2009–2010

Objective: Hospital EDs are a significant and high-profile component of Australia’s health-care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion. Methods: The data for the present article have been extracted, compiled and analysed from publicly available sources for a 10 year period between 2000–2001 and 2009–2010. Results: Demand for public ED care increased by 37% over the decade, an average annual increase of 1.8% in the utilization rate per 1000 persons. There were significant differences in utilization rates and in trends in growth among states and territories that do not easily relate to general population trends alone. Conclusions: This growth in demand exceeds general population growth, and the variability between states both in utilization rates and overall trends defies immediate explanation. The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs across Australia. There is a need for more detailed study, including qualitative analysis of patient motivations in order to identify the factors driving this growth in demand.

Demand for hospital emergency departments : a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.