Patients must be told of unintended injuries during treatment (original) (raw)
Related papers
Management of minor medical problems and trauma: the role of general practice
Rural and remote health
Introduction: It has been established that patients prefer receiving health information from primary care physicians. In Greece, recent reforms supporting urban primary healthcare have not been enacted, and long waiting times in Athens' emergency departments are common. Aim: To evaluate cases treated in the emergency department of a Greek general hospital and explore the potential role of primary care in managing these cases. Methods: A total of 53 926 patients visited the emergency department studied during on-call days from February 2005 to February 2006. The cases were classified into 6 groups according to their main complaint: (1) internal medicine; (2) surgical;
Background: Up to 30-40% of emergency patients undergo surgery, which poses an increased risk of serious complications and death. The Royal College of Surgeons of England recently discussed the concerning variation in patient mortality after emergency surgery (e.g. 3.6% to 41.7%), and discussed poor support for trainees in some hospitals as a contributing factor. Newly qualified doctors are frequently responsible for evaluating patients when they arrive at emergency but non-rapid decision-making and referral to surgery can put patients at risk. Method: The naturalistic experiment design triangulated good versus poor working conditions for new doctors (e.g. staffing levels and training support derived from a random sample of hospitals’ quality data) against two independent variables from a national in-patient survey. These were emergency/nonemergency context and presence/absence of surgical procedures. The dependent variable was the rating of overall experience on a scale of 0-10 by a random sample of 1808 adult patients who spent at least one night in hospital. Results: A 2x2x2 univariate analysis of variance found a significant main effect of new doctors' working conditions, p = .012, a significant simple interaction of new doctors' working conditions and emergency context, p = .045, and a significant three-way interaction of new doctors' working conditions, emergency context and surgery, p = .03. Hospitals where new doctors have good working conditions have patients who report significantly better emergency surgical care. Conclusion: A pressing solution is inductions that improve new doctors’ diagnostic skills, to aid rapid decision-making about emergency patients who need referral to surgery.
Use of Medical Consultants for Hospitalized Surgical Patients
JAMA Internal Medicine, 2014
A s the Centers for Medicare & Medicaid Services (CMS) and others move to bundled payments around longitudinal episodes of care, hospitals are facing a greater need to understand practice variation and areas of excess resource use within episodes of care. In the case of inpatient surgery, for example, one recent study suggests that episodebased payments for surgery vary as much as 10% to 40% after adjusting for case mix and price. 1 For some procedures, variation in episode-based payments is driven by multiple factors, including readmissions, use of home health, skilled nursing services, and other components of postdischarge care. 1,2 Another source of variation is the use of professional services, including the use of medical consultants. Internists and medical subspecialists are frequently called on to provide pre-operative assessments of risk and to provide advice on how to reduce these risks. Medical consultants may also be employed for more routine comanagement, caring for surgical patients' chronic medical conditions such as diabetes and hypertension for the duration of the hospital stay. Finally, medical consultants often assist in the care of patients with certain complications after surgery, including acute kidney injury, surgical site infections, and postoperative myocardial infarction. Although prior work suggests a long-term trend toward increased use of medical consultants for comanagement of surgical patients, 3 variation in the use of consultations for hospitalized surgical patients has not been studied carefully. In this context, we used national Medicare data to explore the use of medical consultations around inpatient surgery, factors as-IMPORTANCE Payments around episodes of inpatient surgery vary widely among hospitals. As payers move toward bundled payments, understanding sources of variation, including use of medical consultants, is important. OBJECTIVE To describe the use of medical consultations for hospitalized surgical patients, factors associated with use, and practice variation across hospitals. DESIGN, SETTING, AND PARTICIPANTS Observational retrospective cohort study of fee-for-service Medicare patients undergoing colectomy or total hip replacement (THR) between January 1, 2007, and December 31, 2010, at US acute care hospitals. MAIN OUTCOMES AND MEASURES Number of inpatient medical consultations. RESULTS More than half of patients undergoing colectomy (91 684) or THR (339 319) received at least 1 medical consultation while hospitalized (69% and 63%, respectively). Median consultant visits from a medicine physician were 9 (interquartile range [IQR], 4-19) for colectomy and 3 for THR (IQR, 2-5). The likelihood of having at least 1 medical consultation varied widely among hospitals (interquartile range [IQR], 50%-91% for colectomy and 36%-90% for THR). For colectomy, settings associated with greater use included nonteaching (adjusted risk ratio [ARR], 1.14 [95% CI, 1.04-1.26]) and for-profit (ARR, 1.10 [95% CI, 1.01-1.20]). Variation in use of medical consultations was greater for colectomy patients without complications (IQR, 47%-79%) compared with those with complications (IQR, 90%-95%). Results stratified by complications were similar for THR. CONCLUSIONS AND RELEVANCE The use of medical consultations varied widely across hospitals, particularly for surgical patients without complications. Understanding the value of medical consultations will be important as hospitals prepare for bundled payments and strive to enhance efficiency.
Acute Surgical Unit: The Consultant Experience
Australasian Medical Journal, 2016
Background Establishment of the Acute Surgical Unit (ASU) has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34-item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on-call rostering and workload, academic pursuits, surgical training, work-life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on-call rostering, improved surgical training and higher levels of job satisfaction and overall work-life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on-call rostering, work-life balance and overall job satisfaction.
Acute medicine units: the current state of affairs in the North-West of England
The journal of the Royal College of Physicians of Edinburgh, 2010
Studies suggest that acute medicine units (AMU) reduce inpatient mortality, length of stay and re-admissions and improve four-hour performance targets. Over the past decade or so, after evaluating the system in place, the Royal College of Physicians of London (RCPL) has made key recommendations for an efficient and effective AMU. This audit reviews the current infrastructure of regional AMUs against those RCPL recommendations in respect of facilities, service provision and staffing. A total of 22 regional hospitals in the North-West of England were invited to participate in this audit; 19 responded. Two units did not have designated AMU facilities. Not a single hospital met all basic infrastructure recommendations. Only four had the recommended bed capacity, nine had recommended cardiac-monitoring facilities and incorporated 'short-stay units', 13 used early warning systems for patient triage and six had the recommended number of consultants assigned to AMUs with a designate...
A retrospective study of seven-day consultant working: Reductions in mortality and length of stay
Journal of the Royal College of Physicians of Edinburgh, 2015
Weekend admission is associated with higher in-hospital mortality than weekday admission. Whether providing enhanced weekend staffing for acute medical inpatient services reduces mortality or length of stay is unknown Methods This paper describes a retrospective analysis of in-hospital mortality and length of stay before and after introduction of an enhanced, consultant-led weekend service in acute medicine in November 2012. In-hospital mortality was compared for matching admission calendar months before and after introduction of the new service, adjusted for case volume. Length of stay and 30-day post-discharge mortality were also compared; illness severity of patients admitted was assessed by cross-sectional acuity audits. Results Admission numbers increased from 6,304 (November 2011–July 2012) to 7,382 (November 2012–July 2013), with no change in acuity score in elderly medical patients but a small fall in younger patients. At the same time, however, a 57% increase in early-warni...
Determining the true burden of general practice patients in the emergency department: Getting closer
Emergency Medicine Australasia, 2013
The issue of correct estimation of the number of patients who attend the ED with conditions that could be potentially managed by a general practitioner (GP) continues. The Australian Institute of Health and Welfare (AIHW) recently reported 2 176 612 ED attendances in 2012-2013 as potentially general practitioner (GP)-type presentations. 1 This represents one-third (32.4%) of all ED presentations and, we contend, significantly overestimates the numbers of this type of patient in AIHW annual Australian hospital statistics.
General practitioners providing non-urgent care in emergency department: a natural experiment
BMJ open, 2018
To examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators. Propensity score matched cohort study. GPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016. Non-urgent attendances visits to the A&E department. Process outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4 hours plus, left without being seen and 7-day reattendance). A total of 5426 patients seen by GPs in A&E were matched with 10 852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to othe...
Impact of specialist care on clinical outcomes for medical emergencies
Clinical Medicine, 2006
General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit -a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. This showed that the implementation of specialty triage in May 1999 was associated with a subsequent additional reduction in the mortality of the under-65 age group by 0.64% (95% CI 0.11 to 1.17%; P=0.021) from the 2.4% mortality rate prior to specialty triage, equivalent to approximately 51 fewer deaths per year. No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.