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This change project involves the commissioning of a Short Stay Observation Unit (SSOU)
within a DATH’s Hospital.
SSOU’s deliver intensive short-term assessment, observation or therapy to selected ED
patients to optimize early treatment and discharge. Observation medicine in dedicated units
is a feature of many adult Emergency Departments (ED) but this has not been reflected in
children’s ED’s in Ireland.
The current literature supports the development of SSOU’s, indeed it is very much in line
with the new National Model of Care for Paediatrics in Ireland and the new National
Children’s Hospital.
Developing a unit can be challenging and there is much to be considered when selecting the
governance structure, choosing suitable conditions, staffing and developing metrics to help
monitor its performance post opening. The creation of this new unit required a cultural
change with regard to how care is delivered within the hospital. This required a change to the
“day to day” practices of the consultants and nurses. Such changes can be difficult in large,
complex healthcare organizations. However, the underlying assumption of this project is that
the patient comes first and that SSOU’s are designed to prioritise the patient and not staff,
management or finances.
The rational for the change is to streamline ED services by transferring observational patients
from ED to the SSOU thus reducing ED waiting times and inpatient admissions. The HSE
Model of Change (2008) was used to guide and manage the change process. The projected
was evaluated against the project objectives, a nursing survey (n=55) and nurse management
focus group (n=5) was also used to evaluate the success of the project. The results indicate
that although staff have some concerns with regard to the development 71% (n=39) would be
interested in redeploying to the unit upon its opening.
The study also identified a potential saving of 6-7 inpatient beds per day with an operational
SSOU. SSOU’s have been shown to reduced hospital length of stay and costs while
increasing parental satisfaction.
Finally, the author discussed the findings of the project in light of the current literature and
from the experience of undertaking the project. The strengths and limitations are identified
and recommendations for the organisations are documented.
The lymphocyte-specific kinase (Lck) is a cytoplasmic tyrosine kinase of the Src family expressed in T cells and NK cells. Genetic evidence in both mice and humans demonstrates that Lck kinase activity is critical for signaling mediated by the T cell receptor (TCR), which leads to normal T cell development and activation. A small molecule inhibitor of Lck is expected to be useful in the treatment of T cell-mediated autoimmune and inflammatory disorders and/or organ transplant rejection. In this paper, we describe the synthesis, structure-activity relationships, and pharmacological characterization of 2-aminopyrimidine carbamates, a new class of compounds with potent and selective inhibition of Lck. The most promising compound of this series, 2,6-dimethylphenyl 2-((3,5-bis(methyloxy)-4-((3-(4-methyl-1-piperazinyl)propyl)oxy)phenyl)amino)-4-pyrimidinyl(2,4-bis(methyloxy)phenyl)carbamate (43) exhibits good activity when evaluated in in vitro assays and in an in vivo model of T cell activation.
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