Stop the violence against health care workers in Turkey
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Abstract:
Background
Violence against health care workers (HCW) in health care settings is a significant phenomenon in recent years in Turkey. We aimed to describe the prevalence and risk factors of the violence attacks against HCWs by this first study in Istanbul.
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The study was conducted in two hospitals; Okmeydani Research and Training Hospital, which is a large tertiary hospital with 800 inpatient beds, and Sariyer Ismail Akgun Public Hospital, which is a local hospital with 50 inpatient …Keywords:
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The purpose of this study was to estimate the incidence and hospital costs associated with hypoglycemic episodes (HEs) requiring hospital admission or emergency room (ER) visits in Denmark.This study analyzed data from the National Patient Registry. Data on HE-related hospital admissions or ER visits occurring between 2008 and 2011 were collected and analyzed.There were 1906 hospital admissions and 803 ER visits in 2008 compared with 1646 hospital admissions and 547 ER visits in 2011, corresponding to a decrease in incidence from 10.6 to 7.1. The estimated annual total hospital costs ranged from €3.0 million in 2008 to €2.3 million in 2011.HEs represent a major burden for the Danish healthcare system.
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(2003). Feasibility of routine collection of injured worker occupational information in hospital emergency departments. Injury Control and Safety Promotion: Vol. 10, No. 4, pp. 261-262.
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Background
Many injury victims die before reaching a hospital due to inadequate pre-hospital care and transport. Prompt emergency care can save lives and prevent disabilities but the inconsistent availability of formal Emergency Medical Services (EMS) makes it challenging. This is the case even in some high-income developing countries like Oman. For this study we analysed the trauma registry data from two large hospitals of Oman to understand the pre-hospital and hospital based emergency care in a rapidly developing country in the Arab Gulf.Methods
The data was collected from Khoula and Nizwa hospitals between November 2014 and April 2015. All patients admitted through the emergency department with a history of trauma were included. Information about mechanism of injury, mode of transport, time interval between injury and hospital, pre-hospital care and emergency department (ED) disposition was collected.Results
2,340 patients were received in the ED during the study period. The majority (74%) were males, with a mean age 27 years. Transport injuries and falls accounted for 70% of all injuries. The most common mode of transport was private car (43%); only 13% of patients were transported via EMS. Only 30% of cases were transported to the hospital within an hour of injury; median transport time was 2.53 hours. Only 27% of patients received some form of pre-hospital care. Twenty-three ED deaths were recorded. Mean ED length of stay was 16.35 hours. In the study population, injury severity score in 85% of cases was ≤9, mean revised trauma score was 7.6382 and overall mortality ratio was 2.35%.Conclusion
Despite rapidly developing health care services in the urban parts of Oman, EMS utilisation is low. Patients presenting to the hospital are those who have less severe injuries and thus have better chances of survival. A better-organised EMS system may provide a prompt transport and appropriate triage to patients with severe injuries.Hospital Care
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In this retrospective cohort study in Argentina, risk factors for hospital readmission of older adults, within 72 hours after hospital discharge with home care services, were analyzed. Fifty-three percent of unplanned emergency room visits within 72 hours after hospital discharge resulted in hospital readmissions, 65% of which were potentially avoidable. By multivariate logistic regression, low functionality, pressure ulcers, and age over 83 years predicted hospital readmission among emergency room attendees. It is important to identify and analyze barriers in current home care services and the high-risk population of hospital readmission to improve the strategies to avoid adverse outcomes.
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The Centers for Medicare & Medicaid Services (CMS) readmission measure is based on all-cause readmissions to any hospital within 30 days of discharge. Whether a measure based on same-hospital readmission, an outcome that is easier for hospitals and some systems to track, could serve as a proxy for the all-hospital measure is not known.Evaluate whether same-hospital readmission rate is a good surrogate for all-hospital readmission rate.The study population was derived from the Medicare inpatient, outpatient, and carrier (physician) Standard Analytic Files. Thirty-day risk-standardized readmission rates (RSRRs) for heart failure (HF) for both all-hospital readmission and same-hospital readmission were assessed by using hierarchical logistic regression models.The sample consisted of 501,234 hospitalizations in 4674 hospitals with at least 1 hospitalization.Thirty-day readmission was defined as occurrence of at least 1 hospitalization in any US acute care hospital for any cause within 30 days of discharge after an index hospitalization. Same-hospital readmission was considered if the patient was admitted to the hospital that produced the original discharge within 30 days.Overall, 80.9% of all HF readmissions occurred in the same- hospital, whereas 19.1% of readmissions occurred in a different hospital. The mean difference between all- versus same-hospital RSRR was 4.7 +/- 1.0%, ranging from 0.9% to 10.5% across these hospitals with 25th, 50th, and 75th percentiles of 4.1%, 4.7%, and 5.2%, respectively, and was variable across the range of average RSRR.Same-hospital readmission rate is an unreliable and biased indicator of all-hospital readmission rate with limited value as a benchmark for quality of care processes.
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To assess the potential for substituting alternative forms of care for admission to an acute hospital in particular groups of patients.A screening tool, the intensity-severity-discharge review system with adult criteria (ISD-A), developed for hospital utilisation review in the USA, was used in a cohort of hospital admissions to identify a group of patients who could potentially have been treated outside the acute hospital. These patients were further assessed by a panel of general practitioners (GPs) to determine the most appropriate alternative form of care. A cost analysis was performed on the results obtained.General medicine and geriatric specialties in one acute hospital in the south western region.Patients comprised a sample of 701 admitted to general medical and geriatric specialties.The screening tool identified 19.7% of admissions for whom there was potential for treatment outside the acute hospital. Assessment by the GP panel reduced this potential to between 9.8% and 15.0% of emergency admissions. The alternatives most frequently identified as "most appropriate" were the community hospital/GP bed and the urgent outpatient assessment (within either 24 or 48 hours). Potential resource savings based on the average cost were relatively small. This potential seemed to be greater for the alternative of the urgent outpatient assessment.Potential exists for treating a proportion of patients in lower intensity alternatives to the acute hospital. If this potential were exploited few resource savings would occur.
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To compare prospectively the impact of pre-hospital care by a physician-staffed mobile coronary care unit with patients managed initially in-hospital, all with acute myocardial infarction.This was a single centre registry of consecutive patients (n=750) admitted with acute myocardial infarction to the coronary care unit and cardiology wards of the Royal Victoria Hospital, Belfast between 1998 and 2001. For the 750 patients, in-hospital mortality was 11% and was significantly lower for those managed pre-hospital (8% vs 13%, P=0.04): patients who received fibrinolytic therapy (n=474), the in-hospital mortality was significantly lower in the pre-hospital group (7% vs 13%, P=0.02). Those managed pre-hospital had significant reduction in the median delay times (25th, 75th percentiles) from onset of symptoms to call for help 1.0 (0.5, 2.2) vs 2.0 (0.9, 6.0) h, P<0.001, from call for help to receiving fibrinolytic therapy 1.0 (0.8, 1.5) vs 1.8 (1.2, 2.5) h, P<0.001 resulting in a shorter pain-to-needle time for fibrinolytic therapy 2.3 (1.5, 3.8) vs 4.0 (2.6, 7.2) h, P<0.001. For all patients, older age, haemodynamic indicators on admission (hypotension, higher heart rate, heart failure) and managed by the in-hospital route were significant independent variables for an adverse in-hospital mortality. Although for patients aged >or=75 years no statistical significant reduction in mortality occurred for those managed pre-hospital (P=0.051), nevertheless patients in this age group first treated pre-hospital who received fibrinolytic therapy had a significantly lower mortality than those first treated in-hospital (21% vs 43%, P=0.02).Consecutive patients with acute myocardial infarction seen and managed initially out-of-hospital by a physician-staffed mobile coronary care unit had significantly lower in-hospital mortality.
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This is an investigation of the role that the accident and emergency department of the Auckland Hospital plays in the provision of medical care in the Auckland area. It is demonstrated that a significant part of the work that is done in that department could equally well be performed by general practitioners and that there is a need for further education of the public concerning the delivery of health care.
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Abstract BACKGROUND: Patients who experience intra‐hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single‐center studies or studies that employ ICU admissions as the denominator. OBJECTIVE: To employ automated bed history data to examine outcomes of intra‐hospital transfers using all hospital admissions as the denominator. DESIGN: Retrospective cohort study. SETTING: A total of 19 acute care hospitals. PATIENTS: A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008. MEASUREMENTS: Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre‐existing illness burden; outcomes were: 1) occurrence of intra‐hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS). RESULTS: A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers. CONCLUSIONS: Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.
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