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Scientific literature review: hospital management

On this page IHE presents a few key abstracts from the clinical literature about hospital management, selected by our editorial board.

Concern about patient safety is a priority in the quality policy of health systems. In the pharmacotherapeutic process, from prescription to administration of drugs, failures that cause unwanted effects in patients may occur. This is especially common in patients with multiple pathologies and polypharmacy, common in medical specialities services. It is essential to analyse and identify the causes that trigger medical errors to prevent their occurrence. In this context, computerised physician order entry is an attractive tool for ensuring patients safety.

Different usage of the same oncology information system in two hospitals in Sydney - lessons go beyond the initial introduction.

information systems.
Yu P, Gandhidasan S, Miller AA. Int J Med Inform 2010 Jun;79(6):422-9.

A critical appraisal of physician-hospital integration models.

Satiani B, Vaccaro P. J Vasc Surg. 2010 Apr;51(4): 1046-53.

Implementing an electronic change-of-shift report using transforming care at the bedside processes and methods.
Bedside nurses are well positioned to make changes that positively affect operations and practice. Using Transforming Care at the Bedside processes and methods, the authors describe the clinical nurse-led development, testing and implementation of an electronic template and process for change-of-shift report. Outcomes included a reduction in time spent in change-of-shift reports, reduced end-of-shift overtime and a more standardised process, and staff who perceived improved information quality and were satisfied with the process.
Nelson BA, Massey R. J Nurs Adm. 2010 Apr;40(4):162-8.

Human factors engineering in healthcare systems: the problem of human error and accident management.
This paper discusses some crucial issues associated with the exploitation of data and information about healthcare for the improvement of patient safety. In particular, the issues of human factors and safety management are analysed in relation to exploitation of reports about non-conformity events and field observations. A methodology for integrating field observation and theoretical approaches for safety studies is described. Two sample cases are discussed in detail: the first one makes reference to the use of data collected in the aviation domain and shows how these can be utilised to define hazard and risk; the second one concerns a typical ethnographic study in a large hospital structure for the identification of most relevant areas of intervention. The results show that, if national authorities find a way to harmonise and formalise critical aspects, such as the severity of standard events, it is possible to estimate risk and define auditing needs, well before the occurrence of serious incidents, and to indicate practical ways forward for improving safety standards.
Cacciabue PC, Vella G. Int J Med Inform 2010 Apr;79(4):e1-17.

Effect of point-of-care computer reminders on physician behaviour: a systematic review.
The opportunity to improve care using computer reminders is one of the main incentives for implementing sophisticated clinical information systems. A systematic review was conducted to quantify the expected magnitude of improvements in processes of care from computer reminders delivered to clinicians during their routine activities. The MEDLINE, Embase and CINAHL databases (to July 2008) were searched and the bibliographies of retrieved articles were scanned. Studies were included in the review if they used a randomised or quasi-randomised design to evaluate improvements in processes or outcomes of care from computer reminders delivered to physicians during routine electronic ordering or charting activities. The results were that computer reminders produced much smaller improvements than those generally expected from the implementation of computerised order entry and electronic medical record systems. Further research is required to identify features of reminder systems consistently associated with clinically worthwhile improvements.
Shojania KG et al. CMAJ. 2010 Mar 23;182(5): E216-25.


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