PATIENT EXPERIENCE WITH HOSPITAL CARE-COMPARISON OF A SAMPLE OF GREEN HOS PITALS AND NON-GREEN HOSPITALS

Although the sustainability movement in the healthcare sector was initiated in response to ecological concerns,green hospitals are expected to outperform traditional hospitals on a variety of levels.The impacts of environmental quality on patients and caregivers are demonstrated in numerous studies.However,there is still a lack of evidence on the benefits of green hospitals with respect to different dimensions of patients’experiences.In this study,data from the public Hospital Consumer Assessment of Health Plans Survey is used to compare the performance of green hospitals with the average performance of traditional hospitals.This study included 19 green hospitals and found that patients hospitalized in green facilities reported overall higher ratings than those in traditional hospitals when compared to the average performance of traditional hospitals of similar sizes and locations.Additionally,patients in green hospitals were more likely to recommend the hospital to their friends and family.However,relationships between specific green building features and patient experiences were not identified in this study.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Pocket book of hospital care for children

This pocket book is for use by doctors, senior nurses and other senior health workers who are responsible for the care of young children at the first referral level in developing countries. It presents up-to-date clinical guidelines which are based on a review of the available published evidence by subject experts, for both inpatient and outpatient care in small hospitals where basic laboratory facilities and essential drugs and inexpensive medicines are available. In some settings, these guidelines can be used in the larger health centres where a small number of sick children can be admitted for inpatient care.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Identifying the core competencies of backup nurses in the acute care hospital through a modified Delphi process

Background:The backup nurses are created to meet emergencies in the case of inadequate nursing staff and emergency circumstances,and there are no clear definitions of the core competencies for training and evaluation of backup nurses in the acute care hospitals in China.Methods:This study used a modified Delphi process where an initial list of potential competencies is established following a framework of training need analysis(TNA),literature review,and focus groups.This process generated as a list of 47 core competencies,which is presented to an expert panel(n=20)for consideration in two rounds.Results:As determined by the survey,a combination of 26 core competencies in three specified categories is identified:professional practice ability,critical thinking ability,and interpersonal skills.A total of 154.99 h is required to complete all 26 core competencies,and each item has a corresponding evaluation method.Conclusions:The core competencies provide a scientific basis for the hospital nursing managers to train and evaluate backup nurses,and it may ensure consistency in standards across the country.

Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Medication adherence and quality of life among type-2 diabetes mellitus patients in India

BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study

Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

Development of the trauma emergency care system based on the three links theory

The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

COMPARISON OF RANITIDINE AND PANTOPRAZOLE FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS REQUIRING MECHANICAL VENTILATION

Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia (HAP). Results A total of 63 patients were given Ranitidine, and 58 patients were given Pantoprazole for stress ulcer bleeding prophylaxis. Nine patients (7.44%, 9/121) developed clinically-important upper gastrointestinal bleeding, including 5 (7.94%, 5/63) in the Ranitidine group, and 4 (6.90%,4/58) in the Pantoprazole group. The rate of HAP was 3.17% (2/63) in the Ranitidine group, and 15.52% (9/58) in the Pantoprazole group. Conclusion Ranitidine was associated with lower rates of HAP as compared with Pantoprazole, with no statistically significant difference in clinically-important gastrointestinal hemorrhage. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.