Planning hierarchical hospital service areas for maternal care using a network optimization approach:A case study in Hubei,China

Improving maternal health is one of the Sustainable Development Goals.Hospital service areas(HSAs),which contain most hospitalization behaviors at the local scale,are crucial for health care planning.However,little attention has been given to HSAs for maternal care and the hierarchy structure.Considering Hubei,central China,as a case study,this study aims to fill these gaps by developing a method for delineating hierarchical HSAs for maternal care using a network optimization approach.The approach is driven by actual patient flow data and has an explicit objective to maximize the modularity.It also establishes the hierarchical structure of maternal care HSAs,which is fundamental for the planning of hierarchical maternal care and referral systems.In our case study,45 secondary HSAs and 22tertiary HSAs are delineated to achieve maximal modularity.The HSAs perform well in terms of indices such as the Localization Index and Market Share Index.Furthermore,there is a complementary relationship between secondary and tertiary hospitals,which suggests the need for referral system planning.This study can provide evidence for the validity of the HSA and the planning of maternal care HSAs in China.It also provides transferable methods for planning hierarchical HSAs in other developing countries.

Perception of the Hospital Nutrition Service by Internal Clients: Example of the Results Obtained in the Area of Production of Pediatric Formulas and Enteral Diets

Aim: Client perception was important to indicate points requiring interventions or adjustments and to permit refinement of the services offered. This study aimed to determine the perception of internal clients regarding the quality of the service after integrating these items into the system of electronic prescription. Methods: We applied a questionnaire elaborated based on the SERVQUAL about the five dimensions of service quality (tangibility, reliability, responsiveness, safety, and empathy) with adaptation of the four-point Likert scale, ranging from “I fully disagree” to “I fully agree”. Results: The instrument was applied to 138 professionals, with a 56% return. Analysis revealed that the strong points were related to tangibility, safety and empathy, while the aspects related to reliability showed a lower score regarding time of delivery, occurrences and waste, and those related to responsiveness showed a lower score regarding service to be provided in a timely manner. The Cronbach Alpha Coefficient indicated that the investigation had a high degree of consistency and that the results could be considered reliable. Conclusion: Application of the adapted SERVQUAL questionnaire revealed that the perception of internal clients about the five quality dimensions after the changes made and provided valuable information for the scoring of aspects that still needed adjustment to improve interventions.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

The 55th anniversary of continuous service of the hospital

The First Affiliated Hospital of Zhejiang UniversitySchool of Medicine, Hangzhou, China was found-ed by the noted scientist Ke-Zhen Zhu in 1947 andNovember 2002 represents the 55th anniversary ofcontinuous service of the hospital. We mark the oc-casion with a brief introduction to the hospital. With 1638 staff members including over 300senior doctors and nurse specialists, the hospitalconsisting of 33 clinical, 23 technical departmentsand 1280 beds deals with around one million outpa-tients, 20 thousand inpatients and 12 thousand oper-ations per year. Located in the hospital are severalimportant national institutes such as Laboratory of In-fectious Diseases, Laboratory of Multi-Organ Trans-plantation, Center of Clinical Pharmacology in addi-

Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals

INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.

Evaluating spatial accessibility to healthcare services from the lens of emergency hospital visits based on floating car data

Public medical facilities that are closely related to the health of residents have been recognised as one of the most crucial elements in sustainable urban planning.For the sake of social equality of medical services(especially for emergency medical conditions),the spatial distributions of medical resources need to be accurately measured and continuously optimized.This study presents an effective method to examine night emergency hospital visit and analyse its spatiotemporal characteristics using float car data(FCD).By extracting the hospital service areas,the two-step floating catchment area(2SFCA)methodology was improved to calculate hospital accessibility.Then,the balance between hospital accessibility and population density was analysed.In addition,we investigated the relationship between individual hospital choice preferences and hospital level and analysed several factors that affect individual choices.These results help us understand the special requirements and need of emergency hospital travel in cities and identify areas where medical resources are scarce.They can be used as guidance for urban hospital planning and construction.And the approach of hospital access behaviour investigation and the improved 2SFCA method can also provide insights for other activity-based travel behaviour research.

Effects of a general practitioner cooperative co-located with an emergency department on patient throughput

BACKGROUND:In 2013 a General Practitioner Cooperative(GPC) was introduced at the Emergency Department(ED) of our hospital.One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED.To determine the change in patient flow,we assessed the number of self-referrals,redirection of self-referrals to the GPC and back to the ED,as well as ward and ICU admission rates and length of stay of the remaining ED population.METHODS:We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands.RESULTS:More than half of our ED patients were self-referrals.At triage,54.5%of these selfreferrals were redirected to the GPC.After assessment at the GPC,8.5%of them were referred back to the ED.The number of patients treated at the ED declined with 20.3%after the introduction of the GPC.In the remaining ED population,there was a significant increase of highly urgent patients(P<0.001),regular admissions(P<0.001),and ICU admissions(P<0.001).Despite the decline of the number of patients at the ED,the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period,a total increase of 270 hours in two months(P<0.001).CONCLUSION:Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.

Impact of lunar phase on the incidence of cardiac events

Objectives: Popular opinion holds that the phase of the moon influences human behavior, and several reports substantiate this claim;however, reports of correlation between the lunar cycle and cardiac events remain controversial. The purpose of the present study was to determine whether a relationship exists between lunar cycle and the occurrence of acute cardiac events. Methods: A retrospective review of cardiac events, including ST-elevated myocardial in-farction (STEMI), non-ST elevated myocardial infarction (NSTEMI), and unstable angina, over a 5- year period was performed. The dates of cardiac events were recorded and merged with the four phases of the lunar cycle (new moon, first quarter, full moon, and last quarter). Results: A total of 4751 cardiac events (578 STEMI, 1446 NSTEMI, 2727 unstable angina) occurred during the 5-year study period in 3935 unique patients. Cardiac events occurred equivalently during various phases of the lunar cycle. Conclusions: Despite popular opinion, our evidence suggests that the lunar cycle has no effect on the occurrence of acute coronary syndromes.

The Journey to Elsewhere:Climbers Who Start Early and Finish Late

The emergence of adventure tourism is indicative of a process of commodification commensurate with the expansive mechanisms of the hospitality industry.The tension between excitement,thrill,and safety is on-going however and the emergence of climbing walls in urban areas has provided new ways of becoming a climber:It is in the interests of climbing as business to normalise pay-to-climb conditions.Such overt commercial connections are anathema to real climbers;nevertheless the convenience of climbing walls means they are well populated and used.The present study investigates the attitudes and methods of engagement by a group of older climbers who,for the most part,started climbing in their youth before climbing walls were commonplace.A typology of climbing types is presented as a framework for discussion.The methodology is ethnographic and the findings suggest that,despite subscribing to an organic and outdoor adventure climbing ethos in their youth,this group remains active and adventurously inclined as they consider wall-climbing to be making a positive contribution to their present collective identity.

Can Low-Price Hospitals Ease The High Cost of Medical Services?

Going to a hospital is not an easy matter for most Chinese people, with overcrowding and soaring medical costs having become two focuses of public complaint. China's medical system has been on a marketization drive since the 1980s. A July 2005 report by the Development Research Center of the State Council, a think tank under China's cabinet, however, came to

Hospitality Leaders Call for Standardisation of Services and Metrics

A select group of Sales and Marketing Leaders from the hospitality industry. speaking at the inaugural HSMAI Asia Pacific Thought Leaders in Marketing Roundtable in Singapore. called for a review of Asian Hospitality practices as well as a body to take charge of the issue of standardizing services. metrics and ratings for the industry.