Annali di igiene : medicina preventiva e di comunità
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Comparative Study
[How to implement a unique triage system in the emergency departments of Latium, Italy].
Triage is an efficient system that emergency departments (EDs) use to sort out presenting patients on the basis of the speed with which they need treatment. Because triage is not used consistently in the EDs of Latium, a region in central Italy, the regional Public Health Agency (PHA) planned and implemented a regional model of triage in all EDs. This manuscript describe the regional implementation strategy. ⋯ They will organize, in their own EDs, small groups of nurses to conduct on-site training of the RTP. The RTP was received with enthusiasm by most HPs, however its introduction into current practice could be hampered by organizational/structural problems and conflicts between nurses and doctors. Next actions of the regional program will be to overcome the possible above mentioned troubles.
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Steps toward overcoming mandatory vaccination policy follow two main tracks: scientific and administrative. Scientific course checks starting conditions of the project in Veneto Region and monitors the effects of policy. ⋯ On 23rd March 2007 Veneto Region passed the regional law number 7 called "Sospensione dell'obbligo vaccinale per l'età evolutiva" becoming in force for children born since January 1st 2008. The law provides for the institution of a scientific committee having the task of monitoring both vaccination coverage and preventable infectious diseases incidence after overcoming mandatory vaccination policy.
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Discharge against medical advice (DAMA) may put patients at risk of adverse health outcomes and often generate hospital readmission. A retrospective case-control study (2000-2004) of all DAMA in Veneto Region hospitals was carried out to determine the baseline characteristics of patients who leaves hospital. During the 5-years study period, the overall DAMA rates were 0.8 from ordinary hospitalization and 0.2 from daily. Prediction of patients at risk of DAMA may be possible with several defined variables and this analysis represent an instrument that should facilitate the development of successful strategies to reduce DAMA for high-risk patients.
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New technologies in these years has taken to a spread and to a growth of the CT application with an increase of patients and population exposure. In clinical practice some technical devices can be used to reduce the exposure dose of multidetector CT that allows radiologist to answer the clinical question with less damage to the patient. The radiologist remains however the guarantor of the ionizing radiation exposition and he has to consider also the opportunity to use other methodics (MR, US) to answer some questions. The radiologist has the role to evaluate the clinical indication to the exam demanded from other doctor and has the responsibility for exam management and for progressive radiologic course, controls and follow-up.
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Several studies on the economic aspect of HAI have two major limitations: (1) the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and (2) the lack of an adequate method for calculating the relative costs. The aim of the study was to test a cost modelling method that could overcome these limitations by applying Appropriateness Evaluation Protocol (AEP) to the medical charts and by using cost-centre accounting. ⋯ Moreover it becomes clear that the weight of the cost for the bed, or for the diagnostic services, or again for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. Comparing cost of HAI calculated on the basis of the main total cost per day of hospitalization attributable to the HAI we have finally seen that some cases do not produce any costs, whereas others account costs due not to HAI (operating room) or more expensive costs than the really HAl-treatment-attributable ones, as sepsis in Urology ward (Euro 988.18 versus Euro 747.41) or UTI in General Surgery ward (Euro 603.77 versus Euro 479.30), in Neurology (Euro 4242.91 versus Euro 2278.48) and in Orthopedics (Euro 2328.99 versus Euro 1332.81).