Healthcare quarterly (Toronto, Ont.)
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Literature suggests little standardization in the practice of medical clearance of patients who present to emergency rooms in psychiatric crisis. The present quality improvement study examined current practice in a large psychiatric teaching hospital setting. ⋯ Results indicated a wide variation in documentation across the four groups and some body systems that were consistently never assessed. To improve standardization, a physical examination form is proposed that is user friendly and based on a review of current literature.
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Hospitals are faced with increasing challenges of antibiotic-resistant organisms and rising antimicrobial costs despite widespread attention to infection prevention and control measures. Government, professional organizations and accreditation bodies are all signalling an urgent need for the establishment of programs in hospitals to address antibiotic misuse. Although variations of such "antimicrobial stewardship programs" have been functioning in Canada for some time, a formal approach using change management and quality improvement principles has largely been lacking. We describe how we have established such a program in a teaching hospital, modelled on John Kotter's eight steps of leading change.
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Early reperfusion of the myocardium is crucial in treating patients with acute ST segment elevation myocardial infarction (STEMI). Emergency medical services (EMS) plays an important role in minimizing delays to reperfusion. ⋯ Thus, such patients cannot benefit from many mechanisms designed to minimize time delays. Healthcare providers are challenged with both implementing strategies for improving care (minimizing delays to reperfusion) for patients not using EMS, and encouraging patients to access care via EMS in the event of acute chest pain.