Hospital & health services administration
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Hosp Health Serv Adm · Jan 1991
ReviewIntensive care units in the triage mode: an organizational perspective.
Decisions to admit and discharge patients to and from the intensive care unit (ICU) when beds are scarce should be made in accordance with the triage principle--that is, allocate resources on the basis of the ability to benefit from intensive care. However, uncertainty over resource capacity and patient prognosis limits the ability of decision makers to use this prioritization principle and results in ICUs containing inappropriately placed patients who are denying or delaying care to patients who could benefit more. Using Jay Galbraith's "information processing" model, ICU admission and discharge decision making is described. Organizational strategies to reduce uncertainty and improve decision making are discussed, including strengthening the management role of the ICU physician director and employing prognostic instruments (e.g., mortality prediction models) to share and process information.
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Hosp Health Serv Adm · Jan 1991
Relationship between inappropriate admissions and days of care: implications for utilization management.
A critical issue for utilization management programs is how much of the hospitalization should be reviewed and whether information relative to the admission provides information about the subsequent days of stay. This study evaluates the relationship between the appropriateness (defined as overutilization of acute, inpatient services) of admissions and all days of stay in a probability sample of 6,063 hospitalizations from 50 Department of Veterans Affairs medical centers (VAMCs). Results suggest that preadmission reviews in hospital-based utilization management programs may eliminate not only unnecessary admissions but also, in most cases, completely inappropriate hospitalizations. In addition, except where inpatient-appropriate surgeries are not performed in a timely manner, review of the rest of the stay may not be an efficient use of time and resources.
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Hosp Health Serv Adm · Jan 1989
Understanding the dynamic role of the hospital executive: the view is better from the top.
This article reports the findings of a study of role conflict, role ambiguity, and job dissatisfaction among 119 hospital executives in Houston and San Antonio, Texas. While other studies have looked at role descriptions, this study is the first to examine the dynamics of role conflict and ambiguity among hospital executives. ⋯ Chief executive officers were found to be more satisfied and to experience less role ambiguity than their subordinates. This is important to understanding better the role of the hospital executive and mentoring.