OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

Objective To learn the capability and functioning status of prenatal ultrasound screening institutions in Beijing and inform decision-making on the optimization of prenatal screening management. Method By using the data from the second and the third National Special Survey on Prenatal Screening and Prenatal Diagnostic Services in Beijing,we analyzed the distribution,human resources,workload,technology,and equipment of ultrasound screening institutions in Beijing as well as their changing trends. Results From 2013 to 2015,there were 100 prenatal ultrasound screening institutions,833 technicians,and 383 prenatal ultrasound screening instruments in Beijing,offering over 600 000 service sessions.In contrast,there were 93 institutions with a total service volume of 644 100 between 2010 and 2012.The general hospitals,tertiary hospitals,and urban areas(especially urban functional development areas and new urban development areas)were the main sources of the services.In particular,the maternal and child health care hospitals in Beijing provided the highest amount of services per unit of resources.The average prenatal ultrasound screening rate was about 98.05%.The service delivery trended to transfer from urban areas to remote county areas and from secondary institutions to tertiary institutions.Conclusion The operation and management of prenatal ultrasound screening institutions in Beijing are relatively standard.The ultrasound screening rate is relatively high in the second trimester,and the distribution of the services has constantly been improved since 2010.
Beijing ; Female ; Hospitals, General ; Humans ; Mass Screening ; statistics & numerical data ; Pregnancy ; Prenatal Diagnosis ; statistics & numerical data ; Ultrasonography ; Ultrasonography, Prenatal

PURPOSE: The aim of this study was to identify the factors influencing nursing performance in caring for patients with delirium.METHODS: This study included 166 nurses who worked for more than 6 months at 4 general hospitals in Jeju Province, South Korea. Patients were administered a self-reported questionnaire. The study was carried out from May 20, 2014, to June 19, 2014. Data analyses were conducted using stepwise multiple regression, Pearson's correlation coefficients, t-test, and analysis of variance using the SAS WIN 9.2 program (SAS Institute, Cary, NC, USA).RESULTS: The factors associated with nurses' performance in delirium care were work position (β=.22, t=2.58, p < .001) and having received education on delirium care (β=.16, t=2.24, p=.026).CONCLUSION: The results showed that the nurses' work position and having received education on delirium care affected nursing performance in delirium care. In order to improve nurses' performance in delirium care, hospitals should provide a delirium education program for nurses and establish standard guidelines on delirium care.
Delirium ; Education ; Hospitals, General ; Humans ; Korea ; Nursing ; Statistics as Topic

This study aimed to examine nutrition care management for in-patients with dysphagia and to evaluate knowledge on nutrition care related to dysphagia among dietitians in clinical settings. A total of 554 questionnaires were distributed to dietitians at hospitals located in Seoul and Gyeonggi Province in Korea, and 147 responses were used for data analysis after excluding responses with significant missing data. Study participants worked at general hospitals (37.2%), long-term care hospitals (24.3%), hospitals (19.2%), and tertiary hospitals (11.5%). Prior education and training related to dysphagia was received by 69.9% of the respondents. The percentage of hospitals that had diet guidelines for dysphagia was 68.0%. Dysphagia diets of 2 levels and 3 levels were provided in 55.1% and 34.7% of the hospitals, respectively. Overall 74.7% of the dietitians responded that they provided information on dysphagia diets to in-patients and caregivers, but only 45.7% of dietitians did so in the long-term care hospitals. Among the respondents who used commercial thickening agents, 77.2% used only one type of commercial thickening agent. Patients or caregivers (75.7%) or nurses (34.5%) were reported to modify viscosity of liquid. Dietitians showed low levels of knowledge on nutrition care related to dysphagia (a mean of 5.14 based on possible scores from 0 to 10 points). To promote nutritional consumption and prevent malnutrition and aspiration, hospitals need the standardized diet guidelines, and dietitians should improve their expertise in nutritional care for patients with dysphagia.
Caregivers ; Deglutition Disorders ; Diet ; Education ; Gyeonggi-do ; Hospitals, General ; Humans ; Korea ; Long-Term Care ; Malnutrition ; Nutritionists ; Seoul ; Statistics as Topic ; Surveys and Questionnaires ; Tertiary Care Centers ; Viscosity

PURPOSE: The purpose of this study was to identify the effect of resilience and job placement on general hospital nurse's intention to relocate, prepare a practical transfer management plan, and provide basic data on effective personnel management. METHODS: Data were collected from 333 nurses in 2 general hospitals with more than 500 beds in P-city. Data analysis was performed using hierarchical regression with the SPSS/WIN 25.0 program. RESULTS: The significant factors influencing turnover intention of hospital nurses were sacrifice, fit, link, interpersonal relationship, followed by experience of turnover. Explanatory power was 42% in the regression model. CONCLUSION: Resilience and job embeddedness have a positive effect on turnover intention in general hospital nurses. Therefore, efforts to improve resilience, job embeddedness, and organizational support are required to decrease turnover intention.
Hospitals, General ; Intention ; Personnel Management ; Statistics as Topic

Clinical laboratories for in vitro diagnostics are facing pressure to preserve cost control while providing better services through new initiatives. Laboratory automation is a partial answer to this problem, having come a long way from the early days of clinical laboratory testing. The journey and implementation of automation in the Singapore General Hospital's Clinical Biochemistry Laboratory has allowed for sustained performance in the light of increasing workload and service commitments amid an evolving healthcare environment. Key to realising predicted outcomes is the optimisation of workflow processes, reduction of errors, and spatial placement of specimen reception and analytical areas. This paper gives an overview of our experience with automation in the clinical laboratory and its subsequent impact on service standards.
Aged ; Automation, Laboratory ; Clinical Laboratory Information Systems ; organization & administration ; Clinical Laboratory Techniques ; Efficiency, Organizational ; statistics & numerical data ; Hospitals, General ; Humans ; Laboratories, Hospital ; organization & administration ; Middle Aged ; Quality of Health Care ; Singapore ; Tertiary Healthcare ; organization & administration ; User-Computer Interface ; Workload

PURPOSE: This study was to investigate the performance of safety care activities among nurses in small-medium sized general hospitals and to identify factors associated with the safety care activities. METHODS: In this cross-sectional descriptive study, 455 nurses were recruited from small-medium sized general hospitals. Data were collected with the ‘Questionnaire on Patient Safety Care Activities’ by web based survey. Descriptive statistics, independent t-test and One-way ANOVA with Duncan test for multiple comparison were used for data analysis. RESULTS: The mean score of patient safety care activity was 4.52 out of a total of 5 points. The total score of patient safety care activities according to the characteristics of the subjects was significantly higher than those of patients who had more than 15 years of clinical nursing career (F=7.06, p < .001) and there was a significant difference according to experience of healthcare accreditation (t=−2.10, p=.036). CONCLUSION: In order to raise the level of patient safety care activity among nurses in small-medium sized general hospitals, it is important to retain experienced nurses. Practical training and regular educations on patient safety care activities are required for nurses in small-medium sized general hospitals.
Accreditation ; Delivery of Health Care ; Hospitals, General* ; Humans ; Nursing ; Patient Safety* ; Statistics as Topic

PURPOSE: The purpose of this study was to determine the effects of labor intensity and fatigue on the sleep quality of clinical nurses and provide basic data for preparation of nursing interventions to improve sleep quality. METHODS: Data were collected from 198 nurses in 2 general hospitals with more than 500 beds in D-city. Data analysis was performed using stepwise regression with the SPSS/WIN 22.0 program. RESULTS: The significant factors influencing sleep quality of the clinical nurses were fatigue, absolute labor intensity, and shift type. Explanatory power was 66% in the regression model. CONCLUSION: Findings indicate that nurses with higher level of fatigue, and greater absolute labor intensity which implies extended work hours, had lower sleep quality for all the three shifts. To improve the sleep quality of clinical nurses, an intervention program for fatigue management is needed. In addition, hospitals should establish an internal legal standard to compensate overtime work with breaks. At the same time, as shift work is inevitable for nurses, it is necessary to develop a work system that can minimize the disturbance of daily rhythms.
Fatigue ; Hospitals, General ; Nursing ; Statistics as Topic

PURPOSE: To describe nursing students' experience of sexual harassment during clinical practicum. METHODS: An interpretive phenomenological qualitative approach was used to understand contextual experiences of participants. Individual in-depth interviews were conducted to collect data from thirteen nursing students who experienced sexual harassment during clinical practice in general hospitals at D metropolitan city. All interviews were recorded and transcribed into Korean and English. Transcripts were analyzed using the data analysis method described by Diekelmann, Allen, and Tanner. RESULTS: The following 12 themes emerged from the data: ‘unprepared to respond’, ‘lack of education’, ‘unsure about when behavior crosses the line’, ‘power differential for nursing students’, ‘balancing self-preservation with obligations to patients’, ‘shame’, ‘feeling responsible for not being able to prevent the harassment’, ‘impact on patient care’, ‘fear of what might have happened’, ‘fear of repercussions’, ‘long term impact’, and ‘peer support’. CONCLUSION: Participants in this study described feeling an obligation to care for their patients. However, they seemed to be unable to balance this while feeling vulnerable to sexual harassment with strong negative feelings. Helping students recognize and effectively deal with sexual harassment is a critical element to assure quality learning for participants and maintain quality of care during clinical practice.
Hospitals, General ; Humans ; Learning ; Methods ; Nursing* ; Preceptorship* ; Qualitative Research ; Sexual Harassment* ; Statistics as Topic ; Students, Nursing

PURPOSE: The purpose of the study is to examine the impact of job stress on the patient safety nursing activities among nurses. METHODS: The subjects of the study are 258 nurses working at 15 small-medium sized hospitals in D city. Data analysis was done using frequency, percentage, average and standard deviation, t-test, one-way ANOVA, Scheffé test, Pearson's correlation coefficient, stepwise multiple regression. RESULTS: The job stress scored average 3.67 and patient safety nursing activity scored average 4.35. Job stress was positively associated with patient safety nursing activity. It explains 9.49% of the variance. CONCLUSION: Universal and inevitable job stress among nurses should not exceed optimum level to assure patient safety. So, personal and organizational efforts to manage job stress are needed.
Hospitals, General* ; Humans ; Nursing* ; Patient Safety* ; Statistics as Topic