Institution-wide program for impaired residents at a major teaching hospital

An institution-wide program for residents impaired by alcohol, other drugs, or emotional problems was established in 1983 at the Medical College of Wisconsin Affiliated Hospitals. The goal of the program was to help impaired house staff members to continue their training in a nonpunitive environment. An approach to reviewing allegations of impairment and a legal agreement between the hospital and the recovering resident were implemented. Because no residents were reported for impairment during its first two years, the program's emphasis was shifted from an investigative to an educational, assistive role. Major problems in carrying out the program have been the program's lack of authority to ensure cooperation by program directors and by impaired residents; a widespread unfamiliarity with intervention procedures despite efforts to inform residents, their spouses, faculty members, and administrators about the program; and misconceptions that the program is punitive. Further impediments are lack of a budget to provide educational activities, inadequate socializing between the faculty and the house staff that would enable faculty members to recognize early signs of impairment; and inadequate health insurance coverage for long-term treatment.     

Assessment of service delays and impact on bed utilisation in a major teaching hospital

Background  

Increasing economic pressures coupled with an expanding and ageing population and a hostile economic climate have led to growing interest in the optimisation of bed usage within hospitals. There are many causes for delay in a patient’s discharge.     

Attitudes to alcoholism in a Sydney teaching hospital

The physical and psychosocial tolls that are attributable to alcohol are well-documented. However, our community has been slow to respond to this serious problem. A survey of attitudes to alcoholism at a Sydney teaching hospital found an acceptance of the disease model and an acknowledgement of alcohol as Australia's main problem drug. The vast majority of respondents felt that the National Campaign against Drug Abuse had paid inadequate attention to alcohol.     

Antibiotic-resistant staphylococci in a teaching hospital

A large, continuing outbreak of infection and colonisation with a Staphylococcus aureus which is resistant to methicillin and gentamicin is reported. Affected patients and staff members seen between September, 1980, and August, 1981, are reviewed in detail. Methods of management of such persons and their treatment, if required, are discussed. The antibiotic-resistant Staph. aureus is readily disseminated in hospitals and may cause outbreaks of infection in wards, which require isolation of affected patients in the attempt to control the problem. It is suggested that a special isolation unit is needed. Use of the few effective antibiotic agents should be restricted. Despite these measures, the spread of this organism may not be contained.     

Psychiatry in a postgraduate teaching hospital

A study is presented of 217 adults referred for psychiatric assessment from the wards of a postgraduate teaching hospital.     

Medication prescribing errors in a teaching hospital

A study of prescribing errors committed by physicians that occurred in a tertiary-care teaching hospital is reported. From a total of 289 411 medication orders written during the 1-year study period, 905 prescribing errors were detected and averted, of which 522 (57.7%) were rated as having potential for adverse consequences. The overall detected error rate was 3.13 errors for each 1000 orders written and a rate of 1.81 significant errors per 1000 orders. The error rate (4.01 per 1000 orders) was greatest between 12 pm and 3:59 pm. First-year postgraduate residents were found to have a higher error rate (4.25 per 1000 orders) than other prescriber classes, and obstetrics/gynecology services (3.54 per 1000 orders) and surgery/anesthesia services (3.42 per 1000 orders) had greater error rates than other services. The study results demonstrate the significant risk to patients from medication prescribing errors. Educational, operational, and risk-management activities should include efforts directed at reducing the risk to patients from prescribing errors.     

Subspecialty consultations in a teaching hospital.

A chart review of 60 consultations by the nephrology service of a teaching hospital was carried out to determine their diagnostic and therapeutic utility. General medicine residents on elective rotations in nephrology performed 72% of the consultations, only 26% being written by residents in the subspecialty. Consultants made an average of 2.2 diagnoses per patient, of which 57% confirmed the working diagnosis already in the medical record. They made an average of 3.0 recommendations for further investigation per patient, but referring physicians implemented only 58% of these. An average of 1.6 recommendations for therapy were made per patient, of which 64% were implemented. The apparent neglect of the consultant's advice for investigation and therapy suggests that the written consultation to some extent fails to convey information useful for the referring physician and the patient. Further study is needed to determine if this failure reflects inadequate training of house officers as consultants.     

教学医院青年医师提高教学能力途径的探索

医学院校师资力量的培养已成当务之急。青年医师应系统学习教育理论、积极观摩、开展教学查房及经验交流、利用互联网、阅读文献、重视学术实践,以不断提高临床教学能力。     

医院多媒体网络教学实施方案的探讨

医院多媒体网络教学实施中的许多具体问题需要不断摸索和解决,本文对医院多媒体教学网络构成有关问题、手术示教的实时转播、医学图片的教学利用等方面的解决进行了阐述和探讨.