Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

In this paper, we address the issue of whether it is economically advantageous to concentrate emergency rooms (ERs) in large hospitals. Besides identifying economies of scale of ERs, we also focus on chain economies. The latter term refers to the effects on a hospital's costs of ER patients who also need follow‐up inpatient or outpatient hospital care. We show that, for each service examined, product‐specific economies of scale prevail indicating that it would be beneficial for hospitals to increase ER services. However, this seems to be inconsistent with the overall diseconomies of scale for the hospital as a whole. This intuitively contradictory result is indicated as the economies of scale paradox. This scale paradox also explains why, in general, hospitals are too large. There are internal (departmental) pressures to expand certain services, such as ER, in order to benefit from the product‐specific economies of scale. However, the financial burden of this expansion is borne by the hospital as a whole. The policy implications of the results are that concentrating ERs seems to be advantageous from a product‐specific perspective, but is far less advantageous from the hospital perspective. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.     

层流净化产房感染控制管理研究现状

层流净化系统常用于外科手术室。层流净化产房是参考医院层流净化外科手术室建筑技术规范相关要求，在产房内不同区域实施不同级别空气净化技术，使其达到一定空气洁净度级别。启用层流净化系统，可使产房硬件条件得到提升。规范的产房感染控制管理，可降低产妇感染发生率，为产妇分娩提供安全的理想环境，保障母婴健康。笔者查阅大量国内外文献，尚未发现对层流净化产房感染控制管理研究的系统阐述。笔者在整合层流洁净手术室及产房感染控制管理经验的基础上，结合本院实际，从人员(man)、设备(machine)、物料(material)、措施(method)、环境(enviroment)、监测(measurement)等方面，对层流净化产房感染控制管理的研究现状进行阐述，使产房感染控制管理做到规范化、制度化，进而有效降低医院感染发生率，提高医疗水平，保证医疗安全和质量。     

Fetal Left Ventricular Apical Aneurysm Progressing to Dilated Cardiomyopathy Due to Glycogen Storage Disease

Fetal dilated cardiomyopathy is a rare anomaly characterized by ventricular dilation and dysfunction. Its causes are diverse, and its outcomes are generally dismal. We describe a rare case of prenatally diagnosed left ventricular apical aneurysm that progressed rapidly to dilated cardiomyopathy. At age 2 months, the infant underwent heart transplantation. Pathologic examination of the explanted heart revealed that the cause of the dilated cardiomyopathy was glycogen storage disease. This case highlights the crucial roles of timely diagnosis, frequent close monitoring, and multidisciplinary care in achieving a successful postnatal outcome.     

手术室护士职业生涯管理现状及其影响因素分析

目的:了解山东省手术室护士职业生涯管理现状,并对其影响因素进行分析。方法:于2019年2月,以便利抽样方法选取山东省1 418名手术室护士为研究对象,采用《一般资料调查表》《护士职业生涯管理问卷》《护士职业生涯规划问卷》对其一般情况以及职业生涯管理和规划现状进行调查,分析可能的影响因素。结果:手术室护士职业生涯管理得分...     

细节管理在手术室标本留送中的应用

手术是治疗疾病的主要手段,通过手术从患者体内采集的病变组织作为标本,是诊断和治疗疾病的重要依据,也是病理教学和科研的重要资料来源之一。每例手术切取的病变组织大小不等、数目各异,这些标本要经过手术室护士正确处理后送至病理科,进行病理检查。如果发生标本遗漏、丢失、混淆或者固定不良,不仅影响了对疾病的诊断和治疗,也给患者带来巨大的痛苦。我科在加大标本管理力度的同时,更注重细节管理,加强对手术标本的收集、处理、登记及送检等各环节的严格管理,严防差错事故的发生。精细的管理是标准化的管理,     

洁净手术室的感染现状及控制措施分析

目的对洁净手术室的感染现状进行调查分析,并针对性提出控制措施,以降低洁净手术室的感染率。方法医院2010年1月-2012年1月在洁净手术室共完成手术26 958例,对159例发生手术切口感染、无菌物品细菌检测以及手术室卫生学等结果进行统计分析,数据采用SPSS17.0软件进行处理。结果 26 958例手术患者发生切口感染159例,感染率为0.59%,其中择期手术患者发生切口感染73例,感染率为0.41%,急诊手术患者发生切口感染86例,感染率为0.95%,两组感染率比较,差异有统计学意义(P<0.05);医院共监测456间次手术室空气,其中合格的有446间,合格率为97.80%;物体表面共监测647次、合格589次,合格率为91.00%;监测医务人员手295人次,合格289人次,合格率为97.90%;无菌物品共监测561份,所有物品均合格。结论对洁净手术室进行质量管理的加强,严格控制手术室内各项无菌操作,定期检测手术室内空气净化质量,能有效降低手术室内医院感染的发生。     

An environmental survey of compliance with Occupational Exposure Standards (OES) for anaesthetic gases

Environmental monitoring of nitrous oxide and volatile agents was carried out between August 1996 and October 1997 within operating theatre areas in eight hospitals within the Bro Taf Health Authority. Static monitoring and personal sampling were undertaken to assess compliance with the Occupational Exposure Standards introduced in January 1996 by the Health and Safety Executive for anaesthetic agents. The monitoring concentrated on nitrous oxide with the results showing that compliance was being achieved. Limited monitoring was carried out of the volatile agents, which again were well below the Occupational Exposure Limits. Monitoring was also carried out in nontheatre areas in which anaesthetic agents were used. The results show that many of these locations, such as delivery suites and radiology units, have inadequate ventilation and no anaesthetic gas scavenging, both of which combined to produce levels that exceeded the standards.     

新型冠状病毒肺炎疫情下手术室感染控制与管理

目的优化新型冠状病毒肺炎疫情下手术流程,规范手术室感染控制管理方案。 方法规划手术方案,拟定管理流程,科学防控,精准施策。 结果按制定的手术室感染控制管理方案,在疫情期间开展的手术,做到手术室安全、病人安全、医护人员安全,无院内交叉感染发生。 结论制定的新型冠状病毒肺炎疫情下手术室感染控制与管理流程方案,保障了手术患者和医护人员的安全,避免发生院内交叉感染。     

Optimizing the operating theatre environment

The operating theatre is a complex place. There are many potential factors which can interfere with surgery and predispose to errors. Optimizing the operating theatre environment can enhance surgeon performance, which can ultimately improve patient outcomes. These factors include the physical environment (such as noise and light), human factors (such as ergonomics), and surgeon-related factors (such as fatigue and stress). As individual factors, they may not affect surgical outcome but in combination, they may exert a significant influence. The evidence for some of these working environment factors are examined individually. Optimizing the operating environment may have a potentially more significant impact on overall surgical outcome than improving individual surgical skill.