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Article

Meritxell Mondejar-Pont, Anna Ramon-Aribau and Xavier Gómez-Batiste

The purpose of this paper is to propose a unified definition of integrated palliative care (IPC), and to identify the elements that facilitate or hinder implementation of…

Abstract

Purpose

The purpose of this paper is to propose a unified definition of integrated palliative care (IPC), and to identify the elements that facilitate or hinder implementation of an integrated palliative care system (IPCS).

Design/methodology/approach

A scoping review of the conceptualization and essential elements of IPC was undertaken, based on a search of the PubMed, Scopus and ISI Web of Science databases. The search identified 79 unduplicated articles; 43 articles were selected for content analysis.

Findings

IPC is coordinated and collaborative across different health organizations, levels of care and types of providers. Eight key elements facilitate implementation of an IPCS: coordination, early patient identification, patient-centered services, care continuity, provider education and training, a standard implementation model and screening tool, shared information technology system, and supportive policies and funding. These elements were plotted as a “Circle of Integrated Palliative Care System Elements.”

Practical implications

This paper offers researchers an inclusive definition of IPC and describes the essential elements of its successful implementation.

Originality/value

This study provides evidence from researchers on five continents, offering insights from multiple countries and cultures on the topic of IPC. The findings of this thematic analysis could assist international researchers aiming to develop a standard evaluative model or assess the level of integration in a health care system’s delivery of palliative care.

Details

Journal of Integrated Care, vol. 27 no. 4
Type: Research Article
ISSN: 1476-9018

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Article

Hamidreza Khalili and Ardalan Sameti

This study aims to measure the quality of services provided to elderly people at the most crowded governmental ambulatory clinics of Tehran Province using the SERVQUAL…

Abstract

Purpose

This study aims to measure the quality of services provided to elderly people at the most crowded governmental ambulatory clinics of Tehran Province using the SERVQUAL scale (Study 1). Moreover, the research indicates the medicine reimbursement criteria to inform the decision-makers of public health insurance organizations using the Borda method (Study 2).

Design/methodology/approach

This study was done as a cross-sectional research on 425 elderly patients who came to the clinics during 2014 and 2015. Finally, using the paired t-test, Friedman test, Borda method, SPSS, Matlab software and Delphi method, the collected data were analysed.

Findings

Regarding the perceived quality, the services assurance dimension was ranked as having the highest quality (4.48) and the accessibility dimension as the lowest one (3.22). Based on the Borda method, the most important criterion for the Iranian health insurance companies to accept a medicine in their reimbursement list is the “life-threatening conditions” factor. On the other hand, “evidence quality” is accounted as the fifth important factor.

Research limitations/implications

The main limitation was the senility of participants that makes it difficult for understanding and completing the questionnaires.

Practical implications

The results can be useful for healthcare policy makers and related authorities. Besides, public health insurers can use the findings for decision-making about the elderly diseases and the problems such as the medical expenses.

Originality/value

The present research has been done in a two-year time frame, and it is more recent than other related studies. Thus, the results are far more authentic and applicable.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 11 no. 4
Type: Research Article
ISSN: 1750-6123

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Article

Shamsuddin Ahmed and Addas F. Mohammed

Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service…

Abstract

Purpose

Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service efficiency in AEHs is difficult to quantify due to the clinical complexity involved in treatment involving various units, patient conditions, changes in contemporary medical practices and technological developments. This paper aims to show how to measure efficiency by eliminating waste in AEH system, identify service failure points, identify benchmark medical services, identify patient throughput time and measure treatment time when AEH services are nonstandard. The applications shown in this paper are distinct in particular; we the authors use nontraditional and systems engineering approach to collect data as the traditional data collection is difficult in real-time AEHs.

Design/methodology/approach

The authors show in this study how to measure overall patient treatment time from admission to discharge. Project evaluation and review technique (PERT) captures the inconsistencies involved in measuring treatment time, including measures of variability. The irregular treatment time and complexity involved in the emergency health-care services are usual. The research methodology illustrates how the time function map and service blueprint can improve value-added time in AEHs and benchmark services between similar AEHs.

Findings

The inconsistency in treatment time between AEH in public and private hospital is found to be in ratio of 1:20. The private hospital suggests variety of treatments and long stays for recovery. The PERT computations show that the average time a patient remains in a government AEH is about 10 days. The standard deviation of the AEH treatment time is about 0.043 per cent of the expected patient care time. The inconsistency is not significant as compared to the expected value. In 89.64 per cent of the cases, a patient may be discharged in less than 10 days’ time. The patient on average is discharged in 13 days in a private hospital.

Originality/value

The patient treatment time of an AEH is evaluated with PERT project management approach to account for inconsistencies in treatment time. This research makes new contributions in benchmarking AEH throughput time, identify medical service failure points with service blueprint, measure the efficiency with time function map and collect patient data with nontraditional methods. The inherent inconsistencies in a clinical process are identified by PERT analysis with the variance as a characteristic of the treatment time. Improvement of variability implies cost reduction in AEH system.

Details

Kybernetes, vol. 48 no. 3
Type: Research Article
ISSN: 0368-492X

Keywords

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Book part

Maureen Cluskey and Kelly Schwend

The role of the school nurse has evolved. It has expanded from administering first aid and promoting hand washing to key participation in program planning for health and…

Abstract

The role of the school nurse has evolved. It has expanded from administering first aid and promoting hand washing to key participation in program planning for health and educational outcomes for the school-aged child. Nurses provide leadership in promoting a healthy and safe school environment, case management of chronically ill children, collaboration between family and school, and referral to essential community resources. Additionally, the school nurse is a valuable resource on the multidisciplinary special education team. The school nurse is the health care expert in the school and is in a unique position to meet the actual and potential needs of all students – including those with special needs.

Details

Interdisciplinary Connections to Special Education: Key Related Professionals Involved
Type: Book
ISBN: 978-1-78441-663-8

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Book part

Sandra C. Buttigieg, Wilfried von Eiff, Patrick Farrugia and Maximilian C. von Eiff

Point-of-care testing (POCT) at the Emergency Department (ED) attains better objectives in patient care while aiming to achieve early diagnosis for faster medical…

Abstract

Purpose

Point-of-care testing (POCT) at the Emergency Department (ED) attains better objectives in patient care while aiming to achieve early diagnosis for faster medical decision-making. This study assesses and compares the benefits of POCT in the ED in Germany and Malta, while considering differences in their health systems.

Methodology/approach

This chapter utilizes multiple case study approach using Six Sigma. The German case study assesses the use of POCT in acute coronary syndrome patients, compared to the central lab setting. The Maltese case study is a pilot study of the use of medical ultrasonography as a POCT to detect abdominal free fluid in post-blunt trauma.

Findings

This study provides clear examples of the effectiveness of POCT in life-threatening conditions, as compared to the use of traditional central lab or the medical imaging department. Therapeutic quality in the ED and patient outcomes directly depend upon turnaround time, particularly for life-threatening conditions. Faster turnaround time not only saves lives but reduces morbidity, which in the long-term is a critical cost driver for hospitals.

Originality/value

The application of Six Sigma and the international comparison of POCT as best practice for life-threatening conditions in the ED.

Details

International Best Practices in Health Care Management
Type: Book
ISBN: 978-1-78441-278-4

Keywords

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Article

Margaret H. Vickers

Spotlights the existence of “invisible” chronic illness (ICI) in organizations and, in particular, how disclosure of these conditions presents a potentially traumatizing…

Abstract

Spotlights the existence of “invisible” chronic illness (ICI) in organizations and, in particular, how disclosure of these conditions presents a potentially traumatizing dilemma for affected individuals. “Damned if they do, damned if they do not”, the person with “invisible” chronic illness (PwICI) risks deviant labelling, stigmatization and discrimination if they disclose a stigmatizing condition, and real threats to physical and emotional well‐being if they do not. Arguments for and against disclosure are framed, with some notes underscoring the western capitalist philosophy that efficiency in organizations must predominate, regardless of the cost to the individual. The attention of management scholars and practitioners is drawn to the“pain of silence” at a time when chronic illness is increasing, yet little understanding of the working life of the PwICI exists.

Details

Journal of Workplace Learning, vol. 9 no. 7
Type: Research Article
ISSN: 1366-5626

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Article

Hong Qin, Gayle L. Prybutok, Victor R. Prybutok and Bin Wang

The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service…

Abstract

Purpose

The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices.

Design/methodology/approach

This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality.

Findings

Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions.

Research limitations/implications

The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings.

Practical implications

The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape.

Social implications

This work contributes to the understanding of how to provide cost effective and efficient UC services.

Originality/value

This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

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Article

R.R. West, S.J. Frankel and R.E. Roberts

A study comprising both questionnaire and interview of patientswaiting for general surgery revealed that the majority of patientssuffer from relatively few clinical…

Abstract

A study comprising both questionnaire and interview of patients waiting for general surgery revealed that the majority of patients suffer from relatively few clinical conditions, that more than three‐quarters had been on the in‐patient list for over a year and that they suffered significant pain while waiting. Patients added to long lists with initially non‐serious (non‐life‐threatening) conditions may be overlooked, yet their clinical and associated social conditions may deteriorate. Since treatment for these conditions is generally effective, many patients would benefit from more organised queue management and earlier surgery.

Details

Journal of Management in Medicine, vol. 5 no. 3
Type: Research Article
ISSN: 0268-9235

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Article

W.M. Chiang, C.S. Lim, C.K. Chua, P.L. Lo and C.T. Eng

Tracheobronchial stents are commonly used in airway management as a form of palliation for obstruction. This form of therapy immediately relieves the patients from…

Abstract

Purpose

Tracheobronchial stents are commonly used in airway management as a form of palliation for obstruction. This form of therapy immediately relieves the patients from life‐threatening conditions and significantly improves their quality of life. In the cases of complex tracheobronchial obstruction, customised airway stents are required for effective palliation. In this work, an Airway Stent Customisation Protocol (ASCP) is introduced.

Design/methodology/approach

It describes two variant routes that use a combination of rapid prototyping (RP) and rapid tooling (RT) techniques to fabricate customised airway stents in short lead times. The ASCP allows the stents to be tailored in terms of geometry, and distending strength. A brief comparison between the ASCP and other RP/RT manufacturing routes is also carried out.

Findings

The ability to customise airway stents in short lead times is important as it allows surgeons to swiftly treat life‐threatening conditions arising from tracheobronchial obstructions. It is shown that the ASCP is capable of providing relief to patients quickly. The application of RP and RT in the ASCP has not only allowed shorter response time to patients, but has also allowed the stents to be produced at a relatively low cost.

Originality/value

Tracheobronchial stents are commonly used in patients facing advanced stages of cancer. Focuses on a time and cost‐effective solution that is provided to improve their quality of life.

Details

Rapid Prototyping Journal, vol. 11 no. 2
Type: Research Article
ISSN: 1355-2546

Keywords

Content available
Article

Abstract

Details

Disaster Prevention and Management: An International Journal, vol. 12 no. 4
Type: Research Article
ISSN: 0965-3562

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