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A hospital represents a special environment, serving health care to patients, and as a work environment for medical and other staff. The problems of the hospital environment, its risks and the prevention of nosocomial infections have become an important topic in activities concerning the environmental education of medical students at the Institute of Hygiene, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic. Educational objectives were different, regarding knowledge, behaviour, attitude and social action. The hygienic level of the hospital ward was observed by students themselves, including microclimate assessment and evaluations. Microbial contamination and acoustic well‐being of the indoor air in a hospital ward were also assessed. Results from environmental investigations performed in several hospitals have shown improvement of microbial contamination in internal, surgical and neurological departments. We believe that if educational objectives targeted at the beginning of practical sessions are fulfilled then medical students will think and behave more pro‐environmentally.

The purpose of this paper is to determine which factors are associated with 6,065 patient presentations with non-life-threatening urgent conditions (NLTUCs) to an after-hours general practice, an urgent care clinic (UCC) and an emergency department (ED) on Sundays in Southeast Queensland (Qld).

A retrospective, comparative and observational study was conducted involving the auditing of medical records of patients with NLTUCs consulting three medical services between 0,800 and 1,700 h, on Sundays, over a one-year period. The study was limited to 6,065 patients.

There were statistically significant differences in choice of location according to age, number of postcodes from the patient's residence, time of the day, season, patient presentations for infection and injury, non-infectious, non-injurious conditions of the circulatory, gastrointestinal and genitourinary systems, and need for imaging, pathology, plastering/back-slab application, splinting and wound closure. Older adults were more likely to be admitted to the hospital and Ed Short Stay Unit, compared with other age groups.

Based on international models of UCC healthcare systems in United Kingdom (UK), USA and New Zealand (NZ) and the results of this study, it is recommended that UCCs in Australia have extended hours, walk-in availability, access to on-site radiology, ability to treat fractures and wounds and staffing by medical practitioners able to manage these conditions. Recommendations also include setting a national standard for UCC operation (National Urgent Care Centre Accreditation, 2018; NHS, 2020; RNZCUC, 2015) and requirements for vocational registration for medical practitioners (National Urgent Care Centre Accreditation, 2018; RNZCUC, 2015; The Royal College of Surgeons of Edinburgh, 2021a, b).

This study has highlighted three key areas for future research: first, research involving general practitioners (GPs), emergency physicians, urgent care physicians, nurse practitioners, urgent care pharmacists and paramedics could help to predict the type of patients more accurately, patient presentations and associated comorbidities that might be encouraged to attend or be diverted to Urgent Care Clinics. Second, larger studies of more facilities and more patients could improve the accuracy and generalisability of the findings. Lastly, studies of public health messaging need to be undertaken to determine how best to encourage patients with NLTUCs (especially infections and injuries) to present to UCCs.

The Urgent Care Clinic model has existed in developed countries since 1973. The adoption of this model in Australia close to a patient's home, open extended hours and with onsite radiology could provide a community option, to ED, for NLTUCs (especially patient presentations with infections and injuries).

This study reviewed three types of medical facilities for the management of NLTUCs. They were an after-hours general practice, an urgent care clinic and an emergency department. This study found that the patient choice of destination depends on the ability of the service to manage their NLTUCs, patient age, type of condition, postcodes lived away from the facility, availability of testing and provision of consumables. This study also provides recommendations for the development of an urgent care healthcare system in Australia based on international models and includes requirements for extended hours, walk-in availability, radiology on-site, national standard and national requirements for vocational registration for medical professionals.

The purpose of this article is to examine a sample of paper‐based incident reports concerning drug incidents to assess the utility of a reporting system.

A 50 per cent random sample of drug‐related incident reports between 1999 and 2003 (n=1,253) was reviewed. Details of the incident including error type and contributory factors were identified, as was status of the reporter. Content analysis of the free text established whether the data provided could promote medication safety and organisational learning.

The paper finds that all definitive drug errors (n=991) allowed an error type to be identified, but 276 (27.8 per cent) did not include the contributory factor(s) involved. Content analysis of the errors demonstrated an inconsistent level of completeness, and circumstances, causation and action taken were not always logically related. Inter‐rater reliability scores were varied. There was sometimes a significant focus on the actions of one individual in comparison to other factors.

Incident reports can be biased by psychological phenomena, and may not be representative of the parent organisation other than those who report. This study was carried out in a single health care organisation and generalisability may be questioned.

How health professionals interpret drug errors and their reporting could be improved. Reporting can be further developed by reference to taxonomies, but their validity should be considered. Incident report analysis can provide an insight into the competence of individual reporters and the organisation's approach to risk management.

This paper highlights the various data that can be captured from drug error reports but also their shortfalls which include: superficial content, incoherence; and according to professional group – varied reporting rates and an inclination to target individuals.

Overcrowding in emergency departments (EDs) leads to longer waiting times and results in higher number of patients leaving the ED without being seen by a physician. EDs need to improve quality for patients’ waiting time and length of stay (LoS) from the perspective of process and flow control management. The paper aims to discuss these issues.

The retrospective case study was performed using the computerized ED patient time logs from arrival to discharge between July 1, 2009 and June 30, 2010. Patients were divided into two groups either adult or pediatric with a cutoff age of 18. Patients’ characteristics were measured by arrival time periods, waiting times before being seen by a physician, total LoS and acuity levels. A discrete event simulation was applied to the comparison of quality performance measures.

Statistically significant differences were found between the two groups in terms of arrival times, acuity levels, waiting time stratified for various arrival times and acuity levels. The process quality for pediatric patients could be improved by redesign of patient flow management and medical resource.

The results are limited to a case of one community and ED. This study did not analyze the characteristic of leaving the ED without being seen by a physician.

Separation of pediatric patients from adult patients in an ED can reduce the waiting time before being seen by a physician and the total staying time in the ED for pediatric patients. It can also lessen the chances for pediatric patients to leave the ED without being seen by a physician.

A process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

The purpose of this paper is to explore the relationship between perceived distributed leadership and job satisfaction among nurses. Leadership is central to improving quality care. Reports following investigations of poor care standards, identified inadequate leadership as a contributory factor and called for a new kind of leadership. One alternative is distributed leadership. Evidence suggests associations between leadership and job satisfaction but, there is a paucity of research examining associations between distributed leadership and job satisfaction: the purpose of this study was to address this gap.

A cross-sectional survey design was used and data collected via questionnaires. Using census sampling, 350 nurses in a hospital in Malta were selected. A response rate of 50% (n = 176) was achieved. Data were analysed using Spearman’s correlation coefficient and multiple regression. Ethical approval was obtained from relevant committees/individuals.

Results indicated a moderate application of perceived distributed leadership and application of all components of distributed leadership could be improved. Nurses were neither satisfied nor dissatisfied with their jobs. Correlation analysis showed a positive relationship between distributed leadership and job satisfaction. Multiple regression showed that commitment and participative decision-making were major predictors of job satisfaction while supervision by managers had a negative effect.

Improving distributed leadership is a priority in the nursing profession.

To the best of the authors’ knowledge, this study is the first to show that distributed leadership has a positive effect on job satisfaction among nurses. Supervision, a constituent of distributed leadership, was associated with reduced job satisfaction, therefore reducing this is paramount.

A healthy, balanced and nutritious diet for children and young people is essential for normal growth and development. Vending machines can be a source of food and drink high in fat, sugar and salt, and can undermine healthy eating messages. The purpose of this paper is to examine the contents of vending machines available in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals in Wales.

Questionnaires are completed by staff in the Department of Child Health in each NHS Trust in Wales. This paper summarises the results.

Most vending machines found in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals in Wales contain a majority of foods high in fat salt and sugar. Only a few contain over 50 per cent of drinks classified as healthy.

There is no universally agreed definition of healthy food as related to individual products. This study looks at the availability of foods and drinks classified as “unhealthy” but does not look at the overall diet of the children in the ward.

The results of this study should encourage NHS Trusts to consider the contents of vending machines in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals.

There is much rhetoric around the potential of vending machines to contribute to an unhealthy diet. This is the first paper to identify specific problems with hospital vending machines.

The purpose of this paper is to provide an “inside” account of efforts to enhance the quality of care in a paediatric hospital department in Malawi.

The authors describe the problems they face as health workers in an overcrowded, under-resourced emergency departments in a low-income setting. Where it is helpful, the authors combine reports of their experience with reference to reports emanating from other African countries.

There is increased awareness of the need for a good health system to be able to provide quality care. The authors emphasise the importance of teamwork and the need for cross cutting activities that are not disease-centred or vertically driven. Task sharing and multi-tasking have helped fill the gaps left by inadequate staffing but specialists in emergency medicine are needed to advocate for the specialty and be role models in departments.

This paper is aimed at a broad audience of fellow clinicians, funders and policy makers, and those who have an interest in clinical governance in support of quality improvement in developing countries.

This is a firsthand account of efforts to enhance the quality of emergency care from a paediatric hospital department in Malawi.

Globally, cancer represents an increasing proportion of child mortality as progress against infectious causes is made. Approximately 400,000 children will develop cancer, each year, around the world. Only about half of these cancers will ever be diagnosed. In high-resource settings, 80% of children will survive, but only about 30% will survive in low-resource settings. Digital solutions have a valuable role in increasing health professional knowledge, skills and empowerment to diagnose, treat and otherwise care for children and adolescents with cancer. This review sought to identify digital resources that support the training and development of the paediatric oncology workforce in resource -poor settings.

This paper presents a narrative descriptive review of peer-reviewed publications and digital platforms that contribute to health professionals' education and training regarding paediatric oncology, particularly in rural and other low-resource settings.

Digital solutions were identified for building communities of practice, facilitating access to information and support and providing access to training, education and supervision specifically for paediatric oncology health professionals. A total of 33 resources are discussed in depth. A quality assessment of the digital resources is provided using the Currency, Relevance, Authority, Accuracy and Purpose (CRAAP) tool and suggestions to improve the quality of resources are discussed.

The authors anticipate that this summary of digital resources for the global paediatric oncology professional community will inform digital health investments and design of digital innovations to meet emerging needs and will have an impact on the workforce in the real world. Ultimately, this work will contribute to an improvement in the diagnosis and treatment of children and adolescents with cancer in resource-poor settings.

This is the first discussion and summary of digital education platforms which educate, train and offer support to health professionals with respect to paediatric oncology. These digital platforms are often aimed at, and are essential for, health professionals in rural and other low-resource settings.

To ensure that paediatric surgery patients receive appropriate intravenous fluids post‐operatively.

Retrospective case‐series study of paediatric patients undergoing major abdominal surgery, comparing fluids received with a target regimen and noting the effect on urine output and serum sodium.

Patients in the study received larger amounts of fluid than the target regimen. Urine outputs were normal to high. Post‐operative sodium levels were normal in all patients.

Paediatric surgery fluid management is an ongoing and important subject for debate. Audit can help improve implementation of accepted fluid management protocols. Interdepartmental seminars, a national survey of practice, and revision of fluid management protocols have resulted from this survey.

The purpose of this paper is to implement Six Sigma approach to decrease the length of stay (LOS) of neonatal jaundice patients in an Indian government rural hospital situated in northern hill region.

Six Sigma’s Define–Measure–Analyse–Improve–Control procedure is applied in order to decrease the LOS of neonatal jaundice patients. The mean and standard deviation have been computed as 34.53 and 20.01 h, respectively. The cause and effect diagram is used in the “Analyse” phase of the Six Sigma. The regression analysis and GEMBA observation techniques are used to validate the causes identified through cause and effect diagram.

The waiting time for registration, waiting time for tests, waiting time for phototherapy and time for discharge implementation are the main factors that are responsible for longer LOS. Based on the identified root causes, some recommendations are suggested to the hospital administration and staff members in order to reduce the LOS.

The present research is limited to provide recommendations to the hospital administration to reduce LOS and it entirely depends upon the implementation of the administration. However, target of administration is to reduce the LOS up to 24 h.

Six Sigma model will reduce bottlenecks in LOS and enhance service quality of hospital. The developed regression model will help the doctors and staff members to assess and control the LOS by controlling and minimising the independent variables.

The project will directly provide benefits to society, as LOS will decrease and patients’ satisfaction will automatically increase.

Six Sigma is a developed methodology, but its application in paediatric department is very limited. This is the first ever study of applying Six Sigma for neonatal jaundice patients in India.