If a mistake is made by a staff member, the error is detected and corrected automatically by other staff members before the patient is affected. In employing the Fail-Safe System, all personnel must accept that mistakes are inevitable but can be kept to a minimum through staff cooperation. The two ...

There are no universal guidelines for cleaning and disinfecting large items of medical equipment. Washer/disinfectors provide one method of making medical equipment safe for staff and patients. Methods of evaluating the performance of such machines are discussed in an attempt to stimulate a much needed review of existing advice and ...

1. Provocation is an important risk predictor because these issues can be recognized, assessed, and appropriate interventions can be implemented to reduce the associated risks. It is only by the reduction of such "non-fixed" risk factors that any reduction of assaults can be accomplished. 2. Involuntary admission, patients with dementia ...

Many of the problems that confront hospitals in a rapidly changing and increasingly hostile environment are of their own making. Chief among these self-destructive tendencies has been misjudgment of the characteristics and functions of the medical staff organization. This article explores some common misconceptions and provides a more plausible reality.

The request for assistance by the Command, on the advice of the medical staff, reflected earlier education of such personnel. The ability to respond within an hour of being requested to do so was the result of constant paper exercises and the prior establishment of principles agreed by Command/Management. The ...

The practice of veterinary oncology requires that attention be paid to both the medical and emotional needs of patients, clients, and staff members. In order to attend to these needs effectively, practice management goals for diagnosis, treatment, and euthanasia must be clearly established. Common medical and emotional issues pertinent to ...

We prospectively studied all the deaths that occurred in Sourasky Medical Center (Ichilov Hospital), Tel Aviv, from 1 July through 30 September 1989 for possible eye donation. Of the 135 suitable candidates 29 donations were obtained (21.5%). In the course of the study the procurement rate progressively increased as a ...

For 30 years, in rural Texas, rural Kentucky, and in the Army, I have observed a variety of efforts aimed at changing people's health. Recently I participated in one large effort (USNS MERCY), commanded a second (MED EL, JTF-Bravo, Honduras), was "neighbor" and visitor to a third (Medical Assistance Team ...

The numbers and characteristics of white residents identified by medical and nursing staff to require more staff time and/or expertise and/or medical equipment than was available in rural homes for the aged in the Orange Free State were assessed. In the opinion of institution staff, 12.6% of extremely infirm aged ...

Quirks in the National Practitioner Data Bank regulations and operations may catch medical staffs and hospitals unawares, creating potential traps and pitfalls that could result in exposure to lawsuits and federal sanctions. In this article, the author outlines several areas of possible difficulty and offers tips to help medical staffs ...

Case vignette: Henry, age 19, has been under medical care struggling for 5 months with a non-Hodgkin's lymphoma that has been resistant to treatment. Proven chemotherapy protocols have failed to sustain a remission, and it is evident that his condition is terminal, although not immediately so. When not in temporary ...

Physician leadership in hospital affairs is important to physicians, patients, and the public, as well as to hospitals. In this article, the author advocates payment to medical staff leaders for performance of the patient-protective functions of the traditional organized medical staff, including ensuring the qualifications of practitioners (credentialing) and monitoring ...

The request for assistance from the Command, on the advice of the medical staff, reflected earlier education of such personnel. The ability to respond within an hour of being requested to do so was the result of constant paper exercises and the prior establishment of principles agreed by Command/Management. The ...

One of the most important aspects of a hospital merger is the impact on the medical staff. At University Hospital in British Columbia, which was established when two large general teaching hospitals merged, the comprehensive process to reorganize the medical staff structure was designed to account for this impact. Preliminary ...

The increasing complexity of hospitals and the emergence of corporate responsibility calls for greater trust amongst the Board, Administration and Medical Staff. Physicians will play a more important role in the hospital decision-making process. Boards will expect the medical staff organization to better define and monitor processes for physician credentialling, ...

The clinical engineering or medical engineering departments in the hospitals in Switzerland are in a phase of rapid development. In particular, staffing, as well as official recognition by hospital management, needs improvement in many of the hospitals, as is also found in other countries. An overview is given of the ...

Medical education nowadays experiences an increasing gap between the potential didactic value of educational technology and the practical implementation thereof. One of the important obstacles is the tendency to separate media and media agencies from staff development. A new conceptual model was designed for staff development in medical education, which ...

This article discusses the duties of hospital governing boards, medical staffs, medical staff officers, and individual medical staff members regarding the credentialing of physicians, including the potential liability of these groups for negligent medical care and wrongful denial of staff privileges. This article also proposes possible measures these groups may ...

The odds are stacked against CEOs who hope their jobs will survive embattled relations with their medical staffs. An estimated 50 to 75 percent of CEOs who are fired lose their jobs as a direct result of medical staff conflicts. Some CEOs who have survived such conflicts say that the ...

The Health Care Quality Improvement Act of 1986 can help protect medical professionals and healthcare facilities from antitrust and defamation claims and other forms of litigation arising from the peer review process. Some hospitals may need to make major changes in their peer review activity as a result of the ...

Responding to a mission commitment to serve the elderly, Mercy Medical, Daphne, AL, has developed a multiservice rehabilitation program that includes inpatient and outpatient care, as well as residential and home health services. Mercy Medical staff assume that even elderly patients who have suffered a catastrophic injury or illness can ...

The performance of staff in the ophthalmologist's office will influence the risk that an individual patient may someday file a medical malpractice complaint. Areas of identified risk include improper triage of emergency patients, abandonment, problems in confidentiality, improper maintenance of medical records, and perceived lack of compassion and skill on ...

In January and February 1987 an epidemic of a strange illness involving 31 members of the staff in the Calcutta Telephone Exchange occurred. It commenced in the "operator services" on the 4th floor and after involving 21 members of the staff, progressed to the 6th floor where a further 10 ...

During the past six years the Catholic Health Association (CHA) has developed and modified a process to help leaders evaluate and implement merger, cosponsorship, and sponsorship transfer decisions. CHA's highest priority in these efforts has been to keep Catholic healthcare facilities under Catholic sponsorship, control, and management. Proposals to change ...

Establishing the position of medical director for a hospital entails making a clear exposition of the role of the medical director in relation to the board, the basic administrative structure, and the medical staff. The responsibilities assigned to the medical director in one hospital may differ in more than a ...

Medical staff plans may provide an answer to capacity overload. Hospital strategic managers should consider reducing the size and mix of the medical staff to be more in line with the institution's strategic plan for clinical services. They must assess active medical staff membership in relation to the needs of ...

Within the setting of a regional secure unit, all doses of medication given p.r.n. over three months were ascertained and the details of each administration determined from prescription charts and a semistructured interview with the nursing staff involved. Thirty-two patients were resident for all or part of the study, all ...

Every now and then it pays to review the more thoughtful literature to make sure that what you learned on the job or in school is still current. Here are some recent books that provide important insights you won't get from reading magazines and newsletters or attending medical staff planning ...

The pharmacy staff at the VA Medical Center, Biloxi, Mississippi, has increased direct patient care activities for the Medical Center's inpatients by converting 139 beds from a manual system of unit dose to a computerized unit dose distribution system. Expanded clinical programs were primarily developed, implemented, and operated by staff ...

Osteopathic teaching hospitals are frequently criticized by house staff officers for not being sufficiently didactic or academically oriented. A model for providing academic training for students, interns, and residents as well as continuing medical education for attending staff physicians is described. This model may be administered by a department of ...

The psychiatrist on a hospital's medical staff has a major role in maintaining the quality standards established by the Joint Commission on Accreditation of Healthcare Organizations and in preparing for its accreditation survey. The authors review the medical staff's role in quality assurance activities, including development of clinical indicators, monitoring ...

In this chapter, the topic of medical chronobiology has been presented. Emphasis has been placed on issues related to clinical and occupational medicine. Results of initial studies conducted primarily by clinical pathologists indicate that the results of several commonly ordered diagnostic tests are influenced in a significant way according to ...

Inevitably as the role of the medical director expands, it will directly affect power structures already existing in the hospital hierarchy, including department chiefs, other administrators, and the chief of staff. This article will attempt to define the roles of the medical director and the chief of staff, explore possible ...

To evaluate the accuracy of central venous pressure (CVP) assessment in critically ill patients, and measure disagreement amongst clinicians, 50 consecutive intensive care unit (ICU) patients with right internal jugular catheters were examined. CVP was measured by the indwelling catheter, and was assessed by: (1) one of three ICU staff ...

House staff scheduling is currently one of the most important issues in graduate medical education. Proposals for regulation arose as a result of mistakes made by exhausted interns, and they involve doctors, hospitals, the public, and authorities. The New York State Department of Health recommendations include restricting work to less ...

While perinatal health care professionals have discussed individual methods to support bereaved parents after a perinatal death (miscarriages, stillbirths, or neonatal deaths), there needs to be a comprehensive approach to perinatal bereavement support that extends not only to bereaved family members, but to the perinatal staff and the medical and ...

Medical staff bylaws set out the rights, duties, and responsibilities of medical staffs and their members, and define the relationship between medical staffs and hospitals and their governing bodies. Areas of conflict between medical staffs and governing bodies are commonly highlighted during the process of revising medical staff bylaws. This ...

Reinventing the medical staff is a process that has been hinted at, but not yet pursued in any full scale effort. Hospitals have the most to lose by maintaining the status quo and the most to gain by initiating a reconsideration of their relationships to physicians. This article explores the ...

When considering a joint venture, hospitals should evaluate the risks and benefits associated with cooperating with a major competitor. Factors to be analyzed during the decision-making process include: goals, medical staff involvement, corporate strategies, financial considerations, volume considerations, market share, environmental influences and level of competition. Hospitals can join forces ...

James K. Knoble, president of the 369-bed JFK Medical Center, Atlantis, Fla., and former president of Methodist Medical Center of Illinois, Peoria, is in the midst of his third turnaround situation since he became a hospital CEO in 1965. Knoble is known as a CEO who keeps close track of ...

With the increasing participation in triathlons of all distances has come a corresponding increase in the need for competent medical information relating to the care of these triathletes. Although medical organization at triathlons involves certain principles which should be applied regardless of race specifics, there are certain other arrangements that ...

Beth Israel Medical Center committed itself to a smoke-free environment on May 7, 1987 after seven months of careful study by a policy determination committee and, thereafter, seven months of meticulous planning for its announcement and implementation. The policy rests on two premises: passive smoking is harmful to nonsmokers; a ...

In the past two years there has been a significant increase in the number and variety of hospital medical staff cases decided by the courts. The issues range from whether medical staff bylaws constitute a contract with individual medical staff members, the legal opportunity to assert employment discrimination claims in ...

Bonding of the medical staff to the hospital requires a structured leadership effort on the part of all interested groups. The participants should consist of members of the medical staff, the senior administration, and the board of trustees. The pathways to the bonding process require considerable thought, much planning, frank ...

The justification, establishment, and evaluation of a full-service cancer center pharmacy satellite for a university hospital are described. Providing efficient and effective pharmaceutical services was difficult because (1) the cancer center is housed in a freestanding building adjacent to the hospital and (2) there are special considerations inherent in the ...

The legislative process in Texas more than once has been described as organized chaos. For 140 days every other year, 181 lawmakers, hundreds of legislative staff and agency officials, and scores of lobbyists draft, debate, enact, or defeat thousands of individual bills. Lobbyists representing Texas Medical Association are among the ...

Records of all inmates committed to a state forensic hospital in fiscal year 1982 (N = 472) were studied to examine the inmates' hospital utilization between September 1977 and April 1984 and the reasons for their admissions. Medication refusal, hallucinations and delusions, and threatened or potential violent behavior toward others ...

Successful operation of a medical-psychiatry unit requires special considerations in nursing staff development and facility design. This article will discuss in detail issues related to the selection, training, and development of a medical-psychiatry unit nursing staff. Organizational details regarding establishing schedules and staffing patterns are examined in detail. Additional areas ...

Community pharmacy staff were surveyed for the advice they would offer to a patient with a history highly suggestive of oral carcinoma. Less than 10% of 57 pharmacies indicated that a dental or medical opinion should be sought. This study confirms that the knowledge of pharmacy staff about oral disease ...

The concept of smoke-free medical facilities is in its formative stages, and such policies have received broad support. Although smoking has been restricted at Mayo Medical Center for many years, in 1986 it was decided that the medical center should become smoke free. This report summarizes the methods used in ...