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Despite a strong commitment to delivering quality health care, persistent problems involving medical errors and ineffective treatment continue to plague the industry.Many of these problems are the consequence of poor information and technology (IT) capabilities, and most importantly, the lack cognitive IT support.

AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.

If a teaching hospital loses funding, what is the next option? Mergers of Teaching Hospitals in Boston, New York, and Northern California investigates the recent mergers of six of the nation's most respected teaching hospitals. The author explains the reasons why these institutions decided to change their governance and the factors that have allowed two of them to continue to operate while forcing the third to dissolve after only 23 months of operation. The case studies contained within this book rely on an impressive amount of research. Notably, instead of citing only published articles and books, the author includes information from numerous, extensive personal interviews with key participants in the various mergers. With this research the author not only presents to the reader a picture of why these mergers came about, but also investigates how the organizations have fared since joining together. The mergers are analyzed and compared in order to identify various methods of merger formation as well as ways in which other newly formed hospitals might accomplish a variety of important goals. Offering a spectacular account of some of the mergers that occurred in the health care field at the close of the twentieth century, these stories provide insight into academia's relationship with teaching hospitals and the challenges involved in bringing prestigious and powerful medical institutions together. The institutions discussed are Partners, the corporation which includes the Massachusetts General Hospital and the Brigham and Women's Hospital, New York-Presbyterian Hospital, the union of the New York and Presbyterian hospitals in New York City, and the UCSF Stanford, the merged teaching hospitals of the University of California, San Francisco and Stanford. This book will particularly appeal to professionals and academics interested in medicine, business, and organizational studies.

The implementation of unit-dose dispensing systems (UDDS) in hospital pharmacies represents a major milestone in the digital transformation of medication therapy management, operational efficiency, and improving patient safety. However, the absence of standardized metrics for workforce planning and cost assessment has limited widespread adoption. This gap makes it increasingly challenging for healthcare stakeholders to optimize the allocation of limited medical and financial resources. Using data from a 1,800-bed tertiary care hospital with 1,680 UDDS beds (2021-2024), this study establishes benchmarks for staffing requirements and associated costs. The following key performance metrics were analyzed: task-specific work times, unit-dose machine utilization, and productivity indicators such as blistered tablet output and blister bag production per full-time equivalent (FTE). The findings indicate a staffing benchmark of 0.45 FTE per 100 UDDS-covered hospital beds to support both implementation and routine operations. Workforce efficiency improved significantly, with the number of FTEs per 1 million blistered tablets decreasing from 3.2 in 2021 to 1.7 in 2024. Concurrently, the cost per blister bag improved from €0.55 in 2021 to €0.22 in 2024, well within the optimal unit target price range of €0.20-€0.25; blistered tablet production tripled, rising from 1.5x106 to 4.7x106 between 2021 and 2024 respectively. A gold standard of 1 FTE per 10,000 cases was established to optimize staffing and operational workflows. The sharp decline in FTE per 1 million requirements from 5.45 to 2.29 underscores the pivotal role of experienced clinical pharmacists in ensuring safe, accurate, and resource-optimized prescription validation. The proposed benchmarks provide practical guidance for improving UDDS productivity, optimizing resource allocation, and strengthening workforce management. Our findings provide a framework that supports continuous UDDS improvement in hospital pharmacy operations and evidence-based decision-making for key stakeholders. By establishing clear UDDS benchmarks, this study supports cost-efficient UDDS operations while providing surrogate indicators of patient safety and clinical quality.

Internet hospitals (IHs) have rapidly developed as a promising strategy to address supply-demand imbalances in China's medical industry, with their capabilities directly dependent on information platform functionality. Furthermore, a novel theory of \"Trinity\" smart hospital has provided advanced guidelines on IH constructions. This study aimed to explore the construction experience, construction models, and development prospects based on operational data from IHs. Based on existing information systems and internet service functionalities, our hospital has built a \"Smart Hospital Internet Information Platform (SHIIP)\" for IH operations, actively to expand online services, digitalize traditional health care, and explore health care services modes throughout the entire process and lifecycle. This article encompasses the platform architecture design, technological applications, patient service content and processes, health care professional support features, administrative management tools, and associated operational data. Our platform has presented a set of data, including 82,279,669 visits, 420,120 online medical consultations, 124,422 electronic prescriptions, 92,285 medication deliveries, 6,965,566 prediagnosis triages, 4,995,824 offline outpatient appointments, 2025 medical education articles with a total of 15,148,310 views, and so on. These data demonstrate the significant role of IH as an indispensable component of our physical hospital services, with deep integration between online and offline health care systems. The upward trends in various data metrics indicate that our IH has gained significant recognition and usage among both the public and healthcare workers, and may have promising development prospects. Additionally, the platform construction approach, which prioritizes comprehensive service digitization and the 'Trinity' of the public, healthcare workers, and managers, serves as an effective means of promoting the development of Internet Hospitals. Such insights may prove invaluable in guiding the development of IH and facilitating the continued evolution of the Internet healthcare sector.

Background: Weak governance of hospital information systems interoperability can impede data accuracy, security and accessibility. Aim: To review and synthesise published literature on governance of hospital information systems interoperability. Methods: Using the preferred reporting Items for systematic reviews and meta-analyses method, we reviewed on Scopus, PubMed and ScienceDirect literature on governance of hospital information systems interoperability published between June 2014 and June 2024, across Africa, Asia, Americas, Middle East, Europe, and Oceania. Results: The key governance strategies are classified into 3: policy and regulation, standards and frameworks, and sustainable funding and resources. Policies and regulations governing hospital information systems interoperability are typically established at national, regional and organisational levels to safeguard patient data privacy. Interoperability frameworks typically address system structures, core functions and interoperability standards, while some also incorporate access to open-source digital tools. Human and technical resources are often recognised as influential and essential factors for efficient interoperability. Conclusion: Effective governance is essential for building and operating integrated interoperable hospital information systems as well as for improving efficiency, optimising resource use and advancing health outcomes.

ObjectivesAutomated dispensing cabinets (ADCs) offer improved medication safety, greater efficiency and return on investment. However, integrating ADCs into medication dispensing processes can be challenging in complex hospital environments. This study aimed to draft suggestions to help hospitals adopt ADCs.MethodsTwo-day visits were organised in seven European hospitals operating ADCs. Investigators used an observational grid, a questionnaire and interviews, each divided into the themes of medication processes before and after the introduction of ADCs, the major steps followed and the resources involved, ergonomics and staff perceptions.ResultsADCs were integrated into four global hospital medication dispensing systems (packs of drugs are distributed from the central pharmacy to wards for dispensing) and three nominative systems—that is, patient-specific ones (drug doses prescribed for individuals are distributed from the central pharmacy to wards with ADC as supplementary stock). A general ADC project implementation timeline was shaped: main drivers of automation to initiate the project, visit of other sites, pilot test (with IT integration and staff training), and evaluation phase (satisfaction, safety, efficiency) to justify a possible expansion. Users (7 pharmacists, 21 nurses, 7 data engineers) identified facilitators (such as a dedicated project manager, a pilot phase, an intuitive device), barriers and any improvements needed (training for incoming staff, reorganisation of ward workflow, dynamic inventories).ConclusionsDespite their diverse pharmacy organisations, each hospital raised similar challenges and reported analogous major steps in project implementation. Although integration processes are complex, ADCs rapidly provide users with benefits. By following the practical advice and recommendations from these hospitals, new adopters might reduce the risks of failed ADC projects and accelerate their integration.

The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma. Mayo Clinic served as the central institutional review board for all participating facilities, and any US physician could participate as a local physician-principal investigator. Eligible patients were hospitalized, were aged 18 years or older, and had-or were at risk of progression to-severe or life-threatening COVID-19; eligible patients were enrolled through the EAP central website. Blood collection facilities rapidly implemented programs to collect convalescent plasma for hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal patterns in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate at the state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions, as well as assessing enrollment in metropolitan areas and less populated areas that did not have access to COVID-19 clinical trials. From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. The majority of patients were 60 years of age or older (57.8%), were male (58.4%), and had overweight or obesity (83.8%). There was substantial inclusion of minorities and underserved populations: 46.4% of patients were of a race other than white, and 37.2% of patients were of Hispanic ethnicity. Chronologically and geographically, increases in the number of both enrollments and transfusions in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled and transfused patients in the EAP, including both in metropolitan and in less populated areas. The incidence of serious adverse events was objectively low (<1%), and the overall crude 30-day mortality rate was 25.2% (95% CI, 25.0% to 25.5%). This registry study was limited by the observational and pragmatic study design that did not include a control or comparator group; thus, the data should not be used to infer definitive treatment effects. These results suggest that the EAP provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The study design of the EAP may serve as a model for future efforts when broad access to a treatment is needed in response to an emerging infectious disease. ClinicalTrials.gov NCT#: NCT04338360.