Aziz MBA in Hospital Management Project 0205009

7/29/2019 Aziz MBA in Hospital Management Project 0205009

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Health administration or healthcare administration is the field relating toleadership, management, and administration ofhospitals, hospitalnetworks, health care systems, and public health systems. Health care

administrators are considered health care professionals.The discipline is known by many names, including healthmanagement, healthcare management, health systems management, health caresystems management, andmedical and health services management

EDUCATION TRANING

Amaster's degree is considered the "standard credential for most healthadministrators in the United States. There are multiple recognized degree typesthat are considered equivalent from the perspective of professional preparation.

The Commission on the Accreditation of Healthcare ManagementEducation (CAHME) is the accrediting bodyoverseeing master's-level programsin the United States and Canadaon behalf of the United States Department ofEducation. It accredits several degree program types, including Master of Health

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Services Administration (MHSA), Master of Business Administration in HospitalManagement (MBA-HM), Master of Health Administration (MHA), Master ofPublic Health (MPH, MSPH, MSHPM), Master of Science (MS-HSM, MS-HA),and Master of Public Administration (MPA).

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Professional Organizations

There are numerous professional associations related to health systemsmanagement, which can be subcategorized as either personal orinstitutional membership groups. Personal membership groups are joinedby individuals, and typically have individual skill and career development as

their focus. Larger personal membership groups include the AmericanCollege of Healthcare Executives, the Healthcare Financial ManagementAssociation, and the Healthcare Information and Management SystemsSociety. Institutional membership groups are joined by organizations; theytypically focus on organizational effectiveness, and may also include data-sharing agreements and other best-practice sharing vehicles for memberorganizations. Prominent examples include the American HospitalAssociation and the University Healthsystems Consortium

theMaster of Health AdministrationorMaster of HealthcareAdministration(MHA) is a master's-levelprofessional degreegrantedto students who complete a course of study in the knowledge andcompetencies needed for careers inhealth administration, involving themanagement of hospitals and other health services organizations, as well aspublic health infrastructure. Programs can differ according to setting;althoughpractitioner-teacher modelprograms are typically found incolleges of medicine or allied health, classroom-based programs can befound in colleges of business or public health.

Accredited programs of study typically require students to complete appliedexperiences as well as course work in areas such as population health,healthcare economics, health policy, organizational behavior,management of healthcare organizations, healthcare marketing and

communications, human resource management, information systemsmanagement and assessment, operations assessment and improvement,governance, leadership, statistical analysis and application, financialanalysis and management, and strategy formulation and implementation.The degree program is designed to give graduates ofhealthdisciplines (inparticular) greater understanding ofmanagementissues and preparethem for senior management roles, and is awarded by many American,European and Australian universities. The degree traditionally focuses onhealth administration at the local, state, and federal level as well as in thenonprofit sector. This contrasts with the generalMaster of Business

Administrationor theMaster of Public Administrationdegrees.

Pharmacists

Pharmacists are highly-trained and skilled healthcare professionals whoperform various roles to ensure optimal health outcomes for their patients.Many pharmacists are also owners, owning the pharmacy in which theypractice.

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Pharmacists are represented internationally by the International PharmaceuticalFederation International_Pharmaceutical_Federation> (FIP). They arerepresented at the national level by professional organisationsProfessional_body> such as the Dutch Pharmacists AssociationDutch_Pharmacists_Association&action=edit&redlink=1> (VNA) Royal

Pharmaceutical Society of Great.wikipedia.org/wiki/Royal_Pharmaceutical_Society_of_Great_Britain>(RPSGB), the Pharmacy Guild of Australia (PPS) and theAmerican Pharmacists Association American_Pharmacists_Association

In some cases, the representative body is also the registering body, which isresponsible for the ethics

Ibn al-Haytham

Translation

Ibn al-Haytham

Infobox_Muslim scholars | notability = Muslim scientist| era = Islamic GoldenAge| color = #cef2e0 |

| image_caption = Ibn al-Haytham drawing taken from a 1982 Iraqi 10-dinarnote.

name = Unicode|Ab Al al-asan ibn al-asan ibn al-Haytham

DEPARTMENT OF HOSPITAL

An acute assessment unit, acute medical unit (AMU) or acute admissions unit

(AAU) is a short-stay department in some hospitals that is sometimes part of

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the emergency department, although a separate department. The AAU acts as a

gateway between a patient's general practitioner, the emergency department, and

the wards of the hospital. The AAU helps the emergency department produce a

healthy turnaround for patients, helping with the four-hour waiting rule. An AAU

is usually made up of several bays and has a small number of side-rooms and

treatment rooms. They are fully equipped with emergency medical treatment

facilities including defibrilators and resuscitation equipment.

Patients

From the emergency department, patients can be moved to AAU where they willundergo further tests and stabilisation before they are transferred to therelevant ward or sent home. Also, patients can be admitted straight to AAUfrom their general practitioner if he or she believes the patient needshospital treatment. A patient's stay in the unit is limited, usually no more

than 48 hours.

The AAU deals with admissions only, patients will never be transferred from award to the AAU. Surgical Procedures are not carried out in the unit either;these are referred on to the relevant theatre such as cardiothoracics andgeneral surgery.

Staff

Senior staff in an AAU include aconsultantin generalmedicine,emergency medicine, orcritical care. Often aregistraringeneral medicine, and award sisteror acharge nursehave roles in the

unit. A number ofstaff nurseswork alongside the senior staff to providecare to patients in the unit.

Although AAU has its own staff trained to deal with patients and provide care,members of staff from other departments in the hospital are needed in AAU toassess patients and provide further diagnosis. Typical examples of staff who maybe needed in AAU are general surgeons, cardiothoracic surgeons, cardiologists,and a psychiatric liaison nurse.

Alternative names for the department

Different hospitals use different names for the department - common names for

this department are:

Acute Assessment Unit (AAU)

Acute Admissions Unit (AAU)

Acute Medical Unit (AMU)

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Clinical Decision Unit (CDU)

Emergency Assessment Unit (EAU)

Emergency Medical Assessment/Admissions Unit (EMAU)

Medical Assessment and planning unit (MAPU) or, informally, MAP unit -in Australia and New Zealand

Medical Assessment Unit (MAU) Multi speciality Assessment Area (MSAA)

Medical Receiving Unit (MRU)

Emergency Receiving Unit (ERU)

The department can also include pharmacists, who carry out duties such asmedical history taking.

ACUTE ASSESSMENT UNIT

AN(AMU)ORACUTE ADMISSIONS UNIT (AAU)IS A SHORT-STAYDEPARTMENT IN SOME HOSPITALS THAT IS SOMETIMES PART OFTHEEMERGENCY DEPARTMENT, ALTHOUGH A SEPARATEDEPARTMENT. THE AAU ACTS AS A GATEWAY BETWEEN APATIENT'SGENERAL PRACTITIONER, THE EMERGENCYDEPARTMENT, AND THE WARDS OF THE HOSPITAL. THE AAU HELPSTHE EMERGENCY DEPARTMENT PRODUCE A HEALTHYTURNAROUND FOR PATIENTS, HELPING WITH THEFOUR-HOUR

WAITING RULE. AN AAU IS USUALLY MADE UP OF SEVERAL BAYSAND HAS A SMALL NUMBER OF SIDE-ROOMS AND TREATMENTROOMS. THEY ARE FULLY EQUIPPED WITH EMERGENCY MEDICALTREATMENT FACILITIESINCLUDINGDEFIBRILATORSANDRESUSCITATIONEQUIPMENT.

Patients

From the emergency department, patients can be moved to AAU where they will

undergo further tests and stabilisation before they are transferred to the relevant

ward or sent home. Also, patients can be admitted straight to AAU from their

general practitioner if he or she believes the patient needs hospital treatment. A

patient's stay in the unit is limited, usually no more than 48 hours.

The AAU deals with admissions only, patients will never be transferred from a

ward to the AAU. Surgical Procedures are not carried out in the unit either; these

are referred on to the relevant theatre such as cardiothoracics and general

surgery.

Staff(6)
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Senior staff in an AAU include a consultant in general medicine, emergency

medicine, or critical care. Often a registrar in general medicine, and award

sister or a charge nurse have roles in the unit. A number ofstaff nurses work

alongside the senior staff to provide care to patients in the unit.

Although AAU has its own staff trained to deal with patients and provide care,members of staff from other departments in the hospital are needed in AAU toassess patients and provide further diagnosis. Typical examples of staff who maybe needed in AAU are general surgeons, cardiothoracic surgeons, cardiologists,and a psychiatric liaison nurseAlternative names for the department

Different hospitals use different names for the department - common names for

this department are:

Acute Assessment Unit (AAU)

Acute Admissions Unit (AAU)

Acute Medical Unit (AMU)

Clinical Decision Unit (CDU)

Emergency Assessment Unit (EAU)

Emergency Medical Assessment/Admissions Unit (EMAU)

Medical Assessment and planning unit (MAPU) or, informally, MAP unit -

in Australia and New Zealand

Medical Assessment Unit (MAU)

Multi speciality Assessment Area (MSAA)

Medical Receiving Unit (MRU)

Emergency Receiving Unit (ERU)

The department can also include pharmacists, who carry out duties such as

medical history taking.

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http://en.wikipedia.org/wiki/Consultanthttp://en.wikipedia.org/wiki/Internal_medicinehttp://en.wikipedia.org/wiki/Emergency_medicinehttp://en.wikipedia.org/wiki/Emergency_medicinehttp://en.wikipedia.org/wiki/Critical_care_medicinehttp://en.wikipedia.org/wiki/Specialist_registrarhttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nursehttp://en.wikipedia.org/wiki/General_surgeonhttp://en.wikipedia.org/wiki/Cardiothoracic_surgeryhttp://en.wikipedia.org/wiki/Cardiologistshttp://en.wikipedia.org/wiki/Psychiatryhttp://en.wikipedia.org/wiki/Consultanthttp://en.wikipedia.org/wiki/Internal_medicinehttp://en.wikipedia.org/wiki/Emergency_medicinehttp://en.wikipedia.org/wiki/Emergency_medicinehttp://en.wikipedia.org/wiki/Critical_care_medicinehttp://en.wikipedia.org/wiki/Specialist_registrarhttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nurse#Nursing_titleshttp://en.wikipedia.org/wiki/Nursehttp://en.wikipedia.org/wiki/General_surgeonhttp://en.wikipedia.org/wiki/Cardiothoracic_surgeryhttp://en.wikipedia.org/wiki/Cardiologistshttp://en.wikipedia.org/wiki/Psychiatry


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CORONARY CARE UNIT

ACORONARY CARE UNIT(CCU) ORCARDIAC INTENSIVE CAREUNIT(CICU) IS A HOSPITAL WARD SPECIALIZED IN THE CAREOFPATIENTSWITHHEART ATTACKS,UNSTABLE

ANGINA,CARDIAC DYSRHYTHMIAAND (IN PRACTICE) VARIOUS

OTHER CARDIAC CONDITIONS THAT REQUIRE CONTINUOUSMONITORING AND TREATMENT.

CHARACTERISTICS

The main feature of coronary care is the availability oftelemetryor the

continuous monitoring of the cardiac rhythm byelectrocardiography.

This allows early intervention

withmedication,cardioversionor defibrillation, improving the

prognosis. Asarrhythmias are relatively common in this group, patients

with myocardial infarction or unstable angina are routinely admitted to the

coronary care unit. For other indications, such asatrial fibrillation, a

specific indication is generally necessary, while for others, such as heart

block, coronary care unit admission is standard

Local differences

In the United States, coronary care units are usually subsets ofintensive care

units (ICU) dedicated to the care of critically ill cardiac patients. These units are

usually present in hospitals that routinely engage in cardiothoracic surgery.

Invasive monitoring such as with pulmonary artery catheters is common, as are

supportive modalities such as mechanical ventilation and intra-aortic balloon

pumps (IABP).

Certain hospitals, such as Johns Hopkins , maintain mixed units consisting of

both Acute care units for the critically ill, and intermediate care units for patients

who are not critical.

Acute coronary care

Acute coronary care units (ACCU), also called "critical coronary care units"(CCCU) is equivalent to intensive care in the level of service provided. Patients

with acute myocardial infarction,cardiogenic shock, or post-operative "open-

heart" patients commonly abide here.

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Subacute coronary care

Subacute coronary care units (SCCU), also called Progressive care units (PCU),

Intermediate coronary care units (ICCU), or stepdown units, and provide a level

of care intermediate to that of the intensive care unit and that of the general

medical floor. These units typically serve patients who require cardiac telemetry

such as those with unstable angina

History

Coronary care units developed in the 1960s when it became clear that close

monitoring by specially trained staff, cardiopulmonary resuscitation and medical

measures could reduce the mortality from complications of cardiovascular

disease. The first description of a CCU was given in 1961 to the British Thoracic

Society, and early CCUs were located in Sydney, Kansas CityandPhiladelphia.

Studies published in 1967 revealed that those observed in a coronary care setting

had consistently better outcomes.[1] The first coronary care unit was opened at

Bethany Medical Center in Kansas City, Kansas by Dr Hugh Day, and he coined

the term. Bethany Medical Center is also where the first "crash carts" were

developed.

EMERGENCY DEPARTMENT

"Accident and Emergency" and "Emergency room" redirect here. For other

uses, see Accident and Emergency (disambiguation) andEmergency room

(disambiguation).

"Resus" redirects here. For Resuscitation, see Cardiopulmonary resuscitation.

A clearly marked emergency department at the The Royal Infirmary of Edinburgh

An emergency department (ED), also known as accident &

emergency (A&E), emergency room (ER), or casualty department is a medical

treatment facility specialising in acute care of patients who present without prior

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appointment, either by their own means or byambulance. The emergency

department is usually found in a hospital or other primary care center.

Due to the unplanned nature of patient attendance, the department must provide

initial treatment for a broad spectrum of illnesses and injuries, some of which

may be life-threatening and require immediate attention. In some countries,

emergency departments have become important entry points for those without

other means of access to medical care.

The emergency departments of most hospitals operate 24 hours a day, although

staffing levels may be varied in an attempt to mirror patient volume.

History

Accident services were already provided by workmen's compensation plans,

railway companies, and municipalities in Europe and the United States by thelate mid-nineteenth century, but the first specialized trauma care center in the

world was opened in 1911 in the United States at the University of

Louisville Hospital in Louisville, Kentucky, and was developed by surgeon Arnold

Griswold during the 1930s. Griswold also equipped police and fire vehicles with

medical supplies and trained officers to give emergency care while en route to the

hospital.

Department operation

The emergency department entrance at Mayo Clinic's Saint Marys Hospital. The

red-and-white emergency sign is clearly visible.

Today, a typical hospital has its emergency department in its own section of thefirst floor of the campus, with its own dedicated entrance. As patients can present

at any time and with any complaint, a key part of the operation of an emergency

department is the prioritization of cases based on clinical need. This is usually

achieved though the application oftriage.

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Triage is normally the first stage the patient passes through, and consists of a

brief assessment, a set ofvital signs, and the assignment of a "chief complaint"

(i.e. chest pain, abdominal pain, difficulty breathing, etc). Most emergency

departments have a dedicated area for this process to take place, and may have

staff dedicated to performing nothing but a triage role. In most departments, this

role is fulfilled by a nurse, although dependent on training levels in the country

and area, other health care professionals may perform the triage sorting,

including paramedics or physicians. Triage is typically conducted face-to-face

when the patient presents, or a form of triage may be conducted via radio with an

ambulance crew; in this method, the paramedics will call the hospital's triage

center with a short update about an incoming patient, who will then be triaged to

the appropriate level of care.

Most patients will be initially assessed at triage and then passed to another areaof the department, or another area of the hospital, with their waiting time

determined by their clinical need. However, some patients may complete their

treatment at the triage stage, for instance if the condition is very minor and can

be treated quickly, if only advice is required, or if the emergency department is

not a suitable point of care for the patient. Conversely, patients with evidently

serious conditions, such as cardiac arrest, will bypass triage altogether and move

straight to the appropriate part of the department.

The resuscitation area, commonly referred to as "Trauma" or "Resus", is a keyarea in most departments. The most seriously ill or injured patients will be dealt

with in this area, as it contains the equipment and staff required for dealing with

immediately life threatening illnesses and injuries. Typical resuscitation staffing

involves at least one attending physician, and at least one and usually two nurses

with trauma andAdvanced Cardiac Life Support training. These personnel may

be assigned to the resuscitation area for the entirety of the shift, or may be "on

call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or

ambulance, the team will be paged to the resuscitation area to deal with the case

immediately). Resuscitation cases may also be attended byresidents, medical

students, nursing students, emergency medical technicians, and/or

hospital pharmacists, depending upon the skill mix needed for any given case and

whether or not the hospital provides teaching services.

(11)
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Patients who are seriously ill but not in immediate danger of life or limb will be

triaged to "acute care" or "majors," where they will be seen by a physician and

receive a more thorough assessment and treatment. Examples of "majors"

include chest pain, difficulty breathing, abdominal pain and neurological

complaints. Advanced diagnostic testing may be conducted at this stage,

including laboratory testing of blood and/or

urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage

the patient's condition will also be given. Depending on the resolution of the

patient's chief complaint, he or she may be discharged home from this area or

admitted to the hospital for further treatment.

Patients whose condition is not immediately life threatening will be sent to an

area suitable to deal with them, and these areas might typically be termed as

aprompt care or minors area. Such patients may still have been found to havesignificant problems, including fractures, dislocations,

and lacerations requiring suturing.

Children can present particular challenges in treatment. Some departments have

dedicated pediatrics areas, and some departments employ a play therapist whose

job is to put children at ease to reduce the anxiety caused by visiting the

emergency department, as well as provide distraction therapy for simple

procedures.

Many hospitals have a separate area for evaluation ofpsychiatric problems. These

are often staffed bypsychiatrists and mental health nurses and social workers.

There is typically at least one room for people who are actively a risk to

themselves or others (e.g. suicidal).

Fast decisions on life-and-death cases are critical in hospital emergency rooms.

As a result, doctors face great pressures to overtest and overtreat. The fear of

missing something often leads to extra blood tests and imaging scans for what

may be harmless chest pains, run-of-the-mill head bumps, and non-threatening

stomach aches, with a high cost on the Health Care system.

Nomenclature in English

Emergency Departmentbecame the preferred term when Emergency Medicine

was recognised as a medical speciality and hospitals and medical centers

developed Departments of Emergency Medicine to provide services. Other(12)
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common variations include 'Emergency Ward,' 'Emergency Center' or

'Emergency Unit.'

Historic terminology still exists across the English-speaking world, especially in

vernacular usage. The previously accepted formal term 'Accident and Emergency'

or 'A&E' is still widely known in countries such as the United Kingdom and its

former territories, as are earlier terms such as 'Casualty', or 'Casualty Ward'

which continue to be used informally. The same applies to 'Emergency Room' or

'ER' in North America, originating when emergency facilities were provided in a

single room of the hospital by the Department of Surgery.

Signage

Regardless of naming convention, there is a widespread usage of directional

signage in white text on a red background across the world, which indicates the

location of the emergency department, or a hospital with such facilities.

Signs on emergency departments may contain additional information. In some

American states there is close regulation of the design and content of such signs.

For example, California requires wording such as "Comprehensive Emergency

Medical Service" and "Physician On Duty", to prevent persons in need of critical

care from presenting to facilities that are not fully equipped and staffed.

In some countries, including the United States and Canada, a smaller facility that

may provide assistance in medical emergencies is known as a clinic. Larger

communities often have walk-in clinics where people with medical problems that

would not be considered serious enough to warrant an emergency department

visit can be seen. These clinics often do not operate on a 24 hour basis. Very large

clinics may operate as "free-standing emergency centers," which are open 24

hours and can manage a very large number of conditions. However, if a patient

presents to a free-standing clinic with a condition requiring hospital admission,

he or she must be transferred to an actual hospital, as these facilities do not have

the capability to provide inpatient care.

United States

Many U.S. emergency departments are exceedingly busy. A survey of New York

area doctors in February 2007 found that injuries and even deaths have been

caused by excessive waits for hospital beds by ED patients. A 2005 patient survey

found an average ED wait time from 2.3 hours in Iowa to 5.0 hours in Arizona.(13)
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One inspection of Los Angeles area hospitals by Congressional staff found the

EDs operating at an average of 116% of capacity (meaning there were more

patients than available treatment spaces) with insufficient beds to accommodate

victims of a terrorist attack the size of the 2004 Madrid train bombings. Three of

the five Level I trauma centers were on "diversion", meaning ambulances with all

but the most severely injured patients were being directed elsewhere because the

ED could not safely accommodate any more patients. This controversial practice

was banned in Massachusetts (except for major incidents, such as a fire in the

ED), effective January 1, 2009; in response, hospitals have devoted more staff to

the ED at peak times and moved some elective procedures to non-peak times.

In 2009, there were 1,800 EDs in the country.

United Kingdom

All A&E departments throughout the United Kingdom are financed and managed

publicly by the NHS of each constituent country

(England,Scotland,Wales and Northern Ireland). As with most

other NHS services, emergency care is provided to all, both resident citizens and

those not ordinarily resident in the UK, free at the point of need and regardless of

any ability to pay.

Historically, waits for assessment in A&E were very long in some areas of the UK.

In October 2002, the Department of Health introduced a four-hour target in

emergency departments that required departments in England to assess and treat

patients within four hours of arrival, with referral and assessment by other

departments if deemed necessary. Present policy is that 95% of all patient cases

do not "breach" this four-hour wait.

The 4-hour target triggered the introduction of the acute assessment unit (also

known as the medical assessment unit), which works alongside the emergency

department but is outside it for statistical purposes in thebed management cycle.

It is claimed that though A&E targets have resulted in significant improvements

in completion times, the current target would not have been possible without

some form of patient re-designation or re-labeling taking place, so true

(14)
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improvements are somewhat less than headline figures might suggest and it is

doubtful that a single target (fitting all A&E and related services) is sustainable.

Critical conditions handled

Cardiac arrest

Cardiac arrest may occur in the ED/A&E or a patient may be transported by

ambulance to the emergency department already in this state. Treatment isbasic

life support and advanced life support as taught in advanced life support

and advanced cardiac life support courses. This is an immediately life-

threatening condition which requires immediate action in salvageable cases. Not

to be confused with Cardiakthe music producer.

Heart attack

Patients arriving to the emergency department with a myocardial infarction

(heart attack) are likely to be triaged to the resuscitation area. They will receive

oxygen and monitoring and have an earlyECG; aspirin will be given if

not contraindicated or not already administered by the ambulance team;

morphine or diamorphine will be given for pain; sub lingual (under the tongue)

or buccal (between cheek and upper gum) glyceryl trinitrate [nitroglycerin] (GTN

or NTG) will be given, unless contraindicated by the presence of other drugs,

such as drugs that treat erectile dysfunction.

An ECG that reveals ST segment elevation or newleft bundle branch

blocksuggests complete blockage of one of the main coronary arteries. These

patients require immediate reperfusion (re-opening) of the occluded vessel. This

can be achieved in two ways: thrombolysis (clot-busting medication)

or percutaneous transluminal coronary angioplasty(PTCA). Both of these are

effective in reducing significantly the mortality of myocardial infarction. Many

centers are now moving to the use of PTCA as it is somewhat more effective than

thrombolysis if it can be administered early. This may involve transfer to a nearby

facility with facilities for angioplasty.Trauma

Major trauma, the term for patients with multiple injuries, often from a road

traffic accident or a major fall, is initially handled in the Emergency Department.

However, trauma is a separate (surgical) specialty from emergency medicine

(15)
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(which is a medical specialty, and has certifications in the United states from the

American Board of Emergency Medicine).

Trauma is treated by a trauma team who have been trained using the principles

taught in the internationally recognized Advanced Trauma Life Support (ATLS)

course of theAmerican College of Surgeons. Some other international training

bodies have started to run similar courses based on the same principles.

The services that are provided in an emergency department can range from

simple x-rays and the setting of broken bones to those of a full-scale trauma

center. A patient's chance of survival is greatly improved if the patient receives

definitive treatment (i.e. surgery or reperfusion) within one hour of an accident

(such as a car accident) or onset of acute illness (such as a heart attack). This

critical time frame is commonly known as the "golden hour".

Some emergency departments in smaller hospitals are located near a helipad

which is used by helicopters to transport a patient to a trauma center. This inter-

hospital transfer is often done when a patient requires advanced medical care

unavailable at the local facility. In such cases the emergency department can

onlystabilize the patient for transport.

Mental illness

Some patients arrive at an emergency department for a complaint of mental

illness. In many jurisdictions (including many U.S. states), patients who appearto be mentally ill and to present a danger to themselves or others may be brought

against their will to an emergency department by law enforcement officers for

psychiatric examination. The emergency department conducts medical clearance

rather than treats acute behavioral disorders. From the emergency department,

patients with significant mental illness may be transferred to a psychiatric unit

(in many cases involuntarily).

Asthma and COPD

Acute exacerbations of chronic respiratory diseases, mainlyasthma and chronicobstructive pulmonary disease (COPD), are assessed as emergencies and treated

with oxygen therapy,bronchodilators, steroids or theophylline, have an

urgent chest X-rayand arterial blood gases and are referred for intensive care if

necessary. Non invasive ventilation in the ED has reduced the requirement

for tracheal intubation in many cases of severe exacerbations of COPD.(16)
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Special facilities, training, and equipment

An ED requires different equipment and different approaches than most other

hospital divisions. Patients frequently arrive with unstable conditions, and so

must be treated quickly. They may be unconscious, and information such as their

medical history, allergies, and blood type may be unavailable. ED staff are trained

to work quickly and effectively even with minimal information.

ED staff must also interact efficiently with pre-hospital care providers such

as EMTs, paramedics, and others who are occasionally based in an ED. The pre-

hospital providers may use equipment unfamiliar to the average physician, but

ED physicians must be expert in using (and safely removing) specialized

equipment, since devices such as Military Anti-Shock Trousers ("MAST")

andtraction splints require special procedures. Among other reasons, given that

they must be able to handle specialized equipment, physicians can now specialize

in emergency medicine, and EDs employ many such specialists.

ED staff have much in common with ambulance and fire crews, combat

medics, search and rescue teams, and disaster response teams. Often, joint

training and practice drills are organized to improve the coordination of this

complex response system. Busy EDs exchange a great deal of equipment with

ambulance crews, and both must provide for replacing, returning, or reimbursing

for costly items.

Cardiac arrest and major trauma are relatively common in EDs, so defibrillators,

automatic ventilation and CPRmachines, and bleeding control dressings are used

heavily. Survival in such cases is greatly enhanced by shortening the wait for key

interventions, and in recent years some of this specialized equipment has spread

to pre-hospital settings. The best-known example is defibrillators, which spread

first to ambulances, then in an automatic version to police cars, and most

recently to public spaces such as airports, office buildings, hotels, and even

shopping malls.

Because time is such an essential factor in emergency treatment, EDs typically

have their own diagnostic equipment to avoid waiting for equipment installed

elsewhere in the hospital. Nearly all have an X-ray room, and many now have full

radiology facilities including CT scanners and ultrasonography equipment.

Laboratory services may be handled on a priority basis by the hospital lab, or the

(17)
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ED may have its own "STAT Lab" for basic labs (blood counts, blood typing,

toxicology screens, etc.) that must be returned very rapidly.

The use ofElectronic Medical Records in U.S. EDs has increased rapidly as a

result of the 2009 HITECH Act. Companies such asWellsoft Corporation provide

Emergency Department Information Systems (EDIS) that help hospitals meet

HITECH requirements.Functionality typically offered by these systems include

patient tracking, discharge planning, clinical documentation and coding.

Non-emergency use

Metrics applicable to the ED can be grouped into three main categories, volume,

cycle time, and patient satisfaction. Volume metrics including arrivals per hour,

percentage of ED beds occupied and age of patients are understood at a basic

level at all hospitals as an indication for staffing requirements. Cycle time metricsare the mainstays of the evaluation and tracking of process efficiency and are less

widespread since an active effort is needed to collect and analyze this data.

Patient satisfaction metrics, already commonly collected by physician groups and

hospitals, are useful in demonstrating the impact of changes in patient perception

of care over time. Since patient satisfaction metrics are derivative and subjective,

they are less useful in primary process improvement.

In manyPrimary Care Trusts there may be out of hours doctor services

sometimes known as Keydoc or something similar (varying by area) provided by

volunteer General Practitioners.

In the United States, and many other countries, hospitals are beginning to create

areas in their emergency rooms for people with minor injuries. These are

commonly referred asFast Track orMinor Care units. These units are for people

with non life-threatening injuries. The use of these units within a department

have been shown to significantly improve the flow of patients through a

department and to reduce waiting times. Urgent care clinics are another

alternative, where patients can go to receive immediate care for non-life-

threatening conditions.

Doctors in training

Doctors in training provide a large portion of the medical care in emergency

departments.

(18)
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In the United States, they are called residents and most are supervised by ABEM

or AOBEM board certified attending physicians.

In the United Kingdom, many doctors rotate through the emergency department,

such as during their second foundation year (F2), or as part of a rotational

specialty training programme in General Practice orAcute Care Common

Stem training (Emergency Medicine,Acute medicine,Anaesthetics, and Intensive

Care).

Overcrowding

Emergency department overcrowding is when function of a department is

hindered by an inability to treat all patients in an adequate manner. This is a

common occurrence in emergency departments world wide.[ Overcrowding

causes inadequate patient care which leads to poorer patient outcomes.Frequent presenters

Frequent presenters are persons who will present themselves at a hospital

multiple times, usually those with complex medical requirements or with

psychological issues complicating medical management. These persons

contribute to overcrowding and typically use require more hospital resources

despite the fact that they do not account for a significant amount of visits.

Emergency departments in the military

Emergency departments in the military benefit from the added support of

enlisted personnel who are capable of performing any task they have been trained

for, regardless of actual education obtained from civilian schooling. For example,

in Naval hospitals, Hospital Corpsmen perform tasks that fall under the scope of

practice of both doctors (i.e. sutures and incision and drainages) and nurses (i.e.

medication administration and foley catheter insertion). Often, some civilian

education and/or certification will be required such as an EMT certification, in

case of the need to provide care outside of the base where the member is actually

stationed.

Geriatric intensive-care unit

Geriatric intensive care unit is a special type ofintensive care unit dedicated to

management of critically ill elderly.(19)
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Geriatric intensive care unit's goal is to restore physiologic stability, prevent

complications, maintain comfort and safety, and preserve pre-illness functional

ability and quality of life (QOL) in older adults admitted to critical-care units.

Origin

Geriatric intensive care units appeared in response to the world's

population aging. Managing Geriatrics diseases is unlike adults or pediatrics

diseases, particularly for the critically ill. Not allcritical care physicians are fully

oriented to the peculiarties of geriatric patients.

One definition of a critically ill older adult is:

a person, age 65 or older, who is currently experiencing or at risk for some form

of physiologic instability or alteration warranting urgent or emergent, advanced

nursing/medical interventions and monitoring.

More than half (55.8%) of all ICU days are incurred by patients older than

65.

Older adults are living longer, are more racially and ethnically diverse,

often have multiple chronic conditions, and more than one-quarter report

difficulty performing one or more activities of daily living (ADLs). These

factors may affect both the course and outcome of critical illness.

Once hospitalized for a life-threatening illness, older adults often:

1. Experience high ICU, hospital, and long-term crude mortality rates.

2. Are at risk for deterioration in functional ability and post-discharge

institutional care.

Older age is a factor that could conceptually lead to:

1. Potential bias in refusing ICU admission.

2. The decision to withhold mechanical ventilation, surgery, or

dialysis.

3. An increased likelihood of an established resuscitation directive.

Most critically ill older adults:

(20)
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1. Demonstrate resiliency.

2. Report being satisfied with their QOL post-discharge.

3. Would reaccept ICU care and mechanical ventilation if needed.

Chronologic age alone is not an acceptable or accurate predictor of pooroutcomes after critical illness.

Factors that may influence an older adults ability to survive a catastrophic

illness include:

1. Severity of illness

2. Nature and extent of co-morbidities

3. Diagnosis, reason for/duration of mechanical ventilation

4. Complications length of ICU/hospital stay.

5. Distribution

Geriatric intensive care units have been established many countries.

Practice issues

The most important effort in critical care practice is

maintaining physiological function and restoring homeostasis. However, when

the urgent episode subsides, general practice guidelines and clinical approaches

may be inappropriate in older adults who often have less physiological reserve.

Further, specific geriatric syndromes, medication issues and problems that can be

prevented if they are anticipated. Sleep disorders are prevalent in the elderly.

During a critical care episode, sleeping and waking cycles are disturbed. Because

of the noise in an ICU, less sleep and more noise may trigger delirium.

Altered eating and feeding patterns are common in geriatric intensive care

units. Enteral tube feeding and total parenteral nutrition have many advantages

and disadvantages.

Foley catheters are regularly inserted in patients in the intensive care unit tomonitor fluid balance, this should be changed. urinary catheters are known to

cause urinary tract infections, which are potentially lethal to the elderly. Thus,

when possible, catheters should be avoided in the ICU. In addition, the use

ofincontinence undergarments should be avoided, given the propensity for skin

irritation and breakdown.

(21)
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The ICU environment has been linked to delirium in the

elderly. Disorientation to time or place because of overstimulation, pain and

metabolic imbalances frequently results in cognitive changes. Optimally, critical

care nurses must obtain a baseline mental status on the older patient upon

admission and follow the changes through the use of a standardized assessment

instrument such as a Mini-Mental State Examination. Early detection and

intervention can reduce the use of either physical or chemical restraints

Ethical issues

Geriatric critical care can give rise to ethical issues. Despite the pervasive

conceptual emphasis on evidence-based health care, there is insufficient research

to guide the Geriatrics critical care clinician, which leaves substantial subjectivity

in crucial decisions. Outcome prediction models have been proposed, with age as

one of numerousvariables, but such models have been inadequately validated.

Age alone may not necessarily be a predictor of short-term or long-term outcome

in the older patient who is critically ill. Rationing decisions for intake to a critical

care bed during periods of reduced availability may be based on triage factors of

uncertain importance

Intensive-care unit

ICU room

An Intensive Care Unit (ICU), Critical Care Unit (CCU), Intensive Therapy

Unit or Intensive Treatment Unit (ITU) is a highly specialized department of

a hospital that provides intensive-care medicine.

Intensive Care Units cater to patients with the most serious injuries and illnesses,

most of which are life-threatening and need constant, close monitoring and

support from equipment and medication in order to maintain normal bodily

functions. They have higher levels of staffing and specialist monitoring and

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treatment equipment, alongside doctors and critical care nurseswho are specially

trained in caring for the most severely ill patients

History

In 1854, Florence Nightingale left for the Crimean War, where triage was used toseparate seriously wounded soldiers from the less-seriously wounded was

observed. Until recently, it was reported that Nightingale reduced mortality from

40% to 2% on the battlefield. Although this was not the case, her experiences

during the war formed the foundation for her later discovery of the importance of

sanitary conditions in hospitals, a critical component of intensive care.

In 1950, anesthesiologist Peter Safar established the concept of "Advanced

Support of Life," keeping patients sedated and ventilated in an intensive-care

environment. Safar is considered to be the first practitioner of intensive-caremedicine as a speciality.

In response to a polioepidemic (where many patients required constant

ventilation and surveillance), Bjrn Aage Ibsen established the first intensive-

care unit in Copenhagen in 1953. The first application of this idea in the United

States was in 1955 by Dr. William Mosenthal, a surgeon at the Dartmouth-

Hitchcock Medical Center.[ In the 1960s, the importance ofcardiac

arrhythmias as a source ofmorbidityand mortalityin myocardial

infarctions (heart attacks) was recognized. This led to the routine use of cardiac

monitoring in ICUs, especially after heart attacks.

Specialities

Hospitals may have ICU's that cater to a specific medical speciality or patient,

such as those listed below:

Neonatal Intensive Care Unit (NICU)

Pediatric Intensive Care Unit (PICU)

Psychiatric Intensive Care Unit (PICU)

Coronary Care Unit (CCU) - Also known as Cardiac Intensive Care Unit

(CICU)

Post Anesthesia Care Unit (PACU) - Also known as the Post-Operative

Recovery Unit, or Recovery Room, the PACU provides immediate post-op

observation and stabilisation of patients following surgical operations and

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anesthesia. Patient's are usually held in such facilities for a limited amount of

time, and must meet a set physiological criteria before transfer back to a ward

with a qualified nurse escort takes place. Due to high patient flow in Recovery

Units, and owing to the bed management cycle, if a patient breaches a time

frame and is too unstable to be transferred back to a ward, they are normally

transferred to a High Dependency Unit (HDU) or Post-Operative Critical Care

Unit (POCCU) for closer observation.

High Dependency Unit (HDU) - Many hospitals have a transitional High

Dependency (HDU) facility for patients who require close observation,

treatment and nursing care that cannot be provided on a general ward, but

whose care is not at a critical enough level to warrant an ICU bed. These units

are also called step-down, progressive and intermediate care units and are

utilised until a patient's conditions stabilises enough to qualify them fordischarge to a general ward

Equipment and Systems

Common equipment in an ICU includes mechanical ventilators to assist

breathing through an endotracheal tube or a tracheotomy; cardiac monitors

including those with telemetry;

externalpacemakers; defibrillators; dialysis equipment for renal problems;

equipment for the constant monitoring of bodily functions; a web ofintravenous

lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and

a wide array ofdrugs to treat the primary condition(s) of

hospitalization. Medically induced comas, analgesics, and induced sedation are

common ICU tools designed to reduce pain and prevent secondary infections.

Quality of Care

The available data suggests a relation between ICU volume and quality of care for

mechanically ventilated patients. After adjustment for severity of

illnesses, demographicvariables, and characteristics of different ICUs (including

staffing by intensivists), higher ICU staffing was significantly associated with

lower ICU and hospital mortalityrates. A ratio of 2 patients to 1 nurse is

recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1

typically seen on medical floors. This varies from country to country, though; e.g.,

in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for

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High-Dependency patients who require closer monitoring or more intensive

treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring

very intensive support and monitoring; for example, a patient on a mechanical

ventilator with associated anaesthetics or sedation such

as propofol, Midazolam and use of strong analgesics such

as morphine, fentanyl and/or remifentanil

Neonatal intensive care unit

A Neonatal Intensive Care Unit (NICU) is an intensive care unit specializing in

the care of ill or premature newborn infants.

A NICU is typically directed by one or more neonatologists and staffed

bynurses[, nurse practitioners, pharmacists, physician

assistants, residentphysicians, and respiratory therapists. Many other ancillary

disciplines and specialists are available at larger units. The term neonatalcomes

from neo, "new", and natal, "pertaining to birth or origin"

Nursing and neonatal populations

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A pediatric nurse checking recently-born triplets in an incubator at ECWA

Evangel Hospital, Jos, Nigeria

Healthcare institutions have varying entry-level requirements for neonatal

nurses. Neonatal nurses are Registered Nurses (RNs), and therefore must have

anAssociate of Science in Nursing (ASN) or Bachelor of Science in

Nursing (BSN) degree. Some countries or institutions may also require

amidwiferyqualification. Some institutions may accept newly-graduated RNs

who have passed the NCLEX exam; others may require additional experience

working in adult-health or medical/surgical nursing.

Some countries offer postgraduate degrees in neonatal nursing, such as

the Master of Science in Nursing (MSN) and various doctorates. Anurse

practitioner may be required to hold a postgraduate degree. The National

Association of Neonatal Nurses recommends two years' experience working in a

NICU before taking graduate classes.

As with any registered nurse, local licensing or certifying bodies as well as

employers may set requirements for continuing education.

There are no mandated requirements to becoming an RN in a NICU, although

neonatal nurses must have certification as a Neonatal ResuscitationProvider.

Some units prefer new graduates who do not have experience in other units, so

they may be trained in the specialty exclusively, while others prefer nurses with

more experience already under their belt.

Intensive care nurses endure intensive didactic and clinical orientation, in

addition to their general nursing knowledge, to provide highly specialized care for

critical patients. Their competencies include the administration of high-risk

medications, management of high-acuity patients requiring ventilator support,

surgical care, resuscitation, advanced interventions such as extracorporeal

membrane oxygenation or hypothermia therapy for neonatal

encephalopathyprocedures, as well as chronic-care management or lower acuity

cares associated with premature infants such as feeding

intolerance,phototherapy, or administering antibiotics. NICU RNs undergo

annual skills tests and are subject to additional training to maintain

contemporary practice.

History

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The problem of premature and congenitally ill infants is not a new one. There

were scholarly papers published as early as the 17th and 18th century that

attempted to share knowledge of interventions.[It was not until 1922, however,

that hospitals started grouping the newborn infants into one area, now called the

Neonatal Intensive Care Unit (NICU).

Stphane Tarnier

Before the industrial revolution, premature and ill infants were born and cared

for at home and either lived or died without medical intervention. In the mid-

nineteenth century, the infant incubator was first developed, based on the

incubators used for chicken eggs. Dr. Stephane Tarnier is generally considered to

be the father of the incubator (or isolette as it is now known), having developed it

to attempt to keep premature infants in a Paris maternity ward warm. Other

methods had been used before, but this was the first closed model, additionally,

he helped convince other physicians that the treatment helpedpremature infants.France became a forerunner in assisting premature infants, in part due to their

concerns about a falling birth rate.

Dr. Pierre Budin, followed in Tarniers footsteps after he retired, noting the

limitations of infants in incubators and the importance of breastmilk and the

mothers attachment to the child. Budin is known as the father of

modern perinatology, and his seminal workThe Nursling (Le Nourisson in

French) became the first major publication to deal with the care of the neonate.

Another factor that contributed to the development of modern neonatology was

thanks to Dr. Martin Couneyand his permanent installment of premature babies

in incubators at Coney Island. A more controversial figure, he studied under Dr.

Budin and brought attention to premature babies and their plight through his

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display of infants as sideshow attractions at Coney Island and the Worlds Fair in

New York and Chicago in 1933 and 1939, respectively.

Early years

Bundesarchiv Bild 183-1989-0712-025, Berlin, Krankenhaus "Oskar-Ziethen",

Kinderkrankenhaus

Doctors took an increasing role in childbirth from the eighteenth century

onwards. However, the care of newborn babies, sick or well, remained largely in

the hands of mothers and midwives. Some baby incubators, similar to those used

for hatching chicks, were devised in the late nineteenth century. In the United

States these were shown at commercial exhibitions, complete with babies inside,

until 1931. Dr A. Robert Bauer MD at Henry Ford Hospital in Detroit, MI

successfully combined oxygen, heat, humidity, ease of accessibility, and ease of

nursing care in 1931. It was not until after the Second World War that special care

baby units (SCBUs) were established in many hospitals. In Britain, early SCBUs

opened in Birmingham and Bristol. At Southmead Hospital, Bristol, initial

opposition from obstetricians lessened after quadruplets born there in 1948 were

successfully cared for in

Documents

Aziz MBA in Hospital Management Project 0205009