Where, when and what? A time study of surgeons' work in urology.

INTRODUCTION: Staff time is a relevant resource in the delivery of health care interventions. Its measurement is a prerequisite for unit costing but usually complex. The aim of this study was to analyse the distribution of surgeons' work time among types and places of activities. A second aim was to use these data to calculate costs per unit of output. METHODS: A self-reporting work sampling study was carried out at a department of Urology. All of twelve surgeons involved in clinical care participated in a two-week analysis of their work time. RESULTS: A total of 2,485 data-points were collected, representing about 1,242 hours of work time. Surgeons spent the greater part of their work time in direct patient care, but substantial shares were required for documentation and organisation. Assistants were mainly required at the wards and consultants at the operating theatre and the outpatient unit. Staff costs of surgeons were 32 € and 29 € per patient day at the wards, respectively, 1.30 € per minute at the operating theatre and 32 € per visit at the outpatient unit. CONCLUSION: Results provided a basis for costing of health care interventions at the study site. However, future research should focus on the establishment of standardised terminology in order to increase transferability of results

Medical student views of and responses to expectations of professionalism

Funding this study is part of the corresponding author's (EAS) doctoral programme of research funded by the University of Aberdeen, and supervised by EH and JC. Acknowledgements we thank all the students who took part in this project, and Professor Rona Patey, the Director of the Institute of Education for Medical and Dental Sciences, University of Aberdeen, for her support of this project.Peer reviewedPostprin

Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

Objective: The Surviving Sepsis Campaign (SSC or “the Campaign”) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. Design and setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. Main results: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5–8.4%). Conclusions: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1738-3) contains supplementary material, which is available to authorized users

Nursing Care and Patient Safety: Visualizing Medication Organization, Storage and Distribution with Photographic Research Methods

In this qualitative study, we adapted photographic research methods from earlier nursing research to identify factors related to organization, storage and distribution that could lead to errors in the selection, preparation and administration of medications. The research excerpt presented here was developed in a clinical unit of an urban Brazilian public hospital. The research participants were nurses working at that unit and students from the two final semesters of the Undergraduate Nursing Course. We collected digital photographs of the medication system and subsequently used photo elicitation to review the images with research participants, so as to obtain their perceptions and narratives of working with medications in the unit. We report selected findings here on the organization, storage and distribution of medications, which indicate there is room to improve the safety of the medication system.En este estudio cualitativo, se adoptó el método de investigación fotográfica de estudios anteriores, para identificar factores relacionados a la organización, acondicionamiento y distribución, los que podrían conducir a errores en la selección, preparación y administración de medicamentos. Esta parte de la investigación que se presenta fue desarrollada en una unidad de clínica médica de un Hospital Público, en Brasil. Los participantes de la investigación fueron enfermeros que trabajaban en aquella unidad y estudiantes de los dos últimos semestres del Curso de Graduación en Enfermería. Fueron obtenidas fotografías digitales del sistema de medicación y subsecuentemente, se obtuvieron las fotos para analizar las imágenes con los participantes de la investigación, a fin de obtener sus percepciones y narrativas al respecto del trabajo con medicamentos en aquella unidad. Se presenta una selección de los principales hallazgos de la investigación sobre organización, acondicionamiento y distribución de medicamentos, indicando que hay espacio para mejorar la seguridad del sistema de medicación.Neste estudo qualitativo, adaptou-se o método de pesquisa fotográfica de estudos anteriores, para identificar fatores relacionados à organização, acondicionamento e distribuição que poderiam levar a erros na seleção, preparo e administração de medicamentos. O recorte da pesquisa apresentado foi desenvolvido em unidade de clínica médica de um hospital público, Brasil. Os participantes da pesquisa foram enfermeiros que trabalhavam naquela unidade e acadêmicos dos dois últimos semestres do curso de graduação em Enfermagem. Obtiveram-se fotografias digitais do sistema de medicação e, subsequentemente, utilizou-se a elicitação das fotos para rever imagens com os participantes da pesquisa, a fim de obter suas percepções e narrativas a respeito do trabalho com medicamentos, naquela unidade. Apresenta-se uma seleção dos principais achados da pesquisa sobre organização, acondicionamento e distribuição de medicamentos, indicando que há espaço para melhorar a segurança do sistema de medicação