Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends

<p>Abstract</p> <p>Background</p> <p>Monitoring of hospital information system (HIS) usage can provide insights into best practices within a hospital and help to assess time trends. In terms of effort and cost of benchmarking, figures derived automatically from the routine HIS system are preferable to manual methods like surveys, in particular for repeated analysis.</p> <p>Methods</p> <p>Due to relevance for quality management and efficient resource utilization we focused on time-to-completion of discharge letters (assessed by CT-plots) and usage of patient scheduling. We analyzed these parameters monthly during one year at a major university hospital in Germany.</p> <p>Results</p> <p>We found several distinct patterns of discharge letter documentation indicating a large heterogeneity of HIS usage between different specialties (completeness 51 – 99%, delays 0 – 90 days). Overall usage of scheduling increased during the observation period by 62%, but again showed a considerable variation between departments.</p> <p>Conclusion</p> <p>Regular monitoring of HIS key figures can contribute to a continuous HIS improvement process.</p

During the observation period scheduling was introduced in several departments

<p><b>Copyright information:</b></p><p>Taken from "Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends"</p><p>http://www.biomedcentral.com/1472-6947/8/15</p><p>BMC Medical Informatics and Decision Making 2008;8():15-15.</p><p>Published online 19 Apr 2008</p><p>PMCID:PMC2374775.</p><p></p

This department provides highly complete discharge letters (completeness 98

5%) and no delays – best case. 201 cases from March 2007 were analyzed.<p><b>Copyright information:</b></p><p>Taken from "Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends"</p><p>http://www.biomedcentral.com/1472-6947/8/15</p><p>BMC Medical Informatics and Decision Making 2008;8():15-15.</p><p>Published online 19 Apr 2008</p><p>PMCID:PMC2374775.</p><p></p

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease