Motiivien tarkastelu selittää hoivapalvelujen tilannetta

Ensisijaisena motiivina ei enää ole tavoite tuottaa potilaalle hyvää hoivaa

Patient injury claims involving fractures of the distal radius : 208 compensated claims from the Finnish Patient Insurance Center

Background and purpose Optimal treatment for distal radius fractures remains controversial, with a significant number of fractures resulting in complications and long-term morbidity. We investigated patient injury claims related to distal radius fractures to detect the critical steps in the treatment leading to avoidable adverse eventsPatients and methods We analyzed all compensated patient injury claims in Finland between 2007 and 2011. Claims were collected from the Patient Insurance Center's (PIC) nationwide claim register. Patients of all ages were included. Each claim decision, original patient records, and radiographs related to treatment were reviewed.Results During the study period, the PIC received 584 claims regarding distal radius fractures, of which 208 (36%) were compensated. Pain and impaired wrist function were the most common subjective reasons to file claims among compensated patients. In 66/208 patients, more than 1 adverse event leading to patient injury was detected. The detected adverse events could be divided into 3 main groups: diagnostic errors (36%, n = 103), decision/planning errors (30%, n = 87), and insufficient technical execution (32%, n = 91). Issues related to malalignment were the main concerns in each group. Diagnostic errors were often related to incorrect assessment of the fracture (re)displacement (75%, n = 78). All of the decision-making errors concerned physicians' decisions to accept unsatisfactory fracture alignment. The most common technical error was insufficient reduction (29%, n = 26).Interpretation We identified avoidable adverse events behind patient injuries related to distal radius fracture treatment. This study will help physicians to recognize the critical steps in the treatment of this common fracture and enhance patient safety.Peer reviewe

Distaalisten radiusmurtumien potilasvahingot Suomessa 2007- 2011

English abstrac

Pupils' Experience of Social Participation in Finnish Primary Schools

Social participation means taking a full and active role in school life, being a valued and integral member of the school community. The purpose of this study was to examine pupils’ experiences of social participation and their active roles in Finnish primary schools. The intention was to find out in what ways primary school pupils’ (n = 3,760) personal experiences of pupil–pupil (PP) and pupil–teacher (PT) interaction vary between genders and across age groups in small and large schools. Pupils’ experiences were examined with questions concerning the active participation of the child and the participatory role of the teacher. The results show that pupils’ experiences vary, and there are differences between schools in terms of pupils’ social participation.</p

Patient injuries in primary total hip replacement Nationwide analysis in Finland

Background and purpose - Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods - We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results - We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume >= 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of = 400 primary THRs was established as a protective factor against patient injuries.Peer reviewe

International benchmarking of tertiary trauma centers: productivity and throughput approach

<p>Abstract</p> <p>Background</p> <p>Care process in tertiary trauma centers consists of a chain of care phases in different departments from the emergency department (ED) to post-operative rehabilitation. The historical evolution of healthcare systems and organizations has led to variations in trauma patient processes in different countries. The present study is aimed at revealing differences in the throughput and productivity of trauma patient processes between German (UKB) and Finnish (HUS) tertiary trauma centers. Problems related to the comparison of different healthcare systems were also identified. The share of patients discharged was used as a control measure.</p> <p>Results</p> <p>The biggest differences between the hospitals were found in the use of resources in the ED and in post-operative care. Despite problems in defining comparable patients and resources, ED productivity was significantly higher in UKB. Post-operative care was, on average, 41% shorter in HUS. However, the share of patients discharged was significantly higher in UKB (96.5% vs. 68.9%). Differences were also found in the pre-operative length of stay of patients with proximal femoral fractures (UKB: 0.97 days, HUS: 1.57 days). The productivity of the operating unit was quite similar in the hospitals. In terms of ED mortality, no statistically significant differences were found.</p> <p>Conclusions</p> <p>The results of the present study showed significant differences in the use of resources and throughput times in trauma patient processes between Finnish and German hospitals. However, due to system-level differences between German and Finnish healthcare, the results cannot be directly transformed into development proposals for the organizations. On the other hand, in spite of certain differences regarding the healthcare systems, the demographic data of the trauma patients and medical procedures are comparable. Based on the present study, the ED process of severe trauma, pre-operative care, and operating unit processes were the most comparable parts of trauma care between the hospitals. The study also showed that the international benchmarking approach could be used to reveal bottlenecks in system-level policies and practices.</p

Kulkutautisairaalan pystyttäminen 2020

HUS:n koronapotilaat päätettiin keskittää Kirurgisen sairaalan tiloihin. Kiinteistö soveltui erinomaisesti erilliseksi infektiopotilaiden hoitoyksiköksi – jollaiseksi se pitkälti oli suunniteltukin sairaalan aloittamisvuonna 1882. Näin toiminta rakennettiin

Sote on mahdollinen ilman maakuntiakin

Tavoiteltaviin uusiin maakuntiin ei voida olettaa syntyvän sellaista viisautta tai säästöpotentiaalia, mitä ei jo voitaisi saavuttaa nykyisten sairaanhoitopiirien ja perusterveydenhuollon yksiköiden hallinnossa sekä kliinisen osaamisen johdossa

Kirurgiaa poikkeusoloissa

Luonnonkatastrofit, liikenneonnettomuudet, suurpalot, terroriteot tai aseelliset konfliktit saattavat vammauttaa suuren joukon ihmisiä. Osa heistä tarvitsee kiireellistä leikkaushoitoa, tehohoitoa ja pitkäkestoista kuntoutusta. Suuronnettomuudet tapahtuvat tyypillisesti äkillisesti, ja hoitoa tarvitsevien potilaiden määrä ylittää käytettävissä olevat tavanomaiset voimavarat. Onnettomuudet voidaan luokitella uhrien lukumäärän mukaan. Myös hoidettavien vammojen luonne tai niiden yhdistelmät poikkeavat usein tavanomaisista. Vammojen syntytapa, syntypaikka, uhrien ikärakenne ja hoitoon pääsyn viive luovat omat erityispiirteensä näihin tilanteisiin. Lisääntynyt hoidettavien määrä ja rajalliset resurssit edellyttävät erityistoimia valmiuden ja toiminnan lisäämiseksi sekä lisäksi potilaslajittelua (triage). Käytettävissä olevat voimavarat on suunnattava järkevästi ja tehokkaasti