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87 Cards in this Set
- Front
- Back
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Mesopotamia
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earliest organized institution
Egypt, India, Rome, Iran-centers of civilization and early medicine |
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Early hospitals
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integrated into religious practices, services, and ceremonies
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Secular Institutions
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Served several functions-almshouses, hostels for pilgrims, education for physicians
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where was the first hospital in america?
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A hospital for soldiers on Manhattan Island, was the first hospital in the United States
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almshouses
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were the early hospitals in america. cortes built the first hospital in america in 1524
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Hospitals in the United States emerged in three stages:
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Voluntary hospitals
Religious and ethnic hospitals Profit making hospitals |
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Changing culture in evolution of care
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culture-agrarian society to industrial society
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Social structure in evolution of care
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communal to associative relations
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Pasteur and Koch
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discovered the germ theory which led to laboratory bacteriology, and x-ray
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world wars
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Marked the advent of an interest in the financing of health care
Insurance plans both non-profit and for profit, such as Blue Cross-Blue Shield |
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geography
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rural and community
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Community Access
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25 beds or less
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Tertiary Care Centers
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Very large with many specialties
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specialty hospitals
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can provide better and more efficient treatment for greater numbers of patients who need the same specialization of care.
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VA
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In the VA system, there are approximately 175 hospitals, 400 clinics and 126 Nursing Homes providing services to American Veterans.
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downsizing
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need for fewer beds
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Mergers
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between hospitals to be more cost efficient and provision of services so that they are not duplicated
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Closures
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those that they no longer need in particular areas or who cannot survive financially. This has occurred frequently in rural hospitals due to reductions in Medicare reimbursement
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DRG’s (diagnosed related groups)
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a method of classifying patients by categories according to age, diagnosis, and treatment resource requirements. DRG’s are the basis for the prospective payment system
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tighter reimbursement
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as a result to hospitals. Medicare decided it would no longer pay costs incurred by the hospital but would limit what it would pay.
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outpatient
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downsizing due to less then 50% patients using rooms. everything became out patient to physicians. led to fewer admissions and average length of stay.
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Stark Law
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prohibited by Medicare for physicians to make self-referrals to a healthcare organization in which he or she has a financial vested interest and bills Medicare and Medicaid for services provided to patients.
"physician referral law" |
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Whole hospital exception
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Physicians are permitted to refer patients if they have an ownership interest in the entire hospital and are also authorized to perform services there (they have privileges).
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moratorium
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congress established from 12/8/03 to 6/7/05 to prohibit specialty hospitals from submitting claims for services as a result of physician owner referrals.
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Patient Protection and Affordable Care Act
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specified by the Health Care and Education Reconciliation Act will ban physician ownership of hospitals beginning in 2011.
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Emergency Medical and Active Labor Act EMTALA established in 1986
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makes sure care is provided to the uninsured. mostly emergency rooms. hospitals are required to provide either stabilizing treatment or appropriate transfer for patients with emergency medical conditions.
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harvard medical practice study
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revealed that the hospital emergency department is “a real hot spot” for negligence”.
In this study, 70% of adverse events occurring in the emergency department were because of negligence |
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in court suits compared to out of court settlements
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suits in court are few in comparison to settlements
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problems from baby boomers
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hospitals and all of healthcare will need an increasing need for Nursing Personnel.
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nurse shortage
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to continue and worsen. The majority of Nurses today are in their mid-40’s and for every 8 who leave the field, 5 will enter.
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Patient Protection and Affordable Care Act
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may close the gap of medicare and medicad exceeding revenue in hospitals mandating that most patients purchase insurance
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teams
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lower responsibilities of individuls
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pyramids
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chain of command. trying to make the pyramid flatter with wider span of control so decisions can be made faster
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Line
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authority
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Staff
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Identify and provide Inservice education, Human Resources, and library. These are support depts. And do not have authority to supervise anyone but those who work in their depts.
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Board of Directors
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sometimes elected by citizens sometimes appointed. The Board of Directors is ultimately, legally responsible for hospital operations daily.
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Board responsible
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Appointing, evaluate, and fire CEO
Setting policy Fiduciary for ultimate hospitals welfare Appoint members of the medical staff- Discharge incompetent physicians Monitor quality improvement program Setting policy Fiduciary for ultimate hospitals welfare Appoint members of the medical staff Monitor quality improvement program |
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Medical staff
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their activities significantly affect the management and governance of the hospital.
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Board’s numbers
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depend upon the number of beds in the hospital.
Generally there are 8 or 9 Board Members, larger hospital Boards may have 25. generally meet 10 to 12 times per year. |
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Annual Budget
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must be overseen by the Board as well as any Capital Expenditures that may be planned by the hospital.
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hospital medical staff
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operates under its own bylaws, rules and regulations, but the physicians on the medical staff are accountable to the board of trustees for the professional care of their patients.
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Board of trustees
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delegates the hospital’s daily medical affairs to the medical staff but can never delegate the responsibility for oversight and what happens in the hospital.
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types of board of trustees
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A. Executive Committee
B. Finance Committee C. Planning Committee Tissue Committee Medical Records committee Pharmacy and therapeutics committee Quality assurance committee |
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priority of physician seeing patient 1
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Life threatening (could die from their injuries quickly and all staff need to be attending to pt.
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priority of physician seeing patient 2
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Serious but not life threatening Need to be seen by ER staff but will not die
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priority of physician seeing patient 3
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Non-life threatening (could be seen by Urgent care center located in the hospital)
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triage protocol
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an established policy based on scientific evidence and not on a patient’s pain level or perception of illness.
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trauma centers
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all traumas are emergencies but not all emergencies are traumas.
trauma centers handle the most severe, life-threatening blunt force and penetrating injuries |
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Level IV trauma
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center provides initial evaluation and assessment and 24-hour emergency coverage by a physician.
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Level IV trauma centers
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also have working relations with the nearest Level I, II, or III trauma centers so that patients with severe injuries can be transferred
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Level III trauma centers
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offer continuous surgery coverage, have resuscitation and emergency surgery capabilities and have standardized treatment protocols to address the care of patients who will be transferred to upper-tier trauma centers.
Mt. Carmel East |
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Level II trauma centers
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provide comprehensive trauma care and are usually located in areas with no Level I trauma centers.
riverside Methodist |
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Level I trauma centers
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are regional resource hospitals that are the core of the trauma care system.
grant hospital |
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Trauma
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A system of care
Based on model developed during Viet Nam War Prioritize care based on severity of trauma Increase in intensity with increase in care 4 Levels of Trauma Centers |
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Golden Hour
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First 60 minutes after occurrence
tiered trauma center model was created for the crucial hour. |
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some level of trauma capacity.
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About 10% of U.S. hospitals have some level of trauma capacity.
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Advance Directives
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Living Will in which the patient has specified what medical care he/she does or does not want in the event they are unable to make their wishes known when they arrive at the hospital.
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Trauma patients
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the trauma center will try to save the life of the patient. If this is not successful, the family must think about what the wishes of the patient would be if the patient would be a good organ donor.
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Durable Power of Attorney (DPOA)
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is a document that designates 2 people who have agreed with the individual to carry out his/her wishes in the event the patient is unable to make their wishes known.
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The Medical staff
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an organized body that may include physicians, dentists, podiatrists, nurse midwives, nurse practitioners, physician assistants, psychologists
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allied health staff
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professionals who attend patients and participate in related clinical care duties.
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National Resident Matching Program
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a program developed in 1951 by representatives from the American Association of Medical Colleges (AAMC), the American Medical Association (AMA) and various hospital associations. This group acts as a Clearing house for matching the preferences of new graduates with the hospitals offering residencies.
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PHYSICIAN ASSISTANTS
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Created in 1960s by Dr Eugene Stead of Duke University Medical Center
Filled shortage of primary care physicians 1965 saw first 4 begin program of physician assistants at Duke |
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PHYSICIAN ASSISTANT (PA) duties
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Extension of health professions team
Conducts physical exams Diagnoses and treats Orders and interprets tests Prescribes medicines |
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opportunities for PAs
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Private practice
Outpatient clinics University hospitals HMOs (health maintenance organizations |
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PA in specialty medicine
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General surgery
Emergency Psychiatry Radiology Pathology |
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nurse practitioner
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Works under supervision of physician
Registered nurse with advanced education Focus on individualized care Teach wellness and prevention to patient |
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responsibilities for nurse practitioners
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Collaborate with physicians
Treat and diagnose Physical exams, x-rays, EKGs, lab tests Prescribe medications Refer for rehabilitation |
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midwife
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Provide prenatal care to expectant mothers
Care for infant during birth Assist mother and infant postpartum |
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help from midwives
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Length of labor
Necessity of pain medication Use of forceps Cesarean section |
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Direct-entry midwives
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skills gained through apprenticeship, training in the community, or education through a field outside nursing Nurse midwives
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Nurse midwives
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registered nurses who have undergone an accredited midwifery program and after certification, become a certified nurse-midwife (CNM)
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history of nursing
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Florence Nightingale
New England Hospital for Women and Children - 1872 Bellevue Hospital School of Nursing – 1873 |
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American Nurses Association (ANA)
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promotes policy and legislation on health care and nursing issues, establishes standards for nursing and the Code for Nurses
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National League for Nursing (NLN)
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primarily concerned with promoting standards and innovation in nursing education
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Quality Assurance Nurses
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work with Infection Control Nurses
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Wound Care Nurses
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focus on skin integrity issues
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Infection Control Nurses
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insure proper precautions are in place
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House Supervisor
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acts when administrator not on duty; nurse staffing
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Per diem Nurses
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only work when needed like substitute teachers
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traditional scheduling
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3 months schedule flexible
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cycling scheduling
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same schedule does not change and is not flexible
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DEPARTMENT ORGANIZATION
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Methods to organize the work of health professionals within an acute care hospital
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function
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specialized work to be performed
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program
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output to be achieved
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Specialized Departments
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Memory care center
Arthritis Treatment Center Hospice Unit Pain Management Program Geriatric Psychiatry |
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PATIENT CARE UNIT
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special cardiac care units, kidney dialysis centers, inpatient psychiatric units, inpatient alcoholic and drug addiction units, inpatient rehabilitation units, obstetrics units, pediatric units, and skilled nursing facilities for long-term care
Intensive care units (ICU) Neonatal intensive care units (NICU) Coronary care units Thoracic care units |
