The disclosure of adverse health events is the imparting, by healthcare providers to patients or their family, of information pertaining to any unexpected health event affecting the patient. Even though both the law and professional codes of ethic require the disclosure of all adverse health events, only a fraction of such events are actually disclosed. This disclosure gap is a reflection of the morally difficult decision about whether and how to disclose adverse events to patients. This thesis examines deontological and casuistic theoretical ethical perspectives on the healthcare professional's duty to disclosure adverse health events. Three case studies with different severities of clinical outcomes are used to demonstrate the differences and similarities between the two theories. The conclusions support the reconciliation of the deontological theory and casuistic reasoning in the decision to disclose adverse events, with recommendations to improve communications skills and disclosure training for healthcare providers. / On entend par divulgation d'événements indésirables dans le domaine des soins de santé, la transmission d'information relative à tout événement indésirable affectant un patient. Cette information est communiquée ou aux patients à leur famille par les prestataires de soins de santé. Bien que la loi et les codes de déontologie exigent la divulgation de tout événement indésirable lié à la prestation des soins de santé, seule une fraction de ces événements est divulguée. Cette déficience en matière de divulgation reflète la nature de cette décision moralement difficile. C'est-à-dire, faut-il divulguer un événement indésirable aux patients et, dans l'affirmative, quelle est la façon de procéder? La présente thèse examine les perspectives déontologiques et casuistiques concernant le devoir éthique des professionnels de la santé de divulguer les événements indésirables. Trois études de cas, dont la gravité des résultats cliniques diffère, sont utilisées pour démontrer les différences et les similitudes entre les deux théories. En plus de favoriser la réconciliation de la théorie déontologique et du raisonnement casuistique dans la décision de divulguer les événements indésirables, la conclusion propose des recommandations visant à améliorer les techniques de communications et la formation sur la divulgation, offertes aux prestataires de soins de santé. fr

No description available.

The 1991 reforms to Britain's health service established a quasi-market where the purchasing function was performed by health authorities and those general practices that joined the fund-holding scheme. Whilst the literature lacked any direct comparison of the performance of these agencies as purchasers, there was much controversy about the equity implications of the system. Most notably this focused upon alleged differences in the waiting times for hospital services of patients registered with fund-holding and non fund-holding practices. However, such allegations were based on anecdotal evidence and open to contradiction. The thesis moves this debate beyond a reliance on anecdotal evidence and for one service, elective surgery, redresses the lack of evaluation in the relative merits of fund-holders and health authorities as purchasers. The waiting times of fund-holding and non fund-holding patients for operations covered by the fund-holding scheme were compared at four public providers over a four-year period. Fund-holding patients from the elective waiting list generally had significantly shorter waits than their non fund-holding counterparts. Because such trends became evident after practices joined the scheme, shorter waits were linked to fund-holding status. Another important aim was to ascertain why this tendency occurred. A series of hypotheses were tested, including the generosity of fund-holders' budgets, contrasts in the surgical case mix of each population, plus differences in the way fund-holders and health authorities perform their purchasing roles. An aspect of this last hypothesis was confirmed. Hospitals admitted fund-holding patients sooner to dissuade fund-holding practices from referring elsewhere. This connects to the income hospitals receive from fund-holders being more closely attributable to actual patient throughput than was the case with their income from health authorities. In discussing the policy implications of the study, the thesis then addresses how public sector quasi-markets can work in the contexts of both equity and efficiency.

No description available.

Overcrowding in the emergency department is a worldwide problem impairing the ability of hospitals to offer emergency care within a reasonable time frame. Not merely a problem of patient satisfaction, the problem of overcrowding is leading to an increased number of waiting room death cases, which refer to the death of patients while staying in a hospital's waiting room due to a lack of sufficient medical care, and this problem underscores the significance of improving healthcare quality. As a potential way of improving healthcare quality, a wireless healthcare monitoring system (HMS) could help healthcare staff monitor the condition of patients by automatically sending alert messages to a doctor device (e.g. a smartphone, a personal digital assistant, or a laptop) once emergent conditions occur.From a network design perspective, a wireless HMS should be capable of supporting the number of patients that will be using the system; being able to assess the network's capability to serve a given number of patients (defined as network patient capacity) is a critical factor in promoting adoption of such systems. This thesis investigates schemes for enhancing the network patient capacity within a HMS. The major objective is to explore the tradeoff between the network patient capacity and the Quality-of-Service (QoS) requirements of each patient, so that a fairly good network capacity is achieved subject to the constraints of QoS requirements within real-world transmission scenarios.In the first part of this thesis, we develop novel methods to estimate the average waiting time of a patient to access the Emergency Department (ED) of a hospital, showing why developing a HMS and allocating its limited wireless resources are important to improve the quality of medical care. The following part of this thesis presents various schemes for resource allocation within a HMS, in view of several factors that need to be taken into account in a real scenario, including different QoS requirements, Electromagnetic Interference (EMI) on medical equipments, as well as imperfect channel state information. We propose three novel techniques for improving the network patient capacity within a HMS, including a statistical multiplexing scheme, a channel prediction based scheme, and a medical decision support based scheme. The last part of this thesis focuses on the performance evaluation of a decision support system, a result that is important to assess the validity and acceptability of the decision support based resource allocation scheme proposed above. / La surpopulation dans les urgences est un problème très répandu qui peut incommoder les hôpitaux à promulguer des soins urgents dans des délais raisonnables. Au-delà de la satisfaction du patient, le problème de surpopulation entraine une augmentation du nombre de décès en salle d'attente, référant à la mort de patient durant l'attente d'une prise en charge, laquelle est causée par manque de soins médicaux. Ce problème met en évidence l'importance d'améliorer la qualité des soins médicaux, c'est pourquoi un système de surveillance médicale (SSM) pourrait aider le personnel médical à contrôler l'état des patients, en envoyant automatiquement des messages d'alerte aux appareils des médecins (ex. un téléphone intelligent, un assistant numérique personnel ou un ordinateur portable) dès qu'une condition médicale urgente se déclare. Dans une perspective de conception réseau, un SSM sans fil devrait être capable de supporter le nombre de patients qui utiliseront le système, et le fait de pouvoir évaluer l'aptitude du réseau à traiter un certain nombre de patients (défini comme la capacité en patients du réseau) est un facteur important dans la promotion de tels systèmes. Cette thèse étudie les procédés pour augmenter la capacité en patients du réseau dans un SSM. L'objectif principal est de trouver un compromis entre la capacité en patients du réseau et les exigences de la Qualité de Service (QdS) pour chaque patient, de sorte à avoir une capacité de réseau raisonnable en dépit des contraintes de la QdS dans des scénarios de transmissions réelles. Dans la première partie de cette thèse, nous développons de nouvelles méthodes pour estimer la durée moyenne d'attente d'un patient pour accéder au Département des Urgences (DU) d'un hôpital. Ainsi nous montrons pourquoi le développement d'un SSM et l'allocation de ses ressources sans fil limitées sont importants pour améliorer la qualité des soins médicaux. La suite de cette thèse présente plusieurs plans pour l'allocation de ressources dans un SSM, en considérant plusieurs facteurs qui ont besoin d'être pris en compte dans le cas d'un scénario réel, ce qui comprend les différentes exigences de la QdS, les interférences électromagnétiques (IEM) sur les équipements médicaux, ainsi que l'information imparfaite des états du canal. Nous proposons trois nouvelles techniques pour améliorer la capacité du réseau en patients dans un SSM, ce qui inclut une partie sur le multiplexage statistique, une partie basée sur la prédiction du canal et une partie basée sur la décision médical à l'appui.La dernière partie de cette thèse se concentre autour de l'évaluation des performances pour un système d'aide à la décision, qui est un résultat important pour évaluer la validité et l'acceptabilité de la décision d'aide basée sur le schéma d'allocation des ressources proposé précédemment.

Background: Hospital care utilization has been described as a key measurable indicator of care quality in patients with terminal respiratory diseases. Knowledge about patterns in service utilization for patients with advanced Chronic Obstructive Pulmonary Disease (COPD), however, is fairly limited. The goal of this study was to investigate health care utilization patterns in the last six months of life among patients who died with COPD compared with those who died of lung cancer, and also to examine variations in health care among individuals living with COPD between sex, age, comorbidity, and temporal trends. Methods: We conducted a retrospective study using administrative health data in the province of Saskatchewan to identify indicators associated with greater hospital care utilization between 1997 and 2006. Those with either COPD or lung cancer as the underlying cause of death (UCOD) were included in this study. Characteristics examined in this study included socio-demographics, comorbidity, location of death, and use of institutional services. Multiple logistic regression was the primary method of analysis. Results: Between 1997 and 2006, 7,114 persons covered by Saskatchewan Health were identified as having COPD (N=2,332) or lung cancer as the UCOD (N=4,782). Approximately 60% were males with an average age of 74.2 years (S.D. =10.1 years). Half of the decedents were rural dwellers (47.0%), and were married or common law (51.6%). The majority had multiple comorbid conditions (60.3%), died in hospitals (73.5%), and had never received services from long-term supportive care institutions (74.3%). Compared with those who died from lung cancer, people dying from COPD were less likely to be admitted to hospitals (OR=0.71, 95%CI: 0.64-0.80 in the last six months of life; OR=0.81, 95%CI: 0.70- 0.93 in the last month of life) and had shorter LOS for each admission (OR=0.78, 95%CI: 0.70-0.87 in the six months of life; OR=0.67, 95%CI: 0.60-0.75 in the last month of life). However, persons with COPD were more likely to be managed in an intensive care settings (5.3% of COPD subjects vs. 1.7% of lung cancer subjects in the last six months of life; 4.3% of COPD subjects vs. 0.06% of lung cancer subjects in the last month of life) and had higher numbers of transfers between long-term care facilities (7.7% of COPD subjects vs. 3.2% of lung cancer subjects). Between 1997 and 2006, there was no significant change in the hospital utilization among patients who died of COPD or those who died of lung cancer. Conclusions: Marked differences in terms of hospital service utilization in the last six months of life were observed between subjects dying with COPD and lung cancer. Our study results support previous work indicating that the nature of care management at the end of life for people who died of advanced COPD is different from those who died from lung cancer, which was reflected by reduced likelihood of hospital service usage, more ICU admissions, and frequent transfers between supportive care facilities. There is no significant change observed regarding the patterns of hospitalization over 10-year study period. We would suggest collecting more information on services managed in other care settings, such as emergency departments, out-patient settings, and clinics, etc. This would allow an in-depth examination regarding what types of institutional services influenced the usage of in-patient care. In addition, education of all health care professionals on the complex needs of patients living with respiratory illnesses is required.

No description available.

This thesis covers the following: the hospital movement in Port Philip, the care of patients, the hospital and the University, the hospital and the community and the hospital at Parkville.

This research focuses on the impact of Information Technology (IT) and the corresponding outcomes during an intense period of change and restructuring of the Singapore General Hospital (SGH), the premier public hospital in Singapore.

Thesis (B.A.(Hons.))--University of Adelaide, Dept. of English, 1994? / Includes bibliographical references (leaves 37-38).