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Abstract Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

Abstract Background Physician turnover is a concern in many health care systems globally. A better understanding of physicians’ reasons for leaving their job may inform organisational policies to retain key personnel. The aim of this study was to investigate hospital physicians’ intention to leave their current job, and to investigate if such intentions are associated with how physicians assess their leaders and the organisational context. Methods Data was derived from a survey of 971 physicians working in public hospitals in Norway in 2016. The data was analysed using descriptive statistics and multivariate analysis. Results We found that 21.0% of all hospital physicians expressed an intention to leave their current job for another job. An additional 20.3% of physicians had not made up their mind whether to stay or leave. Physicians’ perceptions of their leaders and the organisational context influence their intention to leave their hospital. Respondents who perceived their leaders as professional-supportive had a significantly lower probability of reporting an intention to leave their job. The analysis suggests that organisational context, such as department mergers, weigh in on physicians’ considerations about leaving their current job. Social climate and commitment are important reasons why physician stay. Conclusions A professional-supportive leadership style may have a positive influence on retention of physicians in public hospitals. Further research should investigate how retention of physicians is associated with performance related to organisational and leadership style.

Injuries account for 9.2% of all deaths and 9.9% of the total disability-adjusted life years in Nepal. To date, there has not been a systematic assessment of the status of first response systems in Nepal. An online survey was cascaded through government, non-governmental organisations and academic networks to identify first response providers across Nepal. Identified organisations were invited to complete a questionnaire to explore the services, personnel, equipment, and resources in these organisations, their first aid training activities and whether the organisation evaluated their first response services and training. Of 28 organisations identified, 17 (61%) completed the questionnaire. The range of services offered varied considerably; 15 (88.2%) provided first aid training, 9 (52.9%) provided treatment at the scene and 5 (29.4%) provided full emergency medical services with assessment, treatment and transport to a health facility. Only 8 (47.1%) of providers had an ambulance, with 6 (35.3%) offering transportation without an ambulance. Of 13 first aid training providers, 7 (53.8%) evaluated skill retention and 6 (46.2%) assessed health outcomes of patients. The length of a training course varied from 1 to 16 days and costs from US$4.0 to 430.0 per participant. There was a variation among training providers in who they train, how they train, and whether they evaluate that training. No standardisation existed for either first aid training or provision of care at the scene of an injury. This survey suggests that coordination and leadership will be required to develop an effective first response system across the country.

Objective: We aim to describe medical services provided by Nordic general practitioners (GPs), and to explore possible differences between the countries. Design and setting: We did a comparative analysis of selected data from the Nordic part of the study Quality and Costs of Primary Care in Europe (QUALICOPC). Subjects: A total of 875 Nordic GPs (198 Norwegian, 80 Icelandic, 97 Swedish, 212 Danish and 288 Finnish) answered identical questionnaires regarding their practices. Main outcome measures: The GPs indicated which equipment they used in practice, which procedures that were carried out, and to what extent they were involved in treatment/follow-up of a selection of diagnoses. Results: The Danish GPs performed minor surgical procedures significantly less frequent than GPs in all other countries, although they inserted IUDs significantly more often than GPs in Iceland, Sweden and Finland. Finnish GPs performed a majority of the medical procedures more frequently than GPs in the other countries. The GPs in Iceland reported involvement in a more narrow selection of conditions than the GPs in the other countries. The Finnish GPs had more advanced technical equipment than GPs in all other Nordic countries. Conclusions: GPs in all Nordic countries are well equipped and offer a wide range of medical services, yet with a substantial variation between countries. There was no clear pattern of GPs in one country doing consistently more procedures, having consistently more equipment and treating a larger diversity of medical conditions than GPs in the other countries. However, structural factors seemed to affect the services offered.

Introduction: Quality in healthcare services has become a subject of study, acquiring a special connotation for both individual and collective health services. Aim: To examine the scientific literature on healthcare service quality indexed in SCOPUS between 1994 and 2015. Materials and Methods: A bibliometric study was conducted using the SCOPUS database along with a structured search equation. A total of 256 academic publications were retrieved and analysed for quantity, quality and structure bibliometric indicators. Results: The interest in the present topic has been increasing exponentially during the past years. The year of 2014 was the most productive period, with 34 research papers published. Likewise, it is worth noting that the existing literature has focused on quality and satisfaction-related issues. Conclusion: Studies conducted between 1994 and 2015 aimed to measure the level of satisfaction among the users of healthcare services using the SERVQUAL model, proving its applicability for quality management in healthcare.

In order to deliver eye care, many resources have to be in place at the right time: your patients, your staff, your facilities, your equipment, and your supplies. In this article, we focus on how you can manage your supplies to ensure that your eye service runs smoothly. These supplies, or consumables, include every little thing needed in the course of your daily work: IOLs, medicines, gloves, forms used for patient care, housekeeping supplies, and equipment spares. If any of these items become unavailable, your eye centre will be unable to provide the same high quality of services, and you may even have to turn patients away.

All health services must be acceptable to attract patients. If patients and their families do not like the services, or the way in which they are offered, they will not use them! Without patients, our eye service will struggle, and we will not meet our VISION2020 goals.

Good practice procedures for purchasing surgical instruments and consumables.

If VISION 2020 is to meet its objective of eliminating avoidable blindness in ten years’ time, eye units have to ensure that they have the equipment they need so they can work quickly and effectively. In this article, we aim to show you how to get the best results when purchasing (procuring) equipment.

This article will focus on the optical products required for the efficient delivery of refractive error and low vision services, and provide insight into how they can be managed effectively to ensure a quality service. You can consult the IAPB Standard List (see page 30) for suggestions regarding the optical products you may require at your facility as well as recommended suppliers.

Everyone working in an ophthalmic operating theatre must be competent in the care, handling, storage, and maintenance of instruments. This will help to improve surgical outcomes, maintain an economic and affordable service for patients, and provide a safe environment for the wellbeing of patients and staff.Including instrument care in theatre courses and in-service training is one way of ensuring staff competence.

Appropriate donated equipment or consumables can help to achieve the goals of VISION 2020. However, according to the World Health Organization (WHO) Guidelines on Healthcare Equipment Donation (2000), an estimated 70% or more of donated medical equipment is not being used.

Meeting the needs of children and their parents in an eye unit, whether at primary, district, or tertiary level, has a significant impact on the eye team’s ability to provide good quality eye care.

Managing a successful eye clinic can be very challenging. We may have many questions.

Advice on how to ensure that your unit benefits the most from donated medicines, medical consumables, and surgical instruments.

The importance of surgical instruments and consumables in the delivery of eye care and covered maintenance, repair, training, purchasing, and donations.

The best systems create little extra work for staff and can be implemented almost without thinking in the course of a busy day. The system used in the stock room of our eye clinic in Ivory Coast illustrates this well.

High-volume eye surgery requires that patients be moved quickly in and out of the operating room (OR). Static operating tables in the OR make this difficult. Better patient flow can be achieved when using mobile tables, which can be expensive. We have developed an economical, wheeled operating table that can be constructed in a local engineering workshop.