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Transitions of care pose a risk to medication safety. To reduce patient harm, medication reconciliation is advised. However, implementation of medication reconciliation is difficult due to time constraints. We present two female patients aged 82 and 84 years. In both women, unintentional discrepancies arose, went undetected and led to patient harm. Accurate information transfer is essential for continuity of patient care. Medication reconciliation comprises four steps, i.e. verification (identify discrepancies), clarification (check the collected list), reconciliation (document the reason for medication changes) and transfer (communicate the updated list). This article discusses the steps of medication reconciliation and those medication errors that arise during a patient's transfer from the home setting to hospitalization or a clinic visit. We show that medication reconciliation is not merely an administrative task. As the patient is the only constant factor in health care, patient participation is essential.

Forensic psychiatric patients can be treated in different security levels. Clear criteria to estimate the required security level or transfer to a less secure setting are not yet available. A literature review shows that, of the few instruments that are used internationally, the DUNDRUM and the HoNOS-Secure are the most promising.br/AIM: To investigate whether these instruments can be used in Flemish forensic psychiatric settings.br/METHOD: DUNDRUM-1 scores were collected for 150 internees. The psychometric qualities of the scale were examined. In a subpopulation, the DUNDRUM-1 was compared with the HoNOS-Secure.br/RESULTS: The psychometric properties of the DUNDRUM-1 were good and exceeded those of the HoNOS-Secure.br/CONCLUSION: The DUNDRUM-1 is an instrument that can help clinicians and judges to better - and in a more transparent way - substantiate their decision-making to secure care. However, further research regarding the practical applicability is needed.

Analysis of national implementation of the foetal fibronectin test in the diagnostics of threatened preterm labour in the Netherlands, and indication of the possible obstacles and consequences of implementation or no implementation.National questionnaire, retrospective cohort study and cost-effectiveness calculation.We approached all hospitals in the Netherlands (n = 86) with a questionnaire on use of the fibronectin test. We also collected data on women who were referred to the Academic Medical Center (AMC), a tertiary care centre in Amsterdam, with symptoms of threatened preterm labour. We investigated whether the referred patients gave birth within 7 days, and whether unnecessary transfer to a centre with a neonatal intensive care unit (NICU) could have been avoided by implementation of the fibronectin test in the referring hospital.The fibronectin test was used in 34% of the hospitals and an additional 17% were in the process of implementation. The most important reasons not to use the fibronectin test were of a financial nature (50%). The cohort study included 96 women who were referred from secondary care. In our cohort, 36% of all transfers could have been avoided by implementation of the fibronectin test in secondary care.The fibronectin test can greatly reduce overtreatment and unnecessary transfer in threatened preterm labour, but implementation remains limited. Costs of the test are an obstacle for the referring hospitals, while implementation prevents unnecessary transport, admission and treatment of pregnant women, giving a potential saving of at least EUR 1,027,930 per year. Inclusion in the Netherlands Society for Obstetrics and Gynaecology (Nederlandse Vereniging voor Obstetrie en Gynaecologie, NVOG) guidelines would be a first step towards wider implementation. Slow implementation exemplifies a more widespread problem: the current reimbursement system does not stimulate such cost-saving innovations.

Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.

On 8 September 2015, flooding of the lower floors of the VU University Medical Center in Amsterdam caused serious damage to many vital technical services, such as water and power supplies. The decision was made to completely evacuate the university hospital. This paper describes the chronology and events of that day and shares a number of important lessons that were learned, in order to help readers to optimise crisis organisation in their own institutions. A serious situation or disaster can never be standardised in protocols or manuals; flexibility, improvisation and confidence in one another's expertise and commitment are therefore essential.

When elderly patients are transferred from a residential to an acute care setting, important information regarding their health care can be lost. Over the past years, the concept of advance care planning has also been given a more prominent place in the care for the elderly. However it remains a challenge to communicate the results achieved by this process when patients are referred to another health care setting. Developing a sound method for transferring information is a key element in the transitional care for the elderly patient.In collaboration with the residential and acute care settings in Leuven, Flemish Brabant, Belgium this study aimed to develop a validated, standardized transfer-sheet.After a literature search a topic list was generated to be used as the basis for a Delphi-procedure in which 16 experts from both the acute and the residential care settings participated. The transfer-sheet was then evaluated for content validity by an expert-panel (n = 9) from the acute and residential care settings. Face validity was assessed by two nurses and two doctors, randomly selected from the above settings.All 44 subthemes in the transfer-sheet showed excellent content validity. The scale content validity universal agreement (S CVIUA) for the entire transfer-sheet was 0.68. The average scale content validity (S CVIAve) was 0.96. After a second and final Delphi-round a final transfer-sheet was constructed consisting of 8 themes and 50 sub-themes.Based on these results standardized transfer-sheet was developed and validated.

To study whether there are differences between day and night in the dispatch of helicopter emergency medical services (HEMS) and in their response and travelling times, medical treatment and transport of patients.Retrospective, descriptive study.All data on helicopter emergency medical service (HEMS) missions available 24/7 from Nijmegen, the Netherlands, during 2007 and 2008 were collected. All missions in this period were divided into daytime and night-time missions. Next, the reason for dispatch, the duration of distinct times during the mission, the method of transport of the HEMS team, medical treatments and patient transport were compared.In 2007 and 2008 the HEMS team was dispatched 2891 times. 1107 patients were treated during daytime and 479 during the night. The mean distance to the incident scene was longer for night missions. During night-time the HEMS team was dispatched more often for road traffic accidents and violence-related accidents but less often for falls, drowning, horse riding accidents and people becoming trapped (non-traffic-related). There were no differences in medical treatment given by the HEMS physician between day and night, but fewer patients were transported by helicopter at night. Travelling times and on-scene times were only slightly different.The number of dispatches of the HEMS team at night was higher than expected, but night missions were cancelled more often due to weather conditions than missions by day. Prehospital times and operations of the Netherlands HEMS differed slightly between day and night.

To compare the actual situation in tertiary perinatal care in the Netherlands with the objectives laid down in the 2001 decree on perinatal care by the Dutch Ministry of Health, Welfare and Sport.Descriptive, retrospective.Data on tertiary perinatal care, the transfer or refusal of women with very endangered pregnancies and the personnel of obstetric high care (OHC) units in 2006 were compared with the targets laid down in the planning decree on perinatal care and in a report by the Dutch Health Council from 2000. Parameters of tertiary perinatal care output were the number of admissions, and the number of beds in OHC units and neonatal intensive care units (NICU).In 2006, 128 of the 250 beds intended for OHC had been obtained. The degree of capacity utilisation was 94%, while the norm is 80%. 312 women were transferred due to lack of capacity of OHC units and NICU. The number of staff, specialised physicians as well as nurses, was considerably lower than the planned capacity. But training for obstetric perinatologists and OHC nurses was given.The targets for the number of beds for tertiary obstetric care and associated medical personnel have not been achieved as yet. As a consequence, the number of transfers is still too high. The funding of OHC units is not attuned to the complexity of tertiary perinatal care. Closer supervision of the execution of the planning decree and an adequate financing system are needed to achieve the objectives of the planning decree in the next 3 years.

To determine how the discharge of older patients proceeds and what factors affect it.Descriptive.Data were collected on the 123 patients admitted to the Department of Geriatric Medicine of the Erasmus Medical Centre in Rotterdam, the Netherlands: retrospectively, from the patient files, for the admissions in the period from 1 July 2001 to 31 March 2002, and prospectively for the admissions between 1 April and 30 June 2002. Key figures in the discharge process were also interviewed during the period from 1 September to 21 November 2002.The average age was 83.5 years (SD: 7); 34% were males. The average duration of treatment was 13 days while the average length of admission was 22 days. There was an average of 10 days between the request from the Geriatrics Department to discharge from the hospital, via a care office for an additional-care facility, an Aftercare Office and a Regional Indicating Office (RIO). Patient characteristics that were associated with a longer duration of admission and a longer discharge procedure were: discharge to a somatic nursing home, a diagnosis of 'delirium' or 'dementia', and living independently at home before admission. Patients who were known to the Geriatrics Department (either via the outpatient clinic or via a previous admission) had a shorter duration of admission. Of all the indication decisions of the RIO, only one deviated from the recommendation of the Geriatrics Department.The average duration of admission was 9 days longer than the average duration of treatment. The discharge procedure could be accelerated by simplifying the bureaucratic process surrounding indication and referral to an additional-care facility and by accepting the recommendations of the Geriatrics Department.

Elderly patients admitted to a hospital ward often need additional care after discharge. Waiting for this additional care often leads to blocked beds. The administrative procedures for transferring patients to additional-care facilities require about 10 days. The main reason for this delay is the time needed by the regional indicating office (RIO) to do their assessment and to give approval. There are various possible ways to make the discharge procedure more efficient. Should the available capacity within the facilities be the only delaying factor, then this would constitute a task for the regional care office.

To describe the results of a structured kidney-transplantation programme available to dialysis patients in Curaçao (Dutch Caribbean), involving transplantation in the Netherlands and follow-up in Curaçao.Descriptive.In 1998, a joint venture was begun with the Academic Medical Center (AMC) in Amsterdam, the Eurotransplant Foundation, the Dutch Transplantation Working Party and the Diagnostic Division of the Sanquin Foundation in Amsterdam, the Netherlands. Its aim was to achieve a structural kidney transplantation programme for patients in the Dutch Caribbean in general and patients in Curaçao in particular. An airlift programme between Curaçao and the AMC was instituted.Between 1998-2001 19 patients underwent a kidney transplant, three of which failed. In most of the transplants the cold ischaemia time was less than 48 hours; the average cold ischaemia time was 32 hours. All patients returned to the Antilles within 3 months where their treatment was continued. Post-transplantation follow-up was on average 13.9 months (limits 3-36); three patients died.

Admission and discharge criteria for intensive care departments have been drawn up in order to optimise the use of scarce and costly intensive care facilities. Every patient who could benefit from admission must be assessed by the intensive care specialist beforehand. Admission is indicated for patients with disrupted vital functions in whom recovery of dysfunctioning or failing organ systems is expected, patients who will act as organ donors and patients who undergo diagnostic investigations associated with a high risk of vital complications. Frequent assessment (several times per day) of the 'indication to stay' is indicated in the case of many patients in order to maximise the admission capacity. Discharge from the intensive care department is indicated if the vital functions are stable without life support and no longer require monitoring or treatment, if nursing the patient in the ward is possible, if continuation of the medical treatment is no longer worthwhile, if the patient no longer consents to the treatment and if the benefit of a treatment no longer outweights its negative effects.

Description of the results of primary percutaneous transluminal coronary angioplasty (PTCA) in the management of acute myocardial infarction.Prospective, descriptive.Data were collected on case record forms of consecutive patients with an acute myocardial infarction who in 1990-1997 were referred for primary PTCA directly to Hospital De Weezenlanden, Zwolle, the Netherlands, or indirectly from another hospital.Patients to be considered numbered 1296, 1004 males and 292 females, with a mean age of 60 years. The number of patients increased markedly in the course of the study period. Patients referred by another hospital more often had anterior wall myocardial infarction (73% as against 42%) or cardiogenic shock (10% as against 7%). A total of 1187 (92%) patients underwent primary PTCA, 46 (4%) an emergency bypass operation and 63 (5%) only pharmacotherapy. Transportation from a referring hospital lasted a median of 70 minutes, but for patients in De Weezenlanden it took 15 minutes more to arrive in the hospital, and 30 minutes more between admission and PTCA. The mortality within 30 days was low in both groups (referred from another hospital: 7%; transported immediately to De Weezenlanden: 5%); the same was true of the risk of a recurrent infarction within 30 days (2% and 1%). Cardiogenic shock was associated with higher mortality (32% and 38%).Primary PTCA as therapy for acute myocardial infarction can be applied in routine clinical practice.

Due to a strong increase of the ageing population in the Netherlands there is a growing need for care for psychogeriatric patients. The shortage of beds in psychogeriatric nursing homes has led to the development of substitute care in residential homes for the elderly and in community centers. If substitution is realized in these substitute care projects in the sense that alternative services are delivered for patients who would otherwise have been admitted to nursing homes, the level of impairment and disruptive behaviour should be of the same level in nursing homes and substitute care projects. Groups of patients of three nursing homes, three day-treatment facilities, eight day-care-projects in residential homes for the elderly and seven centers for day-care in the community were compared. Sociodemographic characteristics, behaviour and care-patterns of all 670 patients who were in care on the first of October of 1992 in these services were investigated. An assessment-scale for elderly patients, based on the Stockton Geriatric Rating Scale, was used to investigate behaviour. Substitute care appears to be possible for a limited and specific group of patients. Substitution for the severely disturbed patients (over 40% of the nursing home patients) does not seem to be possible. Due to the development of substitute care for psychogeriatric patients in residential homes for the elderly and centers for day-care in the community, services seem to develop towards more specific and specialized care. We recommend the foundation of a psychogeriatric case register, which allows the study of the transfer of patients across facilities.(ABSTRACT TRUNCATED AT 250 WORDS)

To establish how many hospitalisations of nursing home patients are realised annually, the characteristics of these patients and the diagnoses and the purposes for which they are hospitalised.Retrospective and prospective.Analysis of national data for the 5-year period 1986-1990 obtained from the registration of nursing home patients (SIVIS) of the Dutch Centre of Health Care information (SIG) and analysis of 385 separately gathered registration data from 30 nursing homes.More than 9000 hospitalisations of nursing home patients were realised annually, over 10% of those who stay in a nursing home for a shorter or longer time. Somatic patients were hospitalised nearly twice as often as psychogeriatric patients, and men about 1.25 times more often than women. The probability of hospitalisation decreased with advancing age. The most frequent reasons for hospitalisation were cardiovascular diseases, digestive tract diseases and femoral neck fractures. The most important purposes of hospitalisation are: to ward off threat to life (31%), to remedy complaints and burdens (29%), to improve the general condition (16%) and diagnostics (16%). The probability of hospitalisation was 2.5 times as large for the elderly living at home as for older nursing home patients.Hospitalisations are an important part of medical treatment and care of nursing home patients. There is a variation in hospitalisation rates for different categories of patients. Objectives of hospitalisation are diverse. There is a need for research into the effects of hospitalisation on the quality of life.

To determine survival rates of patients treated for more than 30 days in an intensive care unit (ICU).Retrospective, descriptive.Intensive care unit of the St. Antonius Hospital in Nieuwegein, the Netherlands.All patients who required more than 30 consecutive days ICU treatment between January 1985 and January 1992 were included. With the aid of a computerised data base the medical records of all patients were analysed. If discharged, their family doctor was contacted for information about survival and quality of life. Kaplan-Meier survival curves were calculated.Among a total of 18,126 ICU admissions, 223 patients required more than 30 days ICU treatment; 25% died in the ICU; 14% died after discharge from the ICU, but still in the hospital; 31% of the patients were discharged to another hospital or nursing home. Of all patients 50% eventually reached home. Two months after ICU discharge 75% were alive, after 1 year 50%. Mean survival time was 36 months (SD: 3). Patients under 60 years of age and those who were discharged directly home had the best prognosis. 30% of the protracted IC patients could ultimately function independently at home.Patients who needed more than 30 days ICU treatment had a high ICU mortality; 2 months after discharge 75% were alive.

To assess the magnitude of hospital bed misoccupation by elderly patients admitted because of a hip fracture.Prospective clinical study.Department of surgery-traumatology of Leiden University Hospital, the Netherlands.All patients with a hip fracture admitted from January 1991 to April 1993 were registered for age, ability level, pre-existent disease, housing situation, social environment, morbidity, mortality and duration of hospital stay. The misexploitation of hospital beds was calculated based on an optimal hospital stay of 9 days. When complications occurred, necessitating longer medical treatment, this optimum was adjusted in each individual case.The mean hospital stay in 123 patients who had to be transferred to a nursing home when they had previously lived in their own homes or in an old people's home was 23.8 days, and 11.6 days above the optimum; for patients who could return to their previous housing situation these figures were 13.5 and 4.2 respectively (por = 0.05). Age, ability level, pre-existent disease and less importantly the social environment influenced the possibilities for a patient to return to his/her own home. Use of a clinimetric scale, which objectively assessed the probability of resocialisation, decreased the mean hospital stay from 28-30 days to less than 17.To minimize the duration of unnecessary hospital stay, use of a clinimetric scale on admission to assess the probability of rapid resocialisation can be useful.

Toxic epidermal necrolysis (TEN; Lyell's disease) was diagnosed in three patients: an 8-year-old boy and two women aged 39 and 25. Treatment consisted of daily sterile wound care using a synthetic wound covering, oral as well as tube feeding and administration of fluid, electrolytes and albumin. Sepsis developed in 2 patients, and was treated with specific antibiotics. Irreversible sight loss developed in 1 patient. A burns centre offers optimal conditions for treatment because of the combined availability of both nursing and medical expertise and of the required infrastructure needed for antisepsis, climate control and intensive care.

Change in medication use was studied in patients admitted to a short-stay geriatric ward of a psychiatric hospital. One hundred ten patients were followed up until discharge from the short-stay ward, or, after transfer, until discharge from the medium-stay ward to home or to a nursing-home. Mean drug use on admission was 2.6 drugs; at discharge mean use was 2.1 drugs. Drugs most prescribed at admission were neuroleptics (41%) and benzodiazepines (39%). At discharge 15% used neuroleptics and 22% benzodiazepines. A reduction in use of cardiovascular drugs, and especially of digoxin, was found. Prescription of laxatives and vitamins, especially folic acid and vitamin B12, increased. In comparison with studies on two other geriatric wards in general hospitals in The Netherlands the most marked difference was a reduction of 17% in this study of the number of patients using benzodiazepines on discharge in contrast to an increase of 18 and 3% in the two other studies. The number of patients using neuroleptics on discharge decreased in the present study with 26%; in the two other studies respectively a decrease of 7% and a constant prescription level was found.

We studied the quality of ambulance transport of critically ill and wounded patients between rural hospitals and a referral centre (so-called secondary transport). The study group comprised all patients transported in the course of one year from a rural hospital in the southwestern part of the Netherlands to a centre hospital in Rotterdam (n = 59). Their records were reviewed retrospectively. A distinction was made between patients whose vital functions were acutely threatened before transport and patients in whom this was not the case. Results show that 24% of all patients were transferred inadequately. The inadequately transferred patients all belonged to the group in whom vital functions were acutely threatened. Frequently occurring shortcomings concerned oxygenation and intravenous lines. It is concluded that medical assistance by a specialist is indicated with all secondary transports, because it is difficult to predict if vital functions will be threatened during transport. Further research may be directed at the question which mode of transportation (ambulance or helicopter) is suited for long-distance interhospital transport.