Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients

OBJECTIVE: Relationships among different dimensions of patient satisfaction and selected demographic, clinical, and outcome variables were explored in a sample of severely ill people receiving inpatient psychiatric services. METHOD: The sample consisted of 81 patients admitted to and discharged from an inpatient psychiatric unit at a midwestern Veterans Affairs medical center. Stepwise multiple regression was used to examine the relationship between patient satisfaction and self-reported changes in quality of life, symptomatology, and level of functioning as measured by the Treatment Outcome Profile. Other variables such as diagnosis, length of stay, employment, living situation, and prior psychiatric and substance abuse treatment were also considered. A subsample of the most satisfied and dissatisfied patients was chosen to further explore variables contributing to satisfaction with services. RESULTS: Patient satisfaction was related to initial level of functioning, certain diagnoses, and treatment gains. Clinicians were highly accurate in identifying patients who were satisfied, based on blind chart reviews. CONCLUSIONS: This study underscores the significant relationships between patient satisfaction, psychiatric diagnosis, and other outcome measures, and argues for the validity and utility of patient satisfaction measures in assessing the efficacy of inpatient care.     

Respiratory effects of extradural analgesia after lower abdominal surgery

Blood-gas tensions, FRC and volume of trapped gas (VTG) in the lung were measured in patients on the day before lower abdominal gynaecological surgery, and twice on the day following surgery, before and after establishing lumbar extradural block (EDB) using 0.5% bupivacaine to provide analgesia after operation. FRC and VTG were measured with the closed-circuit helium-dilution technique. Mean VTG was 175 ml before operation and 275 ml after operation. PaO2 decreased significantly after operation, and the changes in FRC and VTG that occurred were related qualitatively. EDB did not significantly alter FRC, VTG or PaO2. Individual changes in FRC could not be related to changes in VTG or PaO2. Although EDB provided effective analgesia, the variables measured did not indicate that EDB conferred an immediate respiratory advantage.     

Sudden incapacitation: USAF experience, 1970-80

During the period 1970-80, there were reported 146 cases of in-flight sudden incapacitation in the USAF. Of these, 62 involved pilots, 14 were navigators, and 70 were student pilots. The etiologies of sudden incapacitation included illness without loss of consciousness, loss of consciousness, spatial disorientation, and improper M-1 maneuver. Each of these categories is analyzed with emphasis upon prevention, for example, not flying with symptomatic preexisting disease, continued emphasis upon spatial disorientation training, and correct performance of the M-1 maneuver. Based upon the data, conclusions and recommendations are suggested to minimize the risk of episodes of in-flight sudden incapacitation.     

Using an improvement model to reduce adverse drug events in VA facilities

BACKGROUND: Adverse drug events cause significant morbidity and mortality in health care. Many adverse drug events are due to medication errors and are preventable. In 1999 and 2000 the Patient Safety Center of Inquiry collaborated with the Institute for Healthcare Improvement (IHI) to implement a quality improvement (QI) project designed to reduce medication errors within the Veterans Administration system. METHODS: During a 6- to 9-month period, interdisciplinary teams that want to achieve much higher levels of performance work on a common aim, under the guidance of faculty, and come together for three 2-day educational and planning sessions. Between these sessions, teams implement some of the suggested changes, measure the results of those changes, and report back to the larger group. RESULTS: During the formal project, teams collected allergy information on more than 20,000 veterans and averted 1,833 medication errors that had the potential to cause adverse events. At 6-month follow-up, the majority of teams remained intact, continued to collect data, and maintained their gains, approximately doubling the results obtained during the formal project. Half of the teams expanded their efforts to other settings, and one-third of the teams expanded beyond their original topics. Returns on investment in the QI effort were substantial. CONCLUSIONS: The results suggest that gains made in organized QI efforts can be maintained for 6 months without additional external support or coaching if team structure and leadership support remain intact. Facilitators of QI efforts should focus on teams that are having difficulty learning new techniques. Finally, this effort appeared to generate cost savings.     

Spatially partially incoherent and broad spectrum holographic stereo vision

We suggest a technique that allows reconstruction of three-dimensional objects with spatially incoherent broad-spectrum illuminating light sources. The reconstruction is obtained by the realization of a holographically recorded parallax-based stereo vision. Experimental results demonstrate the suggested technique.