Inpatient Settings
Peer review-paper production (autonomy, beneficence, justice)
Take-home messages from media:
Media can manipulate all of us – we believe something just because it’s been written up by something
Look at who wrote it – what kind of credentials do they have?
Think about martketplace model – are they being paid to write this way and persuade you this way?
Where is it being published?
New England Journal of Medicine – rigorous review before things are published in this journal so many people have looked at this and they don’t all think the same but they think this is a good piece of literature
Read in a variety of sources (read widely) – if you are seeing the same idea repeatedly, then there is some truth there
Health care reform – there will be a bill by the end of this week (October 27th) that will involve some public option – follow the media!
This public option will have a choice where each state can “opt out”
Governor Perry (TX) – wanted this “opting out” to be an option, so it will be interesting to see what TX decides to do since this is an option now
First amendment gives us the freedom of speech and freedom of press – but it gives consumers the responsibility to research and find the truth in press
Questions on inpatient and outpatient covered last week – objectives?
Advances in Hospital/Inpatient Services
Advances in medical science/education (anesthesia, surgery, sterilization, sulfa drugs, long-term care, SNU (skilled nursing units), outpatient care; no longer apprenticeship – Flexnor Report (report that came out in 1920s that was commissioned by Cornegy Foundation and there was concern that Drs were practicing based on on-the-job training – concerned because there is a lot you don’t learn, variability, no curriculum. This foundation said they needed a structured curriculum that allowed physicians to meet different criteria)
Development of specialized technology (x-rays, blood types, EKG/EEG, minimally invasive surgery, info systems)
Growth of health insurance
Development of nursing (professional from technical, place for care, organizations to advocate for Profession)
BUT
Nurses used to be trained in the hospital
Graduated after a 3-year program that was hospital-based
Now, over 60% of care provided in outpatient areas – largest outpatient area = doctor’s office; others are clinics, hospice, long-term care facilities, and free-standing clinics
Largest outpatient area is doctor’s offices
Mary Wakefield, nurse, just appointed to head HRSA (many underserved clinics and training of health care providers)
Nurse as boss of this federal program (HRSA)
Reform will involve, without a doubt, community based clinics and right now there are a limited number of community based clinics
Money will be poured into these HRSA
Advances in technology – significant factor in where we are today in health care and where we will be in the future (computerized charting, health care records, access to information, etc)
Discussion Items:
Historically, what was the focus of inpatient facilities in the 1700’s and 1800’s – who was involved in these facilities and why?
What is “inpatient” and which entities in our health care system manage most hospitals in inpatient areas?
What type of hospitals exist and how do they differ? How are hospitals organized to provide services? Who assesses them to meet consumer needs for safe care?
What is the “Patient’s Bill of Rights” and how does it meet ethical principles discussed in class?
Informed consent, beneficence, justice, autonomy
How do horizontal and vertical integration work in defining the re-engineering of health care? How do these concepts address marketplace and social justice concepts?
How do the following assessment measures for health care agencies work:
Licensure – think state, regulated by the state. Every health care facility that practices in the state of TX has to be licensed.
Basic safety stuff: staffing ratios, access to A/C, fire alarms, access to nutritious foods.