Underutilization of acute care settings in a tertiary care hospital.

Objective: To estimate underutilization of acute care settings in a tertiary care hospital.

Design: A retrospective and concurrent cohort study using chart reviews and the Intensity of service, Severity of illness, Discharge screen for Acute Care (ISD-AC(R)) tool to measure appropriateness of acute care for patients who were receiving care in a less acute setting, as an indicator of underutilization.

Setting: A 450-bed tertiary care teaching hospital.

An assessment of the introduction of a multi-skilled worker into an acute care setting.

The first reengineering project undertaken by the Sunnybrook Health Science Centre after adopting a philosophy of patient-focused care was the introduction of a new category of worker: the multi-skilled service assistant. This article describes the experiences of the first two cohorts of service assistants and assesses the changes made to the work itself and the integration of the new workers into the work environment. It concludes by sharing recommendations for introducing a new work role.

Economic evaluation of 2 treatments for pediatric femoral shaft fractures.

The purpose of this study was to assess the relative health system costs of early hip spica cast immobilization and external fixation for pediatric femoral shaft fractures. A cost analysis was performed from the viewpoint of the study hospital and physicians using protocols based on current practice. Cost estimates were based on patient and financial information from April 1, 1993, to January 31, 1994, including the fully allocated inpatient and outpatient costs.