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PURPOSE: Novel organization models ensure early management of treatment-related adverse events (TRAEs) of new anticancer drugs. The aim of this prospective observational study was to evaluate the impact of the introduction of a nurse-led telephone triage (NTT) in reducing hospitalization of patients with cancer (CPs). PATIENTS AND METHODS: CPs on active medical treatment were educated to call the NTT in case of symptoms or TRAEs. Assessment of TRAEs was performed by trained oncology nurses according to the Common Terminology Criteria for Adverse Events grading scales and subsequent actions were taken according to the severity of the events. The primary end point of the study was to compare the rate of hospitalization of CPs on anticancer treatment after the introduction of NTT with that of the 2017-2018 period. RESULTS: From September 2018 to September 2019, a total of 1,075 patients received systemic anticancer treatment (v 936 patients in the same 2017-2018 period). Total consultations at NTT were 429 and 581 TRAEs were reported. Notably, 117 patients reported more than one TRAE. Common Terminology Criteria for Adverse Events were graded as G1 (237, 40.8%), G2 (231, 39.8%), or G3-4 (113, 19.4%). In the observation period, 109 CPs on treatment were hospitalized versus 138 in the 2017-2018 period with a normalized hospitalization rate of 10.1% versus 14.7% (P = .002 chi-square) with a reduction in normalized number of hospitalization of 44 and an estimated cost savings of 345,246 euros. CONCLUSION: The implementation of the NTT system in the clinical practice may help reducing the rates of hospitalization through the emergency room of CPs receiving modern medical treatments. [ABSTRACT FROM AUTHOR]

The authors comment on a study published within the issue which concluded that the quality of recovery only has a marginal supplementary effect on patient satisfaction. Topics covered include the suggestion of the study that satisfaction would be a poor global measure to assess quality of recovery outcomes, and vice-versa, the difference of quality of recovery outcomes from satisfaction outcomes, and recovery scales and approaches to measure either satisfaction or quality of recovery.

Background.Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.Method.Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.Results.Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.Conclusions.The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service. [ABSTRACT FROM AUTHOR]

Avoidable hospitalizations for ambulatory care sensitive conditions (AH-ACSCs) identify health problems that could be avoided by improving primary health care (PHC). On the basis of hospital discharges from Argentine public sector facilities, an expert panel convened to define a list of AH-ACSCs for children and adults. AH-ACSCs represented less than 30% of hospitalizations. Compared with country averages, poorer districts showed large differences in trends for adults but not for children. Despite that AH-ACSCs have demonstrated empirical validity to evaluate health system performance, its implementation to assess PHC in countries like Argentina, with pluralistic and fragmented health care systems, remains a big challenge. [ABSTRACT FROM AUTHOR]

Aims The ADVANCE trial recruited participants from 20 countries worldwide. We analyse here regional variations and causes of hospitalization for people with Type 2 diabetes from Asia, Established Market Economies and Eastern Europe. Methods A cohort analysis examining the effects of region on causes of first hospitalization, and the association of participant characteristics on all-cause first hospitalization across regions, using multivariable (adjusted for clinical, physiological, behavioural and socio-demographic factors) Cox models. Results Of 11 140 individuals (6407 men), all-cause hospitalization rates were highest in Established Market Economies, followed by Eastern Europe then Asia. Eastern Europe had rates of hospitalization for diabetic causes four times greater than Established Market Economies [multivariable-adjusted hazard ratio 4.02 (95% CI 2.86-5.63)]. There were no significant regional variations in hospitalization rates for cardiovascular disease ( P = 0.534), but much lower rates for musculoskeletal and non-specific causes in Eastern Europe [multivariable-adjusted hazard ratio 0.44 (95% CI 0.32-0.60) and 0.19 (95% CI 0.12-0.29)] and Asia [hazard ratio 0.21 (95% CI 0.16-0.29) and 0.09 (95% CI 0.06-0.14)] compared with Established Market Economies. In all regions, participants hospitalized for any cause were more likely to be older, male, hypertensive, smokers, have higher glycated haemoglobin and a history of macrovascular or macrovascular disease. Conclusions Across three markedly different regions of the world, regional rates and causes of hospitalization varied widely in patients with Type 2 diabetes. Adjustment for a range of patient characteristics did not explain these regional differences in hospitalization, which appear to be attributable to health system factors. [ABSTRACT FROM AUTHOR]

Objective: Hospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children. Materials & Methods: In this cross-sectional study, 225 mothers of hospitalized children in the pediatric ward of Besat hospital were randomly selected and studied. Data collection tool was a two-part questionnaire gathered by interviewing the mother. The first part included demographic information of the patients. The second part included questions regarding stressors in four different categories; child-related factors, environmental factors, socioeconomic factors and health professional factors. SPSS 16.5 was used for statistical analysis and data were analyzed by one way ANOVA and T test. Results: In the child-related factor category, fear of child death (84%); in the socioeconomic factor category, fear of disease in the other siblings (84%); in the environmental factor category, unpleasant odors in the ward (56%); and in the health professional category, not enough explanation about inserting IV lines, (54.2%) constituted the most important factors. There was a meaningful correlation between the stressors and the mothers’ age and occupation, child age, days of hospitalization, types of admission and health insurance coverage, but there was no meaningful correlation between stressors and other factors. Conclusion:Professional and in depth training programs should be provided for health care providers and nursing staff regarding dealing with mothers of hospitalized children. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the effect of a Medical Assessment Unit (MAU) on older patients. Methods. Retrospective case-control study of patients 65 years and above admitted to the MAU (study group) and the general medical wards (control group) in Bankstown-Lidcombe Hospital from 1 October 2008 to 31 March 2009 with four most common Diagnosis-Related Groups (DRG) ('falls and gait disorder', 'chronic obstructive pulmonary disease (COPD)', 'other major respiratory diseases and 'cellulitis'). Main outcome measures. Length of stay (LOS) in Emergency Department (ED) and in the hospital, mortality, readmissions within 1 month, and discharge destination. Results. Eighty-nine patients were studied; 47 in the MAU group and 42 in the non-MAU group. The MAU cohort was significantly older (84.1±7.9 years v. 80.4±7.8 years, respectively, P=0.03); and had shorter ED LOS (4.9±3.0h v. 6.5±2.8h, P=0.012). Overall hospital LOS did not differ except for patients with 'cellulitis', (5.7±4.9 days for MAU cohort v. 14.8±6.8 days for non-MAU cohort, P=0.022). There was no significant difference in mortality, readmission rate or discharge destination. Conclusions. The MAU can be an effective service model for older patients. More research is required to confirm this and to define the key elements that are essential for its effectiveness. What is known about the topic? The Medical Assessment Unit is a model of care that has been developed in response to increasing Emergency Department presentations and rising demand on hospital beds. There has been some evidence that this model of care improves efficiency by reducing Emergency Department length of stay and overall hospital length of stay, but little published data targeting the Aged Care population group, who account for a high proportion of Emergency Department admissions. What does this paper add? This paper is a case-control study and provides additional evidence on the benefit of the Medical Assessment Unit model in the elderly population, specifically the benefits in the reduction of Emergency Department length of stay and overall hospital length of stay. This paper also assists in identifying key elements essential for the success of the Medical Assessment Unit model. What are the implications for practitioners? With increasing demand on healthcare, practitioners need to continually redesign how they deliver healthcare to maximise cost efficiency and effectiveness. We believe the Medical Assessment Unit is an effective new model of care. However, more research is required to further refine this model and also identify target patient groups who can most benefit from this model of care.

The article discusses a study on the evaluation and improvement of the effect of a comprehensive unit-based safety program on safety climate in intensive care units. The assessment and implementation of patient safety interventions in intensive care units were conducted in Michigan. The program was designed to enhance the elements of the safety culture of a unit.

Objective: To evaluate the effectiveness of community hospital–based postacute care (PAC) for frail older patients and to provide a baseline profile of functional gain during PAC for use in further long-term outcome studies. Design: Prospective cohort study. Setting: A community hospital in Taiwan. Participants: Elderly patients admitted to a community hospital with acute or postacute conditions. Measurements: Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, and Geriatric Depression Scale. Intervention: A comprehensive geriatric assessment–based functional re-ablement program. Results: Data were collected for 251 patients recruited between July 2006 and June 2008 from Taipei Veterans General Hospital and the acute wards of Yuanshan Veterans Hospital. Overall, clinical improvement was significant in various dimensions, including cognition (Mini-Mental State Examination from 11.9 ± 8.1 to 15.1 ± 8.3, P < .001), physical function (Barthel Index from 42.2 ± 34.1 to 64.9 ± 33.7, P < .001; Lawton-Brody Instrumental Activities of Daily Living from 1.8 ± 2.4 to 3.0 ± 2.8, P < .001), depression (Geriatric Depression Scale from 0.9 ± 1.9 to 0.6 ± 1.3, P < .001), ambulation (timed up-and-go test from 16.4 ± 19.6 to 10.1 ± 19.0, P < .001), and nutrition (Mini Nutritional Assessment from 15.0 ± 4.2 to 17.4 ± 3.7, P < .001). Conclusion: A short-term inpatient physical re-ablement program conducted by an interdisciplinary geriatric team in a community hospital can successfully improve the physical and mental function, mood, ambulation, and nutritional conditions of postacute patients. Further study is needed to evaluate long-term clinical outcomes of patients with different rates of functional recovery during treatment in a PAC unit. [Copyright &y& Elsevier]

Background and objectives: Because of late effects among survivors of cancer in young people, increased hospitalisations would be expected. This study determined the occurrence, frequency and days in hospital (DIH) of hospital admissions among 5-year survivors of childhood and adolescent cancer diagnosed in British Columbia (BC), compared hospitalisation risk with the general population and examined the impact of sociodemographic, health care system and clinical factors. Design: This population-based study frequency matched 1157 survivors of cancer diagnosed before 20years of age from 1970 to 1992 from the BC Cancer Registry with 11,570 randomly selected individuals from BC’s health insurance plan Client Registry. Administrative hospitalisation records from 1998 to 2000 were linked to study cohorts, and regression and trend analyses were carried out. Results: From 1998 to 2000, 240 (21%) of survivors and 614 (5.3%) of the population sample were admitted to hospital at least once [adjusted OR=4.36 (95% CI 3.68–5.16)]. Hospitalised survivors had a higher average number of admissions (2.0 versus 1.5 admissions, respectively) and longer mean DIH (10.9 versus 7.8d, respectively) than hospitalised population controls. Female gender and older age increased the risk of hospitalisation, as did the presence of a relapse or second cancer by 5years post-diagnosis. Conclusion: Our cohort of child and adolescent cancer survivors had higher odds of hospitalisation, more admissions among those hospitalised and longer stay in hospital compared to the population sample. This has implications for health care system resources and appropriate management of late effects of survivors. [Copyright &y& Elsevier]

Many patient satisfaction studies consider patient satisfaction and intention to recommend as the same constructs. However, we propose to investigate the two constructs separately. This study has utilized patient satisfaction data with 32 hospitals in different locations to investigate how hospital discharged patients combine their attribute reactions to arrive at their evaluation of hospital care and their intention to recommend to others. A multiple linear regression analysis with a scatter term was conducted while controlling for age, gender, perceived health, educational attainment and race. The interpretation of the scatter term is presented with a story. There were 31,471 cases for the analysis, and the results show some similarities and critical differences between the two models. In conclusion, hospital managers are well advised to focus on improving nursing care first, and then staff care and environment in order to increase patient evaluation of hospital care and intention to recommend. [ABSTRACT FROM AUTHOR]

The study, first published in 2006, looks at patient safety from the perspective of surgery, looking at surgeons' technical skills, surgical team performance in the operating theatre, the team's views of their performance, interruptions and distractions, and multidisciplinary team training in surgery using simulated training scenarios. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the descriptive and moral evaluation of providing informal medical care to one's own children. The American Medical Association (AMA) permits self-treatment in geographically isolated settings and emergencies until another physician arrives at the scene or has become available. However, according to research, many physicians will self-prescribe, including to their own children.

Assessing patients' views indicates to patients that we are concerned about continuous assessment and improving services in general. It also indicates that we are a conscientious professional within a genuine humanistic line of work. The paper discusses the many theoretical and methodological problems that have arisen from attempts to measure and quantify patient satisfaction. Numerical data are thought to be 'sterile' without any insight into personal meanings. On the other hand purely qualitative methods have not been widely used. This discussion paper ends with the formulation of two simple questions which can help us to explore and negotiate patients' needs and satisfaction. Two non-offensive straightforward questions are proposed as examples which could be used on a regular basis by nurses caring for older patients. [ABSTRACT FROM AUTHOR]

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This study evaluated the performance of a primary health care (PHC) strategy implemented by a public health care network led by Suba Hospital. The study was based on a rapid assessment approach that adapted Starfield's methodology and was validated by Macinko in Brazil. It included surveys for patients, professionals, coordinators and decision-makers. Their perceptions are compared with those of actors in private outpatient settings. This study demonstrated significant perceived gains in comprehensiveness in the public sector and also found that users' perceptions of health are significantly associated with the positive assessment of the institution providing primary health care services and with the public nature of the institution. However, findings also indicated poor performance with regards to family and community orientation and particular elements of other important attributes of CPHC. Strategies must be oriented to address these problems in order to allow Suba Hospital to improve its contribution to population health and equity in health. [ABSTRACT FROM AUTHOR]

In recent years, the number of immigrants treated at hospital pediatric units has increased in accordance with the growing number of immigrants residing in Spain. At the moment, there is little research on the problems that caring for this population could present. The objective of this study is to identify, based on professional opinion, variables that may impact the quality of and satisfaction with pediatric hospital care for immigrants. To achieve these objectives, a phenomenological qualitative methodology was applied. Specifically, the key informer interview procedure was used. The participants in the study were pediatric services workers in hospitals in the autonomous region of Andalusia, Spain. The circumstances most related to difficulties in pediatric hospital care included language barriers followed by social-economic factors or psychological and personality aspects during the hospitalization process. The results obtained help to explain difficulties observed in caring for this population in pediatric hospitals and could support efforts to improve hospital care practices. [TRANSLATION]

The article focuses on the findings of a study concerning the significance of patient satisfaction for ambulatory anesthesia. The study conducts a systematic review to evaluate questionnaires to measure patient satisfaction with ambulatory anesthesia. Researchers scanned 131 articles yielded by the search strategy and 11 articles were included in the study. It mentions that only a few studies have developed questionnaires with rigorous psychometric methods to measure patient satisfaction with anesthesia care. Moreover, it determines that there is still no valid questionnaire for measuring patient satisfaction in ambulatory anesthesia.

Copyright of Revista Eletronica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Se examinan factores que contribuyen a las deficiencias en el servicio a los pacientes psiquiátricos de urgencia del Johns Hopkins Hospital, ubicado en Baltimore, Maryland. Se informa que el proceso por el hospital de pacientes psiquiátricos de urgencia tarda cada vez más. Se nota que los hospitales docentes, como Johns Hopkins, se enfrentan con retos únicos en el cuidado de los pacientes, debido al tiempo y recursos adicionales requeridos para educar a los residentes.

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a 'Shared Vision' of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in 'silos' and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market. [ABSTRACT FROM AUTHOR]

The article proposes a method of measuring patient safety in hospital care. Current methods of measuring patient safety are reviewed. Challenges in measuring patient safety include quantifying rare medical errors, identifying risk factors, and reliance on self-reporting of errors. A proposed framework for measuring patient safety involves tracking incidents of harm to patients, clinician response to patient harm, and the response of the organization to safety concerns. Challenges in implementing the patient safety model are addressed.

The article discusses the annual performance rating system used for Great Britain's National Health Service trusts and whether targets have improved due to its administration. Reported performance shows improvement on key targets though it is suggested that manipulation of data was practiced to achieve some of these targets. Measures to prevent gaming are considered. INSET: Summary points.

Background: While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. Methods: We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. Results: 728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora- Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires. Conclusion: Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous. [ABSTRACT FROM AUTHOR]

Objective: To translate, to test inter-rater and intra-rater reliability and concurrent validity of the Basic Care Needs (BCN) section of the Northwick Park Dependency Score (NPDS). Design: Test–retest reliability and validity testing. Observed data were collected by the staff (nursing staff, occupational therapists). Setting: Three rehabilitation units. Subjects: Forty inpatients between 16 and 65 years of age with brain injury were included. Main measures: Inter-rater and intra-rater reliability was calculated by percentage agreement (PA) and unweighted kappa measure. Concurrent validity was examined by computing Goodman–Kruskal's gamma, a nonparametric statistic for degree of association between the BCN score and the total score of the Functional Independence Measure (FIM). Results: Inter-rater reliability showed a good percentage agreement between nursing staff. Between nursing staff and occupational therapists the percentage agreement was lower especially in one item. Intra-rater reliability showed a good percentage agreement for all assessors. Concordance was good with a gamma -0.83 and an asymptotic error (ase) of 0.04, for nursing staff and for occupational therapists -0.87, ase 0.04. Conclusion: The BCN section of NPDS was found to be inter-rater and intra-rater reliable, to have concurrent validity. Further studies are needed on clinical utility. The instrument can be used for assessment of dependency for individual patients with brain injury, and information when transferring between different caregivers. Further studies need to investigate the sensitivity of the instrument. [ABSTRACT FROM AUTHOR]

In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients’ views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization.Three different data sets were collected among patients being discharged from hospital (n1 = 203,n2 = 279,n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view.The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85–0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB.The ICS has demonstrated promise as a tool for measuring patients’ evaluations of their hospital experience and individuality in care. [ABSTRACT FROM AUTHOR]

Many Greek politicians and media attribute high dissatisfaction with the public health services to the quality of public hospitals. Provoking this view, this study attempts to investigate the patient's opinion and provides some preliminary results for the level of services provided by three public hospitals. A patient satisfaction survey with a self-administered questionnaire of 1295 adult patients show high rates for medical and nursing services and fair rates for hotel services and facilities. The medical–nursing index (which can range from 0 to 100) shows a mean of 86.4 and the rate for the hotel services is 75.9. Statistical analysis shows different satisfaction rates by age and level of education, an outcome that is consistent with other similar satisfaction studies. Differences of patient satisfaction relating to the area of hospital need to be examined carefully by gathering more data from Greek hospitals. Our preliminary results demonstrate that the high dissatisfaction of the public cannot be attributed to the quality of hospital care. [ABSTRACT FROM AUTHOR]

Provides information on a clinical trial which tests the clinical equivalence and resource consequences of day care and conventional inpatient care for active rheumatoid arthritis. Subjects and methodology used in conducting the study; Results of the study; Resource costs of day care. INSET: Key messages.

The article reports on the grade of D+ given to the U.S. emergency care system by the American College of Emergency Physicians (ACEP) in 2014. The ACEP report card outlines the problems contributed to emergency departments by failures in the larger health care system. The report also discusses how increasing demands on emergency departments have pushed them to operate in a near-continuous state of crisis.

The authors discuss the importance of risk stratification tool to identify emergency department (ED) patients with acute heart failure (AHF). They comment on the limitations that should be considered for interpreting the results. They suggest that recalibration of approach towards an implementation of risk-stratification tool is needed for ED patients with AHF.

The article discusses how hospitals can improve patient experience. Topics discussed include patient experience involving the satisfaction of customers toward their inpatient and outpatient stays and emergency department encounters, linking reimbursements to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) scores and the author's description of how the radiology department he is managing achieved the highest employee engagement scores.

The author reports that the Great Britain National Health Service watchdog body, the Healthcare Commission, has found that medical patients at some England hospitals are waiting too long for medical services. Services included routine diagnostics, such as scans and blood tests. The projected target had been a maximum wait of 18 weeks from referral to treatment.

Reports that children and teenagers are unhappy with the lack of communication they receive when they are treated by in the British National Health Service. Report published by the Commission for Health Improvement; Claim by young patients that they have the right to participate in decisions about their treatment; Dislike of the hospital environment.

Reports on improvement of the management of coronary heart disease by the British National Health Service. Lack of improvement in preventing the disease; Evaluation of services by the Commission for Health Improvement and the Audit Commission; Progress related to clinical care of patients.