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To identify baseline sound levels, patterns of sound levels, and potential barriers and facilitators to sound level reduction. The study setting was neonatal and pediatric intensive care units in a tertiary care hospital. Participants were staff in both units and parents of currently hospitalized children or infants. One 24-hour sound measurements and one 4-hour sound measurement linked to observed sound events were conducted in each area of the center's neonatal intensive care unit. Two of each measurement type were conducted in the pediatric intensive care unit. Focus groups were conducted with parents and staff. Transcripts were analyzed with descriptive content analysis and themes were compared against results from quantitative measurements. Sound levels exceeded recommended standards at nearly every time point. The most common code was related to talking. Themes from focus groups included the critical care context and sound levels, effects of sound levels, and reducing sound levels--the way forward. Results are consistent with work conducted in other critical care environments. Staff and families realize that high sound levels can be a problem, but feel that the culture and context are not supportive of a quiet care space. High levels of ambient sound suggest that the largest changes in sound levels are likely to come from design and equipment purchase decisions. L10 and Lmax appear to be the best outcomes for measurement of behavioral interventions. [ABSTRACT FROM AUTHOR]

Access to palliative care (PC) is a major need worldwide. Using hospital charts of all patients who died over one year (April 2008–March 2009) in two mid-sized hospitals of a large Canadian city, similar in size and function and operated by the same administrative group, this study examined which patients who could benefit from PC services actually received these services and which ones did not, and compared their care characteristics.A significantly lower proportion (29%) of patients dying in hospital 2 (without a PC unit and reliant on a visiting PC team) was referred to PC services as compared to in hospital 1 (with a PC unit; 68%). This lower referral likelihood was found for all patient groups, even among cancer patients, and remained after controlling for patient mix. Referral was strongly associated with having cancer and younger age.Referral to PC thus seems to depend, at least in part, on the coincidence of being admitted to the right hospital. This finding suggests that establishing PC units or a team of committed PC providers in every hospital could increase referral rates and equity of access to PC services. The relatively lower access for older and non-cancer patients and technology use in hospital PC services require further attention. [ABSTRACT FROM PUBLISHER]

The article reports on the revisions of Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines based on the feedback of users and expert consensus as well as the changing emergency department (ED) environment in the country. It states that CTAS National Working Group will go forward to meet all feedbacks and will continue to plan future revisions of the guidelines as new evidence and practice environment changes demand. However, these changes require more ongoing tracking.

Background: The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction., Method: Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations., Results: We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options., Interpretation: There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability., (© 2022. The Author(s).)

Regionalization, which emphasizes matching patient needs with the capabilities of the hospital in which care is provided, has long been a recommended approach to reducing neonatal morbidity and mortality. Over the past decade, research methods surrounding the measurement and evaluation of such programs have improved, thus strengthening arguments for implementation of these strategies. However, regionalization policies vary widely across regions and between countries, with potential impacts on neonatal outcomes as well as costs of care. It is important to account for geographic and other regional differences when determining the feasibility of regionalization for a specific region, as certain areas and populations may need particular consideration in order for regionalization policies to be successful., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Hospital separation data are used to study suicidal behaviour; however, there is little information about the appropriateness of these data for research and planning activities. The study purpose is to examine how consistently hospital separation E-code data reflect suicidal behaviours. Expert clinicians reviewed medical records of individuals who had a separation for self-poisoning to determine whether the self-poisoning was deliberate. Agreement among clinicians was evaluated and latent class analysis performed to derive a summary estimate of the prevalence of deliberate self-poisoning. This estimate was then compared to the prevalence of deliberate self-poisoning based on the external cause of injury (E-codes). Clinicians estimated the prevalence to be 63% higher than the E-code based prevalence. Much larger discrepancies were apparent among older age groups, those whose care was primarily medical in nature and those with a longer length of hospital stay. In acute care settings, self-poisonings among the elderly may not receive adequate attention and/or documentation. Estimating the prevalence of admissions for suicidal behaviour using hospital separation data is of questionable validity, particularly among older age groups.

The literate and effective dissection of the problems of the modern Academic Health Sciences Centre (AHSC) represents a significant contribution by Lozon and Fox. However, the fundamental issues may be both simpler and more intractable than they describe. The hospitals, medical schools and research institutes that compose the AHSC have individually and collectively drifted away from an ethos of service with the patient at its centre. Systems theory teaches us that "emergent behaviour' wherein the AHSC becomes more than the sum of its parts will only be achieved when there is commitment to a common purpose aided by mutual respect and the generalist perspective necessary for its full expression. As social and health trends underscore and support the need for aggregative and problem focused education and research, it is not clear that AHSCs are reacting in an effective way - increased isolation from community and generalist care leaves highly specialized institutions vulnerable to criticism of both irrelevance and sub-optional care. A re-affirmation of unambiguous commitment to both study (research and educate) as well as serve those who suffer provides the most likely avenue to make the 21st century'the best of times 'for the AHSC.

The authors of this commentary acknowledge that Academic Health Sciences Centres(AHSCs) will need to change, but they assert that the need for change and urgency are even more dramatic than presented by Lozon and Fox. While the AHSCs are likely to survive, their form and fabric are likely to change dramatically in the new order. Any solutions to the problems of the AHSCs have to include the community hospital stakeholders, especially the evolving regional teaching hospitals. This applies not only to patient care but also to the potential teaching and research (clinical trials) contributions of the community/regional players. There must also be more involvement by non-medical faculties in defining the vision, mission and values of the AHSC. Federal funding should be available not only to enhance the research activity of the AHSCs and the regional partners but also to provide the informatic linkages between players. Alternative funding programs for academic physicians along with enhanced productivity measures in areas of patient care, education and research are important in order to level the playing field not only with respect to remuneration but also with respect to other incentives such as recognition and promotion.

The nature and extent of computerization in Canadian hospitals vary widely. Is this a reflection of the management style of CEOs? In a series of eight interviews, Lynne Cohen found that in most cases, the CEO played a key role in shaping the computerization process.

How well hospitals weather today's increasingly stormy environment depends upon the performance of their trustees in handling four essential areas of governance: strategic planning, financing, quality assurance, and community relations.

The need to plan health and especially hospital care delivery systems is becoming more critical in this period of severe financial constraints and even cutbacks of services. This article reports on a survey of hospital planning norms and bed requirements methodologies in Canada conducted in 1977 and 1980. The comparison and assessment of approaches to bed need determination in the Canadian provinces, together with some recommendations, are preceded by a review of basic hospital planning methods and their use in a number of selected countries. The literature review and the analysis conducted reveal that the "formula method" (beds per 1000 population) is the most common approach used to define and to allocate the "optimum" number of beds in the countries reviewed and in Canada. Despite its shortcomings, this method appears to have many advantages (e.g., simplicity, equity, flexibility). In general, provincial authorities use similar factors in the calculation of the number of beds to be provided, the most important ones being the size of the projected geographic population or population served by age groups. The acute care bed guidelines in Canada range from 3.5 per 1000 population in southern Ontario to 5.0 in Saskatchewan and Alberta. Extended care bed guidelines are much more spread between provinces. The analysis underlines the difficulties faced by the planner and the researcher in comparing bed guidelines due to significant definition and content differences between provinces. It finally leads to the observation that hospital planning remains arbitrary and appears to be more designed to ration the supply of services and to contain overall expenditures than to really try to meet the "need" of the population for hospital services.

Boards can exercise strategic leadership, but to do so well, they must change their concept of governance. Most of what is traditionally accepted in the boardroom is not conducive to excellence in strategic leadership and, in fact, actually impedes it. First, trustees must be able to escape the clutter that interferes with a continual emphasis on strategic issues. This calls for a far more incisive way to withdraw responsibility from administrative tissues in favor of control by policy. Second, trustees must understand that strategic leadership is a matter of how the board approaches its job, not a mechanical annual tussle with setting long-range goals. Third, trustees must structure their annual plans around updating their long-range intentions--chiefly concerning mission issues and priorities--and restating them in amended ends policies. Finally, trustees must realize that strategic leadership--hence, good governance--is not so much about budgets, personnel practices, construction projects or medical staff bylaws as it is about public policy, purpose, values and the vision that shapes institutional destiny.