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Infection control link nurses (ICLN) act as a link between colleagues in their own clinical area and the infection prevention and control team. They help to raise awareness for infection control by educating colleagues and motivating them to improve practice. To fulfil this role, link nurses are trained by infection control practitioners. Programs to train and support ICLN vary in the way they are organized and implemented. In this thesis, the elements that influence the successful engagement of ICLN in acute care hospitals were systematically explored and described. The aim was to explain how current programs could be improved to support ICLN, to evaluate the effectiveness of ICLN programs in improving compliance with infection prevention and control guidelines and, finally, to provide strategies for further implementation of these programs. The first part of this thesis, chapter 2, 3 and 4, focused on the characteristics and success factors of link nurses and link nurse programs in acute care hospitals. In chapter 5 and 6, the second part of this thesis, the results of the ICLN program in a university hospital were evaluated. The third part of this thesis, chapter 7 and 8, provided a synthesis of the results and a general discussion on infection control link nurses and the programs that support these nurses. The findings from this thesis support the investment in link nurses and the accompanying programs: ICLN raise awareness of infection prevention and have the potential to improve clinical practice in acute care hospitals. ICLN programs are yet not aligned, they vary widely in content and organization. Elements that facilitated the support of ICLN included a clear role profile, commitment from the infection prevention and control team, support from hospital and ward management, education on infection prevention topics in combination with implementation skills and contact with other ICLN. At the ward level action plans helped to structure ICLNs’ activities. Two main implementation strategies were found to support implementation: the development of stakeholder interrelationships to support cultural change and the use evaluative and iterative strategies to address the areas of system change and monitoring and feedback. In view of these findings, future research should include studies to provide robust evidence on the effectiveness of ICLN programs, the application of participatory action research and human-centered design techniques to learn from implementation of these findings in real world settings, the investigation of how ICLN programs can transform into networks using social network theory and to study the influence of individual characteristics of nurses on the adoption of their link nurse role.

This study investigates patients’ access to surgical care for burns in a low- and middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50% reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within 3 weeks for 74% in this group. Of contracture patients, 74% had sought healthcare after the acute burn injury. Of the same group, only 4% had been treated with skin grafts beforehand, and 70% never received surgical care or a referral. Together, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively affecting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socioeconomic factors that determine patient mortality and disability.

Aim: To describe the extent of perceived collaboration between family caregivers of older persons and hospital nurses.Background: Collaboration between hospital nurses and family caregivers is of increasing importance in older patient’s care. Research lacks a specific focus on family caregiver’s collaboration with nurses.Method: Using a cross-sectional design, 302 caregivers of older patients (≥ 70 years) completed the 20-item Family Collaboration Scale with the subscales: trust in nursing care, accessible nurse, and influence on decisions. Date were analyzed with descriptive statistics and bivariate correlations.Results: Family caregivers rated their level of trust in nurses and nurses’ accessibility higher than the level of their influence on decisions. Family caregivers who had more contact with nurses perceived higher levels of influence on decisions (p ≤ .001) and overall collaboration (p ≤ .001).Conclusion: Family caregivers’ collaboration with nurses can be improved, especially in recognizing and exploiting family caregivers as partner in the care for older hospitalized persons and regarding their level of influence on decisions.Implications for Nursing ManagementInsight into family caregivers’ collaboration with nurses will help nurse managers to jointly develop policy with nurses on how to organize more family caregiver’ involvement in the standard care for older persons.

Presentation Research Group Facility Management

Presentation Research Group Facility Management

Stuuroverleg

Objective: Malnutrition screening instruments used in hospitals mainly include criteria to identify characteristics of malnutrition. However, to tackle malnutrition in an early stage, identifying risk factors for malnutrition in addition to characteristics may be valuable.The aim of this study was to determine the predictive validity of the Patient-Generated Subjective Global Assessment (PG-SGA SF), which addresses malnutrition characteristics and risk factors, and the Short Nutritional Assessment Questionnaire (SNAQ), which addresses mainly malnutrition characteristics, for length stay (LOS) in a mixed hospital population.Methods: Patients (N = 443) were screened with the PG-SGA SF and SNAQ in the first 72 h after admission the lung, cardiology, or surgery ward. The McNemar-Bowker test was used to investigate the symmetry between the SNAQ and PG-SGA SF categorization for low, medium, and high risk. The predictive value of the PG-SGA SF and SNAQ was assessed by gamma-regression before and after adjusting for several confounders.Results: Of the 443 patients included, 23% and 58% were categorized as being at medium/high risk for malnutrition according to the SNAQ and PG-SGA SF, respectively. The regression analysis indicated that LOS high-risk patients according to PG-SGA SF was 36% longer than that of low-risk patients (P = 0.001). LOS patients at high risk according to the SNAQ did not significantly differ from that of SNAQ low-risk patients.Conclusions: The PG-SGA SF, as a proactive malnutrition screening instrument, predicts LOS in various hospital wards, whereas the SNAQ, as a reactive instrument, does not. Therefore, we recommend the PG-SGA for proactive screening for malnutrition risk. (C) 2021 The Authors. Published by Elsevier Inc.

Door technologische ontwikkelingen worden steeds meer gegevens (data) in IT-systemen vastgelegd. In de zorg is het daarbij van essentieel (levens)belang dat informatie over patiënten snel beschikbaar is en gezondheids-informatietechnologie (Health Information Technology (HIT)) is daarbij van cruciaal belang voor zorginstellingen om de klinische kwaliteit te verbeteren, de efficiëntie van de dienstverlening te verbeteren, de toegang te vergroten en de kosten te verlagen. Omdat nog onvoldoende bekend is hoe gedragsaanpassing bij IT-(EPD)systeemgebruik door de zorgprofessionals de prestaties van individuen en organisaties beïnvloedt terwijl het belang van een EPD voor zorgprofessionals en (zorg)organisaties wel toeneemt, had dit onderzoek tot doel om kennis en inzichten te verkrijgen in de verschillende aspecten van gedragsaanpassingen in de praktijk. Om de daaruit voortvloeiende centrale onderzoeksvraag ‘Wat stimuleert professionals in ziekenhuizen om het IT-(EPD)systeem aan te passen aan hun gebruikersbehoeften en wat zijn de effecten daarvan in de praktijk?’ te kunnen beantwoorden, werden (deel)onderzoeksvragen geformuleerd en tijdens dit onderzoek beantwoord, werden aan de hand van literatuuronderzoek hypothesen geformuleerd, werd een onderzoeksmodel ontwikkeld, werd het (reflectief) meetmodel gebruikt om de betrouwbaarheid en validiteit van de constructies te waarborgen en werd het structureel model gebruikt om de hypothesen te toetsen met PLS-SEM (in SmartPLS). De centrale onderzoeksvraag van dit onderzoek luidt: ‘Wat stimuleert professionals in ziekenhuizen om het IT-(EPD)systeem aan te passen aan hun gebruikersbehoeften en wat zijn de effecten daarvan in de praktijk?’ De belangrijkste bevindingen die bij dit onderzoek naar voren kwamen, waren: Persoonlijke innovativiteit, computerzelfeffectiviteit en faciliterende voorwaarden hebben een positief effect op gedragsaanpassing door een individu bij IT-(EPD)systeemgebruik, en vanwege het modererende karakter van faciliterende voorwaarden op de relatie persoonlijke innovativiteit → IT-(EPD)gedragsaanpassing zal dit effect worden versterkt naarmate er meer faciliterende condities aanwezig zijn. Taakaanpassingstechnologie heeft derhalve een positieve invloedt op IT-(EPD)gedragsaanpassing. Dit onderzoek kan worden herhaald bij meer zorginstellingen, bijvoorbeeld in het buitenland. Dit onderzoek geeft bestuurders, beleidsmakers en andere professionals bij de overheid en zorginstellingen inzichten die hun kunnen ondersteunen bij het onderling samenwerken en het nemen van beslissingen teneinde de (gezondheids)zorg toekomstbestendiger te maken.

Invited talk about the main results of my thesis for the Client Board of the University Medical Center of Groningen

Background and aim – Patients undergo one or more medical interventions in a hospital. In the hospital, patients are surrounded by spaces and services. The output in a hospital is the patients’ outcome. To gain understanding about a holistic experience of patients, we assessed the experience and well-being of patients at specific focal points of the entire patient journey: from the arrival, to the diagnosis and the actual treatment in a hospital. Methods – This article describes three field experiments that were conducted in a Dutch hospital. First, in an age-simulation study the effect of route complexity and physical ageing was assessed during 108 wayfinding tasks. Second, in a quasi-randomized experiment the use of a motion-nature projection was assessed during a diagnostic scan (N = 97) . Lastly, in a quasi-randomized experiment the effect of a nontalking rule during an outpatient infusion treatment was assessed (N = 263). Results – A wide variety of patients visit a hospital and all patients of course bring an opinion of their own and experience their hospital visit differently. However, patients benefit from a simple building structure during wayfinding, inexpensive beamers to project nature during diagnostics, and a mix of treatment places with respect to social interest during infusion treatments. Originality – There is little discussion about the holistic experience of patients, that concerns the cognitive, emotional, physical, and social well-being of patients. In our study we applied a holistic and patient-centered approach. Practical or social implications – The well-being of patients can be significantly improved when the built, natural, and sound environment is taken into account with respect to individual differences. Type of paper – Research paper.

Introduction In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. Methods A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. Results For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. Conclusion The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. Implications for practice The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.

Het RIVM heeft het aanbod en de bereikbaarheid geïnventariseerd van de ziekenhuizen in Nederland die in april 2017 spoedeisende hulp aanboden. Dit is ook voor de acute verloskunde gedaan. Uit de modelberekeningen blijkt dat deze ziekenhuizen zodanig over Nederland zijn verspreid dat 99,8 procent van de inwoners binnen 45 minuten naar een spoedeisende hulpafdeling (SEH) of een ziekenhuis met acute verloskunde kunnen worden vervoerd. In april 2017 waren er 89 SEH's met 24/7-uurs openingstijden. Dat is één minder dan in 2016 en twee minder dan in 2014. Op 81 ziekenhuislocaties werd 24/7-uur per week acute verloskunde aangeboden. Dat is evenveel als in 2016 en drie minder dan in 2014. In de inventarisatie zijn de locaties van ambulancestandplaatsen ook geactualiseerd. Sinds de laatste actualisatie in 2013 zijn er dertien standplaatsen bijgekomen en zijn sommige standplaatsen verhuisd. In deze bereikbaarheidsanalyse wordt gekeken naar de spreiding van ziekenhuizen over Nederland. De analyse bepaalt hoeveel ziekenhuizen als 'gevoelig' worden aangemerkt. Er zijn nu tien gevoelige ziekenhuizen met een 24/7-uurs basis-SEH. Wat acute verloskunde betreft zijn er twaalf gevoelige ziekenhuizen. Een ziekenhuis wordt zo genoemd als het aantal bewoners dat volgens het bereikbaarheidsmodel niet binnen 45 minuten naar een SEH kan worden gebracht toeneemt wanneer dit ziekenhuis sluit. De duur van de rit wordt berekend op basis van de tijd die de ambulance nodig heeft om van de standplaats, via het woonadres van de patiënt naar het ziekenhuis te komen. Deze modelmatige ritduur wordt vervolgens vergeleken met de spreidingsnorm van 45-minuten. In dit onderzoek is ook de aanwezigheid en beschikbaarheid geïnventariseerd van onder meer specialisten, verpleegkundigen en faciliteiten om op de SEH's diagnoses te stellen en behandelingen te starten. Daarnaast is gekeken naar de samenwerking tussen SEH's en huisartsenposten (HAP's). In 42 gevallen waren de 24/7-uurs SEH en HAP geïntegreerd, met een gezamenlijke ingang en een procedure voor mensen die zelf naar spoedeisende hulp komen met minder urgente/complexe klachten.

Het RIVM heeft het aanbod en de bereikbaarheid geïnventariseerd van de ziekenhuizen in Nederland die in april 2017 spoedeisende hulp aanboden. Dit is ook voor de acute verloskunde gedaan. Uit de modelberekeningen blijkt dat deze ziekenhuizen zodanig over Nederland zijn verspreid dat 99,8 procent van de inwoners binnen 45 minuten naar een spoedeisende hulpafdeling (SEH) of een ziekenhuis met acute verloskunde kunnen worden vervoerd. In april 2017 waren er 89 SEH's met 24/7-uurs openingstijden. Dat is één minder dan in 2016 en twee minder dan in 2014. Op 81 ziekenhuislocaties werd 24/7-uur per week acute verloskunde aangeboden. Dat is evenveel als in 2016 en drie minder dan in 2014. In de inventarisatie zijn de locaties van ambulancestandplaatsen ook geactualiseerd. Sinds de laatste actualisatie in 2013 zijn er dertien standplaatsen bijgekomen en zijn sommige standplaatsen verhuisd. In deze bereikbaarheidsanalyse wordt gekeken naar de spreiding van ziekenhuizen over Nederland. De analyse bepaalt hoeveel ziekenhuizen als 'gevoelig' worden aangemerkt. Er zijn nu tien gevoelige ziekenhuizen met een 24/7-uurs basis-SEH. Wat acute verloskunde betreft zijn er twaalf gevoelige ziekenhuizen. Een ziekenhuis wordt zo genoemd als het aantal bewoners dat volgens het bereikbaarheidsmodel niet binnen 45 minuten naar een SEH kan worden gebracht toeneemt wanneer dit ziekenhuis sluit. De duur van de rit wordt berekend op basis van de tijd die de ambulance nodig heeft om van de standplaats, via het woonadres van de patiënt naar het ziekenhuis te komen. Deze modelmatige ritduur wordt vervolgens vergeleken met de spreidingsnorm van 45-minuten. In dit onderzoek is ook de aanwezigheid en beschikbaarheid geïnventariseerd van onder meer specialisten, verpleegkundigen en faciliteiten om op de SEH's diagnoses te stellen en behandelingen te starten. Daarnaast is gekeken naar de samenwerking tussen SEH's en huisartsenposten (HAP's). In 42 gevallen waren de 24/7-uurs SEH en HAP geïntegreerd, met een gezamenlijke ingang en een procedure voor mensen die zelf naar spoedeisende hulp komen met minder urgente/complexe klachten.

Thermal disinfection is probably the oldest water treatment method ever used. Similarly to other disinfection processes, it targets the inactivation of pathogenic (micro)organisms present in water, wastewater and other media. In this work, a pilot-scale continuous-flow thermal disinfection system was investigated using highly contaminated hospital wastewater as influent without any pre-treatment step for turbidity removal. The results proved that the tested system can be used with influent turbidity as high as 100 NTU and still provide up to log 8 microbial inactivation. Further results have shown energy consumption comparable to other commercially available thermal disinfection systems and relatively low influence on the investigated physical–chemical parameters.

Thermal disinfection is probably the oldest water treatment method ever used. Similarly to other disinfection processes, it targets the inactivation of pathogenic (micro)organisms present in water, wastewater and other media. In this work, a pilot-scale continuous-flow thermal disinfection system was investigated using highly contaminated hospital wastewater as influent without any pre-treatment step for turbidity removal. The results proved that the tested system can be used with influent turbidity as high as 100 NTU and still provide up to log 8 microbial inactivation. Further results have shown energy consumption comparable to other commercially available thermal disinfection systems and relatively low influence on the investigated physical–chemical parameters.

Introduction In the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs). Methods To support the hospitals, train radiography students, and carry out a nationwide dose survey, diagnostic radiography students performed 125 DRL comparisons for nine different procedures in 29 radiology departments. Students were instructed at three Dutch Universities of Applied Sciences with a radiography programme and supervised by medical physicists from the participating hospitals. Results After a pilot study in the western part of the country in eight hospitals, this study was enlarged to involve 21 hospitals from all over the Netherlands. The 86 obtained dose comparisons fall below the DRLs in 97% of all cases. This very high compliance may have been enhanced by the voluntary participation of hospitals that are confident about their performance. Conclusion The results indicate that the current DRLs that were not based on a national survey, may need to be updated, sometimes to half their current value. For chest and pelvis examinations the DRLs could be lowered from 12 and 300 μGy·m 2 to the 75-percentile values found in this study of 5,9 and 188 μGy·m 2 , respectively.

To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post-Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p = 0.011), less restrictive discharge locations (p = 0.001), more independence in activities of daily living (p = 0.001) and less physiotherapy visits (p r= −0.408, p = 0.001), but not between the “6-clicks” and age (r= −0.180, p = 0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828–0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch “6-clicks” shows a good construct validity and moderate-to-excellent inter-rater reliability when used to assess the mobility of hospitalized patients.Implications for RehabilitationEven though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care.The Activity Measure for Post-Acute Care “6-clicks” Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population.This study shows that the Dutch version of the Activity Measure for Post-Acute Care “6-clicks” Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients. Even though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care. The Activity Measure for Post-Acute Care “6-clicks” Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population. This study shows that the Dutch version of the Activity Measure for Post-Acute Care “6-clicks” Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients.

De wet bepaalt hoe ziekenhuizen een calamiteit moeten onderzoeken en aan wie ze moeten rapporteren. De daaruit voortvloeiende verbetermaatregelen zijn lang niet altijd effectief. Internationaal en nationaal is hier nog veel te verbeteren.

In operatiekamers heeft de luchtkwaliteit vanzelfsprekend de meeste aandacht in verband met het risico op postoperatieve wondinfecties bij de patiënt. Echter het belang van thermisch comfort moet niet onderschat worden. In dit onderzoek wordt subjectief (perceptie) en objectief (metingen) de situatie onderzocht in operatiekamers met verschillende ventilatiesystemen. Uitgangspunt is een vergelijk met de theorie.

Noise is a common problem in hospitals, and it is known that social behavior can influence sound levels. The aim of this naturally-occurring field experiment was to assess the influence of a non-talking rule on the actual sound level and perception of patients in an outpatient infusion center. In a quasi-randomized trial two conditions were compared in real life. In the control condition, patients (n = 137) were allowed to talk to fellow patients and visitors during the treatment. In the intervention condition patients (n = 126) were requested not to talk to fellow patients and visitors during their treatment. This study measured the actual sound levels in dB(A) as well as patients' preferences regarding sound and their perceptions of the physical environment, anxiety, and quality of health care. A linear-mixed-model showed a statistically significant, but rather small reduction of the non-talking rule on the actual sound level with an average of 1.1 dB(A). Half of the patients preferred a talking condition (57%), around one-third of the patients had no preference (36%), and 7% of the patients preferred a non-talking condition. Our results suggest that patients who preferred non-talking, perceived the environment more negatively compared to the majority of patients and perceived higher levels of anxiety. Results showed no significant effect of the experimental conditions on patient perceptions. In conclusion, a non-talking rule of conduct only minimally reduced the actual sound level and did not influence the perception of patients.

In operatiekamers heeft de luchtkwaliteit vanzelfsprekend de meeste aandacht in verband met het risico op postoperatieve wondinfecties bij de patiënt. Echter het belang van thermisch comfort moet niet onderschat worden. In dit onderzoek wordt subjectief (perceptie) en objectief (metingen) de situatie onderzocht in operatiekamers met verschillende ventilatiesystemen. Uitgangspunt is een vergelijk met de theorie.

Binnen de medisch specialistische bedrijven (MSB’s) in de Nederlandse ziekenhuizen wordt voor de winstverdeling sinds 2015 op grote schaal gebruik gemaakt van een winstverdelingssysteem dat is geënt op benchmarking en dat is ontwikkeld door het adviesbureau LOGEX. Het winstverdelingssysteem wordt dan ook het LOGEX Prestatiemodel genoemd. Dit artikel onderzoekt de vraag hoe dit prestatiemodel door de praktijk wordt gewaardeerd en of verbeteringen mogelijk zijn. De inrichting, de voor- en nadelen, knelpunten, en de ontwikkelingsmogelijkheden zijn onderzocht door middel van een zelf ontwikkelde en gevalideerde online-vragenlijst. Deze vragenlijst is uitgezet onder alle financieel managers van de MSB’s in de topklinische ziekenhuizen (STZ-ziekenhuizen) in Nederland. Hoewel in de inrichting van het Prestatiemodel en de winstverdeling binnen MSB’s verschillende keuzes zijn gemaakt, en ook diverse knelpunten worden gesignaleerd, is het eindoordeel over het LOGEX Prestatiemodel unaniem positief. Ontwikkelingsmogelijkheden zijn er op het gebied van productiebegroting, kwaliteitsmeting, wegingsproblemen, disutility, en kostenverdeling.

Presentatie over ins en outs van innovatiewerkplaatsen in het algemeen aan de hand van de innovatiewerkplaats Health Space Design specifiek

Background: Undernutrition is a common complication of disease and a major determinant of hospital stay outcome. Dutch hospitals are required to screen for undernutrition on the first day of admission. Objective: We sought to determine the prevalence of the screening score “undernourished” with the use of the Short Nutritional Assessment Questionnaire (SNAQ) or Malnutrition Universal Screening Tool (MUST) and its relation to length of hospital stay (LOS) in the general hospital population and per medical specialty. Design: We conducted an observational cross-sectional study at 2 university, 3 teaching, and 8 general hospitals. All adult inpatients aged ≥18 y with an LOS of at least 1 d were included. Between 2007 and 2014, the SNAQ/MUST score, admitting medical specialty, LOS, age, and sex of each patient were extracted from the digital hospital chart system. Linear regression analysis with ln(LOS) as an outcome measure and SNAQ ≥3 points/MUST ≥2 points, sex, and age as determinant variables was used to test the relation between SNAQ/MUST score and LOS. Results: In total, 564,063 patients were included (48% males and 52% females aged 62 ± 18 y). Of those, 74% (419,086) were screened with SNAQ and 26% (144,977) with MUST, and 13.7% (SNAQ) and 14.9% (MUST) of the patients were defined as being undernourished. Medical specialties with the highest percentage of the screening score of undernourished were geriatrics (38%), oncology (33%), gastroenterology (27%), and internal medicine (27%). Patients who had an undernourished screening score had a higher LOS than did patients who did not (median 6.8 compared with 4.0 d; P < 0.001). Regression analysis showed that a positive SNAQ/MUST score was significantly associated with LOS [SNAQ: +1.43 d (95% CI: 1.42, 1.44 d), P < 0.001; MUST: +1.47 d (95% CI: 1.45, 1.49 d), P < 0.001]. Conclusions: This study provides benchmark data on the prevalence of undernutrition, including more than half a million patients. One out of 7 patients was scored as undernourished. For geriatrics, oncology, gastroenterology, and internal medicine, this ratio was even greater (1 out of 3–4). Hospital stay was 1.4 d longer among undernourished patients than among those who were well nourished.

Item does not contain fulltext BACKGROUND: Undernutrition is a common complication of disease and a major determinant of hospital stay outcome. Dutch hospitals are required to screen for undernutrition on the first day of admission. OBJECTIVE: We sought to determine the prevalence of the screening score "undernourished" with use of the Short Nutritional Assessment Questionnaire (SNAQ) or Malnutrition Universal Screening Tool (MUST) and its relation to length of hospital stay (LOS) in the general hospital population and per medical specialty. DESIGN: We conducted an observational cross-sectional study at 2 university, 3 teaching, and 8 general hospitals. All adult inpatients aged >/=18 y with an LOS of at least 1 d were included. Between 2007 and 2014, the SNAQ/MUST score, admitting medical specialty, LOS, age, and sex of each patient were extracted from the digital hospital chart system. Linear regression analysis with ln(LOS) as an outcome measure and SNAQ >/=3 points/MUST >/=2 points, sex, and age as determinant variables was used to test the relation between SNAQ/MUST score and LOS. RESULTS: In total, 564,063 patients were included (48% males and 52% females aged 62 +/- 18 y). Of those, 74% (419,086) were screened with SNAQ and 26% (144,977) with MUST, and 13.7% (SNAQ) and 14.9% (MUST) of the patients were defined as being undernourished. Medical specialties with the highest percentage of the screening score of undernourished were geriatrics (38%), oncology (33%), gastroenterology (27%), and internal medicine (27%).Patients who had an undernourished screening score had a higher LOS than did patients who did not (median 6.8 compared with 4.0 d; P < 0.001). Regression analysis showed that a positive SNAQ/MUST score was significantly associated with LOS [SNAQ: +1.43 d (95% CI: 1.42, 1.44 d), P < 0.001; MUST: +1.47 d (95% CI: 1.45, 1.49 d), P < 0.001]. CONCLUSIONS: This study provides benchmark data on the prevalence of undernutrition, including more than half a million patients. One out of 7 patients was scored as undernourished. For geriatrics, oncology, gastroenterology, and internal medicine, this ratio was even greater (1 out of 3-4). Hospital stay was 1.4 d longer among undernourished patients than among those who were well nourished.

PURPOSE: The purpose of the study is (a) to describe care needs derived from records of patients in Dutch hospitals, and (b) to evaluate whether nurses employed the NANDA-I classification to formulate patients' care needs. METHODS: A stratified cross-sectional random-sampling nursing documentation audit was conducted employing the D-Catch instrument in 10 hospitals comprising 37 wards. FINDINGS: The most prevalent nursing diagnoses were acute pain, nausea, fatigue, and risk for impaired skin integrity. CONCLUSIONS: Most care needs were determined in physiological health patterns and few in psychosocial patterns. IMPLICATIONS FOR NURSING PRACTICE: To perform effective interventions leading to high-quality nursing-sensitive outcomes, nurses should also diagnose patients' care needs in the health management, value-belief, and coping stress patterns.

The design of healthcare facilities is a complex and dynamic process, which can be supported by design support models. This process involves a large number of stakeholders, of whom some have specific health-related needs. Evidence-based design is an emerging approach for the design of healthcare facilities, basing design choices on scientific data. Apart from the problems accompanying the limited access to, and limited availability of, scientific evidence, the design of a building itself is characterised by dimensional, technological and stakeholder complexities that are derived from technology philosophy. This article deals with the derivation of performance indicators and design solutions for healthcare facilities and links this search to the foundations of evidence-based building. The In2Health design model is elaborated as a framework to steer this process and support architects, programmers and process managers. The applicability of the model in the evaluation and design processes of buildings is illustrated by two case studies concerning (i) the evaluation of the indoor environment for older people with dementia and (ii) the design process of the redevelopment of an existing hospital.

In his studies devoted to the ecclesiastical history of Brussels in the Middle Ages, Canon Placide Lefévre was quite critical about the charity activities of the Sainte-Gudule Chapter. He considered that there was no involvement in the relief, no truly chapter hospital, a global lack of interest after the twelfth century and a focus on the oratories. It appears this vision has to be balanced. On the one hand, the relief provided by the Poor Table has a link with the chapter and the Sainte-Gudule hospital can be considered as a chapter hospital. On the other hand, though the chapter itself is not involved in the foundations or management of the charity institutions, clerics are privately involved as are other ‘members’ of the chapter like the Church fabric, the Poor Table and some dignitaries., Dans ses études consacrées à l’histoire ecclésiastique de Bruxelles au Moyen âge, le chanoine Placide Lefèvre était assez critique par rapport à l’activité du chapitre Sainte-Gudule dans le domaine de l’assistance. Il considérait qu’il n’y avait aucune implication dans les secours, pas d’hôpital réellement capitulaire, un désintérêt après le xiie siècle et un repli sur les oratoires. Il convient sans doute de nuancer cette vision selon deux axes : d’une part les secours assurés par la table des pauvres ont bien un lien avec le chapitre et l’hôpital Sainte-Gudule peut être considéré comme un hôpital capitulaire. D’autre part, si le chapitre lui-même n’est pas impliqué dans la fondation ou la gestion des institutions d’assistance, les clercs le sont à titre privé, et d’autres «membres » du chapitre y participent pleinement : la fabrique, la table des pauvres et certains dignitaires., In zijn studies gewijd aan de kerkelijke geschiedenis van Brussel in de middeleeuwen, was Kanunnik Placide Lefévre nogal kritisch tegenover de activiteiten van het Sint-Goedelekapittel op gebied van armenzorg. Hij was van mening dat zij niet betrokken waren bij de liefdadigheid, er geen echt kappitelziekenhuis bestond, een globaal gebrek aan interesse ontstond na de twaalfde eeuw en een beperking tot de oratoria. Het is ongetwijfeld noodzakelijk deze visie te nuanceren langs twee hoofdlijnen : enerzijds is de Armentafel gelinkt met het kapittel en kan het Sint-Goedele hospitaal worden beschouwd als een kapittelziekenhuis. Aan de andere kant, hoewel het Kapittel niet als dusdanig betrokken was bij de stichting of het beheer van de zorginstellingen, waren de geestelijken «privé » betrokken en namen andere «leden » van het Kapittel er ook volop aan deel, zoals de kerkfabriek, de Armentafel en enkele dignitarissen., Guilardian David. Quelques remarques sur les rapports entre le chapitre Sainte-Gudule et les institutions d’assistance à Bruxelles (XIe-XVe s.). In: Revue belge de philologie et d'histoire, tome 96, fasc. 2, 2018. Histoire – Geschiedenis. pp. 457-476.

To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post- Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p¼0.011), less restrictive discharge locations (p¼0.001), more independence in activities of daily living (p¼0.001) and less physiotherapy visits (p

Even though research has shown the multiple benefits of single-bed patient rooms in hospitals, the majority of rooms in existing hospitals are shared. To share a hospital room, means to share sensitive information with total strangers. This may cause uncomfortable situations for both patients and healthcare professionals. Furthermore, the awareness of other ears in the room could even withhold a patient from sharing important information during visiting rounds. A possible solution is the use of an adjustable soundmasking system combined with a good room acoustic design. The first aim of this pilot study was to gain insight in the importance of speech privacy in multiple-bed patient rooms in a Dutch hospital, from both patients’ and professionals’ perspectives. The second aim was to investigate the impact and acceptance of an adjustable soundmasking system in a 4-bed patient room. Room acoustic measurements were conducted to determine the physical effect of the system on speech intelligibility. Subjective measures included interviews with patients experiencing the system and a questionnaire which was used to gather information on people’s need for speech privacy in the ward. The results indicate that patients as well as healthcare professionals acknowledge the need for speech privacy in multiple-patient rooms. The installed adjustable soundmasking system significantly reduced the speech transmission index but leaves room for improvement. Acoustic software modeling was used to assess the impact of room and system adaptations. The preliminary conclusion is that implementing adjustable sound masking in multiple-bed patient rooms is promising, but further research on the perception of the patient and the acoustic properties of both the room and the system needs to be conducted.

Beschrijving van een studie in het Isala-ziekenhuis naar het toepassen van een preoperatief consult bij hartpatiënten, om te bestuderen of hiermee het risico op postoperatieve complicaties beter ingeschat kan worden.

Het RIVM heeft gedetailleerd in beeld gebracht welke ziekenhuizen in Nederland zowel overdag als 's nachts spoedeisende hulp bieden. Dit is ook voor de acute verloskunde gedaan. Uit een analyse van de resultaten blijkt dat 99,8 procent van de inwoners binnen 45 minuten naar een spoedeisende hulpafdeling (SEH) of een ziekenhuis met acute verloskunde kan worden vervoerd. Sinds de vorige bereikbaarheidsanalyse in 2013 zijn drie SEH's gesloten. Hierdoor is één ziekenhuis extra als 'gevoelig' aangewezen. Als een gevoelig ziekenhuis wordt gesloten, neemt het aantal mensen toe dat er langer dan 45 minuten over doet om een SEH te bereiken. Ziekenhuizen mogen daarom alleen stoppen met het aanbieden van acute zorg als de bereikbaarheid daardoor niet verslechtert. De richtlijn van 45 minuten betreft de tijd waarin een ambulance naar de plaats van een incident rijdt, de patiënt in de ambulance overbrengt en vervoert naar het dichtstbijzijnde SEH. Voor het onderzoek is de aanwezigheid en beschikbaarheid geïnventariseerd van onder meer specialisten, verpleegkundigen en faciliteiten om op de SEH's diagnoses te stellen en behandelingen te bepalen. Eind 2014 waren er 95 ziekenhuislocaties die spoedeisende basiszorg bieden. Hiervan waren 91 locaties 24 uur per dag, 7 dagen per week geopend. Op 84 ziekenhuislocaties werd 24/7 acute verloskunde aangeboden. Ook is gekeken naar de samenwerking tussen SEH's en huisartsenposten (HAP's). Een HAP kan op het terrein van een ziekenhuis zijn gevestigd. In een ruime meerderheid van deze gevallen werkten de HAP en de SEH met elkaar samen.

Het RIVM heeft gedetailleerd in beeld gebracht welke ziekenhuizen in Nederland zowel overdag als 's nachts spoedeisende hulp bieden. Dit is ook voor de acute verloskunde gedaan. Uit een analyse van de resultaten blijkt dat 99,8 procent van de inwoners binnen 45 minuten naar een spoedeisende hulpafdeling (SEH) of een ziekenhuis met acute verloskunde kan worden vervoerd. Sinds de vorige bereikbaarheidsanalyse in 2013 zijn drie SEH's gesloten. Hierdoor is één ziekenhuis extra als 'gevoelig' aangewezen. Als een gevoelig ziekenhuis wordt gesloten, neemt het aantal mensen toe dat er langer dan 45 minuten over doet om een SEH te bereiken. Ziekenhuizen mogen daarom alleen stoppen met het aanbieden van acute zorg als de bereikbaarheid daardoor niet verslechtert. De richtlijn van 45 minuten betreft de tijd waarin een ambulance naar de plaats van een incident rijdt, de patiënt in de ambulance overbrengt en vervoert naar het dichtstbijzijnde SEH. Voor het onderzoek is de aanwezigheid en beschikbaarheid geïnventariseerd van onder meer specialisten, verpleegkundigen en faciliteiten om op de SEH's diagnoses te stellen en behandelingen te bepalen. Eind 2014 waren er 95 ziekenhuislocaties die spoedeisende basiszorg bieden. Hiervan waren 91 locaties 24 uur per dag, 7 dagen per week geopend. Op 84 ziekenhuislocaties werd 24/7 acute verloskunde aangeboden. Ook is gekeken naar de samenwerking tussen SEH's en huisartsenposten (HAP's). Een HAP kan op het terrein van een ziekenhuis zijn gevestigd. In een ruime meerderheid van deze gevallen werkten de HAP en de SEH met elkaar samen.