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The Climate Emergency and Zero-Carbon Healthcare
Published in Vincent La Placa, Julia Morgan, Social Science Perspectives on Global Public Health, 2023
Medical activities produce high levels of waste and pollution. One way to reduce the environmental footprint is switching to lower carbon treatments. For example, in Kenya, anaesthetists and pharmacists collaborated with the government and pharmaceutical companies to negotiate substitutions to lower carbon anaesthetic gases and to make propellant-free inhalers cheaper respectively, and encouraged their use throughout the country (Aga Khan Development Network, 2020). Another way to reduce carbon intensity is to create ‘leaner’ healthcare pathways. Lean healthcare has emerged as a strategy to reduce waste and activities that do not add value to the healthcare process. Poor patient flow and inadequate resource utilisation contribute to delays and overcrowding, affecting patient safety, patient and staff satisfaction, and the overall quality of care (Tlapa et al., 2020). An excellent example is India’s ‘Aravind Eye Clinic’, which developed a highly carbon-efficient cataract surgery pathway through the use of domestic suppliers, a specialised workforce, and a standardised protocol-driven approach. This has drastically reduced the per-patient cataract carbon footprint to roughly 5% of the UK cataract footprint, whilst maintaining safety and quality (Thiel et al., 2017).
The pauper hospital
Published in Kah Seng Loh, Li Yang Hsu, Tuberculosis – The Singapore Experience, 1867–2018, 2019
From the 1870s, the hospital was reaching the point of severe overcrowding. The bulk of these patients were working-class immigrants from south-eastern China. In 1873, TTSH admitted 1,461 patients and although some of them died soon after arrival, the number was already more than double what the committee had projected. The number of admissions jumped to 2,757 in 1877, hit 4,000 in 1882 and exceeded 7,000 in 1897. The substantial increases were mostly due to the immigration-led expansion of Singapore’s population in the final decades of the nineteenth century. The island’s population rose by 136 per cent from 96,000 in 1871 to 227,000 in 1901, but even this was less than the four-fold surge in TTSH’s patient population over the same period. Most of the increase in Singapore’s population was due to immigration: from 1881 to 1901, the natural change was a decrease of 73,000, but this was more than compensated by a net migrational increase of 163,000.27 Similarly, a significant proportion of TTSH’s patients were from the region; in 1884, a quarter of the patients were migrants from plantations in Johor to the north of Singapore.
Prognosis
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
The connection between hospitalization and concurrent or subsequent opportunities to apply multimodality forms of treatment (based on the awareness that the individual’s rehabilitation may extend over considerable time with remission and relapses) has directed attention to the relationship between the individual and the milieu in which the treatment is attempted. In a study of the social and psychological factors associated with the length of stay in the drug treatment facility, it was found that certain types of rehabilitation programs seem to have little appeal to drug addicts,25 whereas some programs report high treatment success rates.26 In these studies, a variety of factors were identified as being probably responsible in determining the length of stay. Those significantly affecting the patient’s course have been related to the milieu, the effect of overcrowding and the amount of individual attention the patient can obtain. A study of this interaction27 indicated that the social and institutional factors militated for a longer stay only among those addicts who were either severely disturbed, very desperately concerned in eliminating their addiction, or in working through some threat to their remaining in the free society. Another aspect that requires consideration is the nature of the treatment philosophies espoused and the relevancy of their application. For example, there are those for whom long-term psychotherapy may not be meaningful and would be inappropriate because the type of commitment that this would involve would be contrary to their life styles.
Need for social work interventions in the emergency department
Published in Social Work in Health Care, 2023
Jobin Tom, Elizabeth K. Thomas, A. Sooraj, Seema P. Uthaman, Harish M. Tharayil, Akhil S.L., Chandni Radhakrishnan
The need to balance limited resources against the provision of timely patient care has led to multiple efforts to optimize processes at emergency departments. Compared to other departments of the health care system, the emergency department (ED) may be one of the most congested units in any hospital, facing greater pressure in terms of patients requiring immediate care, patient load, and healthcare resources. When the emergency department is overcrowded, the quality of care tends to decrease; overcrowding can also lead to delayed treatment, long patient wait times and stays, overworked staff, high medical error rate, low productivity, and poor patient outcomes. Apart from the patients who suffer from life-threatening terminal illnesses, the accompanying persons also might fall into depression/distress and require psycho-social support. Patients’ environment, at times, might hamper the treatment outcome. There is a possibility of a dearth of personal, familial, hospital, and community resources that are necessary to meet the needs of patients (Kumar, 2019). Healthcare providers are also occupied with managing different levels of care and thus unable to provide adequate time to sufficiently explain all treatment protocols that patients and their companions can easily understand, which may be better managed in hospitals in western countries due to low patient flow.
Health-care access and utilization among HIV-infected men who have sex with men in two Chinese municipalities with or without lockdown amidst early COVID-19 pandemic
Published in AIDS Care, 2022
Jiayu He, Yingying Ding, Frank Y. Wong, Na He
This study reveals that the COVID-19 pandemic and city or community lockdown strategy as the most challenging public health reaction could substantially affect health services in general and HIV-related health care in particular among HIV-infected MSM. Approximately 16.4% of respondents in Wuhan experienced ART interruption, higher than their counterparts (6.9%) in Shanghai, mainly during the lockdown period. This was because all hospital departments of infectious diseases in Wuhan were engaged in medical care for COVID-19, and residents, including HIV-infected patients, were usually not allowed to leave home during the lockdown period (Huang et al., 2020). Nevertheless, maintaining ART and HIV healthcare provision during the lockdown period is urgent for the health of HIV-infected MSM (Huang et al., 2020). To prevent potential disruptions to the supply of ART and other essential medications, WHO recommends dispensing ARVs for up to 6 months (WHO, 2020c). Moreover, incorporating telemedicine systems to address some of the unique challenges posed by infectious disease outbreaks is also recommended for managing several challenges in healthcare systems (Rockwell & Gilroy, 2020). Telemedicine, such as institutional mailing service of ARVs and volunteer-based home delivery of ARVs, can help mitigate and prevent overcrowding in primary care clinics and emergency departments, which was also adopted in Wuhan during the COVID-19 pandemic.
Advanced triage to redirect non-urgent Emergency Department visits to alternative care centers: the PERSEE algorithm
Published in Acta Clinica Belgica, 2022
Allison Gilbert, Edmond Brasseur, Mérédith Petit, Anne Françoise Donneau, Vincent D’Orio, Alexandre Ghuysen
Despite many organizational and technological advances, Emergency Department (ED) crowding still represents an international healthcare concern. The management of overcrowded EDs is the subject of several current research to significantly decrease the patients’ flow [1,2]. Indeed, increasing ED presentations have repercussions not only on practitioners’ workload and patients’ waiting times but also on ED staff stress and work-life quality [3]. Moreover, the overcrowding is responsible for a decreased quality of care and increased mortality [4]. Worldwide, the situation is getting worse and solutions are urgently needed. In the United States, a 32% increase in annual ED visits was noted from 1996 to 2006 [5]. In Belgium, the 2016 report from the Organization for Economic Co-operation and Development (OECD) estimated an average annual growth rate around 5% which is stackable with the annual growth rate reported by the University Hospital Center of Liège [6].