Medical ward

The sources of direct costs include the costs of hospitalization in psychiatric hospitals or general medical wards, and the costs of medication and laboratory tests. Out-patient... 

In most Western countries 70% to over 90% of visits to a general practitioner result in the writing of a prescription. Also in the Western world the prescription of 9 drugs on medical wards is common procedure and 20% of patients are using more than 4 agents in the period before they are admitted. 

You are a hospital pharmacist visiting your regular general medical ward to review patients and provide pharmaceutical advice. Mr HA is a 50-year-old... 

Mrs MW, 59 years old, is divorced and unemployed. She was admitted to an acute medical ward at the hospital presenting with general malaise, a grossly distended abdomen, swollen ankles and jaundice. It was also noted that she smelt of alcohol and was showing signs of alcohol withdrawal. 

On the medical ward she was self-ventilating with oxygen saturations of 90% on 4 L/min oxygen, her respiration rate was 25 per minute and she was unable to speak. Her blood pressure was 98/60 mmHg, pulse 120 beats per minute. 

The effect of the environment in which the study was conducted— acute medical ward vs. outpatient sample. 

Suspected aspiration with infection Influenza with bacterial superinfection Inpatient Medical ward... 

Overall incidence in hospital inpatients is 10-20%, with possible prolongation of hospital stay in 2-10% of patients in acute medical wards. 

Wu FL, Yang CC, Shen LJ, Chen CY. Adverse drug reactions in a medical ward. J Formos Med Assoc 1996 95(3) 241-6. 

Sedative-Hypnotics — The benzodiazepines have superceded the barbiturates in hypnotic usage30 with diazepam (2b) the hypnotic of choice for medical ward patients.31... 

Bangkok, was 200 cases per year, which accounted for 4.1% of patients in the medical ward. At one provincial hospital at Nakornrachsima, the medical in-patient admission rate for OP poisoning alone was 2.8%, and OP poisoning was ranked the eighth most common illness requiring hospitalization. 

It has been estimated that every year between 5 and 10% of patients admitted to hospitals in the United States and Europe will acquire an infection that was not present before they were admitted to the hospital [1]. A number of these nosocomial (hospital-acquired) infections lead to the patient s death at one extreme or, at the least, require additional antimicrobial chemotherapy. Among critically ill patients, the prevalence of hospital-acquired infection can reach 50% in intensive care units, where patients remain for prolonged periods, often undergoing invasive therapeutic support, such as mechanical ventilation. Within hospitals, the surgical and medical wards usually have the highest infection rates, while pediatric and neonatal services have the lowest. 

The occurrence of hospital-induced complications in a university medical service was documented in the prospective investigation of over 1000 patients. The reported episodes were the untoward consequences of acceptable medical care in diagnosis and therapy. During the 8-month study, 240 episodes occurred in 198 patients. In 105 patients, hospitalization was either prolonged by an adverse episode or the manifestations were not resolved at the time of discharge. Thus, 20% of the patients admitted to the medical wards experienced one or more untoward episodes and 10 % had a prolonged or unresolved episode. The severity of the 240 episodes was minor in 110, moderate in 82 and major in 48, of which 16 ended fatally. 

The whole content of a vial containing 125 000 international units of heparin was prepared as a continuous infusion, resulting in a 5 times overdose to a patient on a general medical ward in a teaching hospital. 

The medical ward has 14 patient rooms, a delivery suite, six beds in the critical care area, four neonatal critical care areas, and one large observation patient room surrounded by glass. 

Agree whether she ll attend the ward for specific times (e.g. 9am-5pm), or specific reasons (e.g. medication, ward rounds, meals, activities). 

From ED to medical ward (patient with mental and physical problems)... 

If Alex needs further medical investigation or treatment, admit to a medical ward. Provide a written plan (p314) and ask liaison psychiatry to review tomorrow. 

If you suspect dementia and Jeremy s unsafe to return home, he should usually be admitted under the medics to establish the diagnosis and enable a full MDT assessment package of care. Alert liaison psychiatry to review, and only consider a psychiatric admission if he s physically fit, but can t be safely managed on a medical ward, e.g. due to challenging behaviour. Protect him on the ward, e.g. restrict access from suspected abusers. If available, emergency interim placement is another option (via social services) with psychiatric followup. 

Assess as you would on any medical ward, including ABCDE approach and checking allergies. Remember additional problems for psychiatric patients (Box 65.1). Involve the nurse if Roy s uncooperative, e.g. to demonstrate the examination or help him keep still. 

Handover to liaison for next-day follow-up. May need transfer to a psychiatric ward if persistent aggression can t be safely managed on a medical ward. 

People with eating disorders usually present to GPs/CMHTs, but you ll occasionally see them in ED due to physical complications or family crises. There s often professional anxiety that they ll end up in the wrong place - on a medical ward wiiich can t handle the psychological complexities and feeding, or a psychiatric ward ill-equipped to manage physical complications. Liaise closely with the medics to meet Emma s needs first medical, then psychiatric. 

Ask liaison psychiatry to review if admitting to a medical ward... 

NP is the second most common hospital-acquired infection and is the leading cause of death in this category. The incidence of NP ranges from 4 to 50 cases per 1000 admission in community hospitals and general medical wards, and 120-220 cases per 1000 admission in intensive care units (ICUs) or among patients requiring MV. The EPIC study (2), a large... 

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