Supervision of peripheral obstetric units

Overall quality of obstetric care in developing countries depends on the quality of care at a number of levels. The doctor must involve himself in the supervision of every peripheral unit that refers to the base hospital if he is to be succesful in providing the highest quality of care possible. Early diagnosis and correct assessment at the periphery makes for early and less expensive treatment. When planning the supervision of peripheral units, 2 important mistakes must be avoided. The 1st is to delegate supervision to the newest and most inexperienced member of the obstetric team. It is also a mistake to set out to visit and supervise peripheral units without 1st deciding the role and function of each within the system. The supervision of peripheral units must be directed by someone who has already acquired considerable local knowledge regarding the geography and communications of the region, what health providers are active there, and what their strengths and weaknesses are. Problem-oriented management protocols should be used. They can be developed to deal with problems that cannot be simply placed on a list, e.g. the management of the mother with lower abdominal pain in the antenatal clinic. They form the standing orders for treating such patients, and also provide an excellent basis for teaching midwives. The doctor's supervisory visit should have 6 goals in view: he must act as a consultant, to help with the more difficult clinical problems; he has a responsibility to assess the quality of care being delivered by the unit; he has an ongoing responsibility to provide inservice education for the midwives; he has a responsibility to the midwives to ensure that they have the best equipment possible; he has the responsibility of interpreting the needs of midwives to health care authorities; and he has a responsibility to support the midwives in their contacts with the community.     

Combined medical-psychiatric inpatient units

Considering the large number of elderly patients in acute hospitals who receive medical as well as psychiatric treatment because of relevant comorbidity, adequate interdisciplinary treatment models have to be developed and applied. The Centre for Elderly, a cooperation project between the departments of geriatric and psychogeriatric medicine in a community hospital in Germany, was founded in 2000. In addition to traditionally structured units, the centre consists of interdisciplinary units. Patient-, staff- and hospital-related characteristics influenced by the reformation of both departments were evaluated by comparing hospital-based registry data records containing age, gender, main and minor diagnoses, length of stay and patient transferrals within the centre. Experts working at the centre were asked to take a stand on the development of the treatment quality, allocation of patients, diagnostic procedures, consultation services and information transmission. The number of admissions to the Centre for the Elderly increased within one year. The distribution of the main diagnose groups remained unchanged, with an overlap between the geriatric and psychogeriatric department consisting of the main diagnoses dementia and depression. The length of stay and the number of transferrals decreased significantly in both departments. The majority of the interviewed employees stated that the treatment quality and the allocation of patients were improved. We conclude that interdisciplinary treatment between the departments of psychiatry and geriatric medicine may contribute to the medical needs of subgroups of elderly inpatients suffering from medical-psychiatric comorbidity.