Objectives: In patients with burns an early accurate diagnosis of burn depth is essential to determine optimal treatment. The combination of Laser Doppler imaging (LDI) and clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of LDI on therapeutic decisions, clinical outcomes and costs are unknown. The aim of our study was to analyse the effectiveness and cost-effectiveness of LDI in burn care. The effects of LDI on decision-making, clinical outcomes, costs, and cost-effectiveness were assessed. Methods: A randomised controlled trial was conducted in all three Dutch burn centres, including subsequent patients with burns of indeterminate depth. In the standard care (SC) group, burn depth and treatment choices were based on clinical assessment only, in the other group (LDI) clinical assessment and LDI results were combined. Primary outcome was the effect of the introduction of LDI on wound healing time. The economic evaluation was performed from a societal perspective with a bottom up approach, following the micro-costing method. Results: Mean time to wound healing from randomisation was 14.3 days in the LDI group and 15.5 days in the SC group (p= 0.258). In the subgroup of clinical patients requiring surgery earlier decision for surgery and a shorter wound healing time were observed in the LDI group (16.0 versus 19.9 days, p= 0.029). Mean total costs per patient were € 18 549 versus € 18 896 (p= 0.837). Conclusions: LDI proved to provide guidance for therapeutic decisions with a significantly shorter wound healing time in the subgroup of clinical patients requiring surgery. When time to surgery can be reduced by 2.4 days, similar to the time to decision for surgery in our study, cost savings of € 794 per scanned patient can be achieved.
Background: In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown. Methods: A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed. Results: Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups. Conclusions: Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
Background: The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients’ views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. Methods: Adult patients (≥18 years old), 3–36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (
The Dutch hospitality industry, reflecting the wider Dutch society, is increasingly facing social sustainability challenges for a greying population, such as increasing burnout, lifelong learning, and inclusion for those distanced from the job market. Yet, while the past decades have seen notable progress regarding environmental sustainability and good governance, more attention should be paid to social sustainability. This concern is reflected by the top-sector healthcare struggles caused by mounting social welfare pressure, leading to calls by the Dutch government for organizational improvement in social earning capacity. Furthermore, the upcoming EU legislation on CSRD requires greater transparency regarding financial and non-financial reporting this year. Yet, while the existing sustainability accreditation frameworks offer guidance on environmental sustainability and good governance reporting, there must be more guidance on auditing social sustainability. The hospitality industry, as a prominent employer in the Netherlands, thus has a societal and legislative urgency to transition its social earning capacity. Dormben Hotel The Hague OpCo BV (Dormben) has thus sought support in transitioning its social sustainability standards to meet this call. Hotelschool, the Hague leads the consortium, including Green Key Nederland and Dormben, by employing participatory design to present a social sustainability accreditation framework. Initially, Dr. David Brannon and Dr. Melinda Ratkai from Hotelschool The Hague will draft a social sustainability accreditation framework informed by EFRAG. Subsequently, Erik van Wijk, from Green Key Nederland, the hospitality benchmark for sustainability accreditation, and Sander de Jong, from Dormben, will pilot the framework through four participatory workshops involving hospitality operators. Later, during a cross-industry conference, Dr. David Brannon and Dr. Melinda Ratkai will disseminate a social sustainability toolkit across their academic and industry networks. Finally, conference and workshop participants will be invited to form a social sustainability learning community, discussing their social earning capacity based on the revised sustainability accreditation.
Despite Dutch Hospitality industry’s significant economic value, employers struggle to attract and retain early career professionals at a time when tourism is forecasted to grow exponentially (Ruël, 2018). Universally, hospitality management graduates are shunning hospitality careers preferring other career paths; stimulating the Dutch Hospitality to find innovative ways of attracting and retaining early career professionals. Following calls from the Human Resource Management (HRM) community (Ehnert, 2009), we attribute this trend to personnel being depicted as rentable resources, driving profit’’ often at personal expense. For example, hotels primarily employ immigrants and students for a minimum wage suppressing salaries of local talent (Kusluvan, et al 2010, O’Relly and Pfeffer, 2010). Similarly, flattening organizational structures have eliminated management positions, placing responsibility on inexperienced shoulders, with vacancies commonly filled by pressured employees accepting unpaid overtime jeopardizing their work life balance (Davidson, et al 2010,). These HRM practices fuel attrition by exposing early career professionals to burnout (Baum et al, 2016, Goh et al, 2015, Deery and Jog, 2009). Collectively this has eroded the industry’s employer brand, now characterized by unsocial working hours, poor compensation, limited career opportunities, low professional standing, high turnover and substance abuse (Mooney et al, 2016, Gehrels and de Looij, 2011). In contrast, Sustainable HRM “enables an organizational goal achievement while simultaneously reproducing the human resource base over a long-lasting calendar time (Ehnert, 2009, p. 74).” Hence, to overcome this barrier we suggest embracing the ROC framework (Prins et al, 2014), which (R)espects internal stakeholders, embraces an (O)pen HRM approach while ensuring (C)ontinuity of economic and societal sustainability which could overcome this barrier. Accordingly, we will employ field research, narrative discourse, survey analysis and quarterly workshops with industry partners, employees, union representatives, hotel school students to develop sustainable HRM practices attracting and retaining career professionals to pursue Dutch hospitality careers.
Achtergrond: In acute intensieve werksettings, waar de werkdruk al hoog was en er altijd impact is van indrukwekkende gebeurtenissen, zorgt COVID-19 voor toename van druk. Zorgprofessionals worden geconfronteerd met een nieuw en onbekend ziektebeeld, lopen risico op besmetting of om een besmettingsbron voor patiënten te zijn, communicatie met de patiënt is minder goed mogelijk, en zij krijgen te maken met een hogere werkdruk. Dit leidt tot een ongezonde werksituatie. De potentiële gevolgen hiervan zijn (post-traumatische) stress, burn-out en uitval. Er is daarom noodzaak om curatieve ondersteuning tijdens de crisis/indrukwekkende gebeurtenissen en preventieve ondersteuning ter voorbereiding op crisis/indrukwekkende gebeurtenissen en ter nazorg aan te bieden. Professionals uit het netwerk van Lectoraat Acute Intensieve Zorg werkzaam in de frontlinie vanuit ambulance, Spoedeisende Hulp (SEH), Acute Opname Afdelingen en Intensive Care geven aan moeite te hebben met het omgaan met de indrukwekkende situaties bij de COVID-19 crisis. Ze hebben gevraagd om een toolkit van werkzame interventies die kunnen worden ingezet om beter met deze situatie om te kunnen gaan om hiermee duurzame inzetbaarheid in, tijdens en na crisissituaties te vergroten. Het gaat hierbij om interventies gericht op curatieve en preventieve ondersteuning. Plan van aanpak: In dit project wordt ontwerpgericht onderzoek middels mixed methods design toegepast. In co-creatie met de praktijk ontwikkelen we een toolkit met bruikbare, zo mogelijk evidence based, interventies om zorgprofessionals te ondersteunen om om te gaan met indrukwekkende gebeurtenissen, gebaseerd op lessen uit de COVID-19 crisis. Deze toolkit dient ervoor om duurzame inzetbaarheid te ondersteunen en te vergroten. Vanuit de HAN werken de lectoraten Acute Intensieve Zorg en Human Resource Management nauw samen met beroepsverenigingen en publieke instellingen uit de acuut intensieve keten. Alle partners verspreiden ontwikkelde kennis en producten via hun netwerk.
