RESUMO
BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.
Assuntos
COVID-19/terapia , Atenção à Saúde/organização & administração , Gelo-Seco , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Meios de Transporte , Doença Aguda , COVID-19/epidemiologia , COVID-19/patologia , Proliferação de Células , Sobrevivência Celular , Células Cultivadas , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Atenção à Saúde/normas , Equipamentos e Provisões Hospitalares/normas , Equipamentos e Provisões Hospitalares/provisão & distribuição , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Doença Enxerto-Hospedeiro/terapia , Humanos , Itália/epidemiologia , Administração de Materiais no Hospital/organização & administração , Administração de Materiais no Hospital/normas , Transplante de Células-Tronco Mesenquimais/métodos , Transplante de Células-Tronco Mesenquimais/normas , Células-Tronco Mesenquimais/fisiologia , Organização e Administração/normas , Pandemias , Fenótipo , Sistemas Automatizados de Assistência Junto ao Leito/normas , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Meios de Transporte/métodos , Meios de Transporte/normasRESUMO
This case study provides evidence of the impact of the Scan4Safety program demonstrated in six National Health Service (NHS) Trusts, funded to achieve supply chain transformation to improve safety, quality and performance in the NHS in England. All 154 Trusts were mandated to adopt GS1 global standards for supply chain processes and Pan-European Public Procurement On-Line standards in 2014 to enable digital transactions across the NHS. The outcomes of this case reflect the early implementation of the program infrastructure in surgical theatre and cardiac programs. Outcomes include a 4:1 return on investment and projected savings of £1 billion pounds when scaled across the NHS.
Assuntos
Equipamentos e Provisões Hospitalares/normas , Administração de Materiais no Hospital/normas , Qualidade da Assistência à Saúde/organização & administração , Medicina Estatal/organização & administração , Automação , Análise Custo-Benefício , Processamento Eletrônico de Dados , Inglaterra , Equipamentos e Provisões Hospitalares/economia , Humanos , Administração de Materiais no Hospital/economia , Estudos de Casos Organizacionais , Sistemas de Identificação de Pacientes , Segurança do Paciente , Sistemas Automatizados de Assistência Junto ao Leito , Qualidade da Assistência à Saúde/economiaRESUMO
BACKGROUND: There has been interest concerning patient outcomes when older red blood cell (RBC) components are utilized. Inventory management is key to maintaining a stock of fresher RBCs for general transfusion needs. We have altered our practice for RBC management to reduce RBC age at the time of transfusion. STUDY DESIGN AND METHODS: Retrospective review of RBC age at time of transfusion at a tertiary care hospital with active trauma service was performed. The baseline nonirradiated RBC inventory was decreased from 12 to 15 days of stock to 7 to 10 days of stock, with request made to the blood supplier for fresher RBCs, specified at 75% of RBCs less than 14 days old. The age of RBCs at time of receipt and at time of transfusion was tracked on a monthly basis for the next 12 months. RESULTS: The mean age of RBCs at transfusion was decreased by 9 days on average for the year. Significant decreases in the mean age of RBCs at transfusion were seen in the second half of the year, with 4 of 6 months seeing a mean age of less than 20 days. There were no documented incidences of hospital blood shortages after the reduction in inventory; no surgery was canceled or delayed because of inventory. CONCLUSION: Inventory age depends on active management, combined with vendor cooperation to receive fresher components. Reducing the age of RBC components transfused is possible without experiencing blood component shortages. Longer periods of observation may allow for further adjustment of stocking levels on a seasonal basis.
Assuntos
Senescência Celular , Transfusão de Eritrócitos/estatística & dados numéricos , Eritrócitos , Armazenamento de Sangue/métodos , Preservação de Sangue/métodos , Equipamentos e Provisões/provisão & distribuição , Transfusão de Eritrócitos/normas , Humanos , Administração de Materiais no Hospital/métodos , Administração de Materiais no Hospital/normas , Estudos Retrospectivos , Fatores de TempoRESUMO
PURPOSE: The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement. DESIGN/METHODOLOGY/APPROACH: A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case. FINDINGS: The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information. RESEARCH LIMITATIONS/IMPLICATIONS: The small number of cases limits the generalisability of the findings at this time. PRACTICAL IMPLICATIONS: Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems. ORIGINALITY/VALUE: Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.
Assuntos
Eficiência Organizacional , Administração de Materiais no Hospital/normas , Melhoria de Qualidade , Administração de Materiais no Hospital/organização & administração , Modelos OrganizacionaisAssuntos
Tecnologia Biomédica , Manutenção , Administração de Materiais no Hospital , Tecnologia Biomédica/métodos , Tecnologia Biomédica/organização & administração , Tecnologia Biomédica/normas , Humanos , Disseminação de Informação , Manutenção/métodos , Manutenção/organização & administração , Manutenção/normas , Administração de Materiais no Hospital/métodos , Administração de Materiais no Hospital/organização & administração , Administração de Materiais no Hospital/normasAssuntos
Tecnologia Biomédica , Fidelidade a Diretrizes , Administração de Materiais no Hospital , Segurança do Paciente/normas , Tecnologia Biomédica/organização & administração , Tecnologia Biomédica/normas , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/normas , Humanos , Administração de Materiais no Hospital/organização & administração , Administração de Materiais no Hospital/normasRESUMO
INTRODUCTION: Cotton as well as synthetic textile medical products are widely used as barrier materials and individual protection against displacement of biological infectious factors. The required level of protection of these products for multiple use and disposable multilayer laminates against the penetration of microbes depends on the risk connected with type of surgical procedure defined in normative documents. METHODS. Cotton and syntetic medical textiles for multiple use, 30-times subjected to processes simulating conditions of the use as well as disposable multilayer surgical drapes were tested. Resistance to microbial wet penetration was conducted according to the PN-EN ISO 22610: 2007 standard. RESULTS: The barrier of cotton fabrics was reduced after first washing and then systematically grew after each often cycles to the value close to the value at the beginning. From the twentieth cycle of simulated conditions of the use, barrier index was reduced. The barrier of the synthetic textile stayed on the average level, while multilayer disposable products ensured the full impermeability for the bacteria. CONCLUSIONS: Natural cotton textiles for multiple use could be apply on operative blocks in limited range because of the changes of the cotton structure caused by repeated laundering process and sterilization. Synthetic materials also have limited application, although are more resistant to cleaning and sterilization processes. Disposable synthetic laminates with many layers use guarantee impermeability for bacteria and may be applied in operative blocks without restrictions.
Assuntos
Bactérias/isolamento & purificação , Equipamentos Descartáveis/microbiologia , Monitoramento Ambiental/normas , Administração de Materiais no Hospital/normas , Esterilização/normas , Têxteis/microbiologia , Têxteis/normas , Almoxarifado Central Hospitalar/normas , Equipamentos Descartáveis/normas , Monitoramento Ambiental/métodos , Reutilização de Equipamento/normas , Lavanderia/normas , Administração de Materiais no Hospital/métodos , Polônia , Roupa de Proteção/microbiologia , Roupa de Proteção/normas , Gestão de Riscos/métodos , Gestão de Riscos/normas , Campos Cirúrgicos/microbiologia , Campos Cirúrgicos/normasRESUMO
This chapter gives an educational overview of: * The actual application of supply chain practice and disciplines required for service delivery improvement within the current health environment. * A rationale for the application of Supply Chain Management (SCM) approaches to the Health sector. * The tools and methods available for supply chain analysis and benchmarking. * Key supply chain success factors.
Assuntos
Eficiência Organizacional , Administração de Materiais no Hospital/organização & administração , Austrália , Redes de Comunicação de Computadores , Gestão da Informação , Administração de Materiais no Hospital/normas , Estudos de Casos Organizacionais , Controle de Qualidade , Análise de SistemasRESUMO
Developing a disaster preparedness program is just the start of being able to properly respond to supply chain emergency situations. The best plans evolve based on lessons learned during an actual event. The four-level program implemented at Aurora Health Care in Milwaukee shows how improved results can be achieved by focusing on communications. Their work before the second wave of the H1N1 influenza outbreak helped the organization avoid some of the product shortages and capacity strains so many other hospitals and health systems experienced.
Assuntos
Equipamentos e Provisões Hospitalares/provisão & distribuição , Administração de Materiais no Hospital/normas , Surtos de Doenças , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Capacidade de Resposta ante Emergências , Estados Unidos/epidemiologiaRESUMO
Focusing on ways to improve patient outcomes, the American Hospital Association has launched Hospitals in Pursuit of Excellence. This effort to transform patient care through shared innovations highlights achievements at various hospitals around the country in areas including patient safety, reducing health care-acquired infections, medication management and patient throughput. As this report illustrates, the roles of materials management, nursing, infection control specialists and others are critically important to this effort.