Validez y consistencia de una escala rápida de satisfacción del paciente de consulta externa / Validity and consistency of an outpatient department user satisfaction rapid scale

Resumen Antecedentes: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). Método: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). Resultados: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. Conclusiones: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

Abstract Background: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). Method: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach’s a, Spearman’s correlation and intra-class correlation coefficient (ICC) were used. Results: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach’s a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman’s rho. Conclusion: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

[Stem cell transplantation unit: Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. / Unité de greffe : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Allogeneic hematopoietic cell transplantation (HCT) is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic HCT leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of HCT are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for human resources, construction and layout of a unit treating patients during the transplantation procedure and for different complications are not well defined. Here, we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of personnel and infrastructural requirements for hospitals caring for people with severe immunosuppression.

Environmental variables and errors in the preparation and administration of medicines / Variables ambientales y errores en la preparación y administración de medicamentos / Variáveis ambientais e erros no preparo e administração de medicamentos

ABSTRACT Objective: to identify the relationship between environmental factors and errors in the preparation and administration of antibacterial. Method: an observational, cross-sectional study conducted between August and December, 2014 in two clinical units. The sample consisted of 265 doses of medication, observed in different shifts that through a form had the environmental conditions of noise, illumination, humidity, temperature and physical space measured in the preparation and administration stages. Results: the physical dimension for the preparation was inadequate in one unit (3.8m2), and the items illumination, temperature and noise were extremely oscillating in the three shifts and in the two clinics, with averages generally higher than the recommended for the hospital environment, however, variations in illumination and noise were not statistically significant to cause dose errors or erroneous medicine choice (p> 0.05). Conclusion: the environmental variables analyzed may favor medication errors in both the preparation and administration stages.

RESUMEN Objetivo: identificar la relación entre los factores ambientales y los errores de preparación y administración de antibacterianos. Método: estudio observacional, transversal, realizado entre agosto y diciembre de 2014 en dos unidades clínicas. La muestra fue compuesta de 256 dosis de medicamentos, observadas en diferentes turnos, que por medio de un formulario tuvieron las condiciones ambientales de ruido, iluminación, humedad, temperatura y espacio físico medidos en las etapas de preparación y administración. Resultados: la dimensión física para la preparación fue inadecuada en una unidad (3,8m2), y los elementos iluminación, temperatura y ruido fueron extremadamente oscilantes en los tres turnos y en las dos clínicas, con medias generalmente por encima de lo recomendado para el ambiente hospitalario. Sin embargo, las variaciones de iluminación y ruido no fueron estadísticamente significativas para provocar errores de dosis o de elección errónea del medicamento (p>0,05). Conclusión: las variables ambientales analizadas pueden favorecer errores de medicación tanto en la etapa de preparación como en la de administración.

RESUMO Objetivo: identificar a relação entre os fatores ambientais e os erros de preparo e administração de antibacterianos. Método: estudo observacional, transversal, realizado entre agosto a dezembro de 2014 em duas unidades clínicas. A amostra foi composta de 265 doses de medicamentos, observadas em diferentes turnos, que por meio de um formulário tiveram as condições ambientais de ruído, iluminação, umidade, temperatura e espaço físico mensuradas nas etapas de preparo e administração. Resultados: a dimensão física para o preparo foi inadequada em uma unidade (3,8m2), e os itens iluminação, temperatura e ruído foram extremamente oscilantes nos três turnos e nas duas clínicas, com médias geralmente acima do recomendado para o ambiente hospitalar, porém, as variações de iluminação e ruído não foram estatisticamente significativas para provocar erros de dose ou de escolha errada do medicamento (p>0,05). Conclusão: as variáveis ambientais analisadas podem favorecer erros de medicação tanto na etapa de preparo quanto na administração.

A cross-sectional study in a tertiary care hospital in China: noise or silence in the operating room.

OBJECTIVES: This study aims to provide a comprehensive description of noise levels in operating rooms (ORs) in a tertiary care hospital in China. Additionally, the study aims to examine the deviation in noise levels from international and internal standards as well as the differences in noise levels by category of surgery and day of the week. METHODS: We monitored noise levels in 23 ORs in a tertiary care hospital in China between August 2015 and March 2016. Dosimeters were used to determine noise levels. The noise data collected in the dosimeter were downloaded to an IBM computer for subsequent analysis. One-way analysis of variance and Student's t-test were used to examine the differences in noise levels. RESULTS: The noise level in the ORs ranged between 59.2 and 72.3 dB(A), with 100% of the measurements exceeding the recommended hospital noise standards. There was substantial similarity in noise levels from Monday to Friday (F=1.404, p=0.234), with a range between 63.7 and 64.5 dB(A). The difference in noise levels by category of surgery was significant (F=3.381, p<0.001). The results of the post hoc analysis suggested that ophthalmic surgery had significantly higher noise levels than otolaryngological surgery or general surgery. CONCLUSIONS: Ophthalmic surgery had significantly higher noise levels than otolaryngological or general surgeries. High noise levels were identified in all evaluated ORs during weekdays, and these levels consistently exceeded the currently accepted standards. These findings warrant further investigation to determine the harmful effects of noise on both patients and staff in ORs..

Evaluating of fungal contamination in hospital wet cooling systems in Markazi province, Central Iran.

OBJECTIVE: Fungal infections are common complication among hospitalized patients especially between who is immunocompromised. Wet cooling systems in the hospital environment play a critical role as a source of these infections. The aim of this study was survey of wet cooling system of hospitals for fungal contamination in Arak city. MATERIALS AND METHODS: This study was conducted during May to September of 2016. Sampling was done as random. Samples were obtained from water and straw of 84 wet cooling systems of four hospitals in Arak city. Samples were cultured in Sabouraud dextrose agar medium contain of chloramphenicol. Identification of fungi was performed by Slide culture method. RESULTS: From 84 wet cooling systems, 32 (38.1%) were contaminated with fungi. The highest fungal contamination was found in wards of oncology and CCU. The most prevalent of fungi isolated in this study were Aspergillus spp. and Candida spp., respectively. CONCLUSION: The findings of this descriptive cross-sectional study clearly indicate, in wards of the hospital that used wet cooling systems, there was considerable fungal contamination, particularly Aspergillus contamination. These results highlight a clear need for greater attention to the use of non-aqueous or closed circulation cooling systems, especially where susceptible patients receive medical care.

Patients' Expectations and Perceptions of Service Quality in the Selected Hospitals.

BACKGROUND: Hospital's success depends on patients' expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients' perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. MATERIALS AND METHODS: This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive - analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. RESULTS: The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients' perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal-Wallis test, the difference observed in these three hospitals were significant. CONCLUSION: The results showed that patients' expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed that necessary for managers and relevant authorities to plan and pay special attention to this important issue.

A gap in patient tape storage and use practices puts patients at risk for cutaneous fungal infections.

We report a case of a cutaneous fungal infection in a 12-year-old oncology patient related to patient tape. Our facility had no established guidelines for patient tape. A survey conducted of multiple local healthcare facilities revealed no existing policies or standards of care related to tape storage or use. This reveals a gap in practice. We call for formal recommendations for tape storage and use to enhance patient safety.

[Correlations between the dimensions of clinical learning environments from the perspective of medical residents]. / Correlaciones entre las dimensiones de los ambientes clínicos de aprendizaje desde la percepción de los médicos residentes.

OBJECTIVES: The aim of the present study was to establish correlations between the dimensions of clinical learning environments (ACA) considering variables like: health institutions, hospital offices, specialty, and year of residency. METHODS: 4,189 doctors were evaluated through an online survey in 2012. RESULTS: The results revealed that the dimension of "educational processes" correlated best with others; specialties with the best ACA from the view of the medical residents were Internal Medicine and Surgery; and the third year residents had less favorable perceptions of their ACA. CONCLUSIONS: The pursuance of the academic program is relevant to physicians in training and teachers play an important role in the educational process.

Structural barriers to screening for and treatment of cervical cancer in Peru.

Through in-depth interviews with 30 key informants from 19 institutions in the health care system in four regions of Peru, this study identifies multiple barriers to obtaining cervical cancer screening, follow-up, and treatment. Some facilities outside Lima do not have the capacity to take Pap smear samples; others cannot do so on a continuing basis. Variation in procedures used by facilities and between regions, differences in women's ability to pay, as well as varying levels of training of laboratory personnel, all affect the quality and timing of service delivery and outcomes. In some settings, perverse incentives to accrue overtime payments increase the lag time between sample collection and reporting back of results. Some patients with abnormal results are lost to follow-up; others find needed treatment to be out of their financial or geographic reach. To increase coverage for cervical cancer screening and follow-up, interventions are needed at all levels, including an institutional overhaul to ensure that referral mechanisms are appropriate and that treatment is accessible and affordable. Training for midwives and gynaecologists is needed in good sample collection and fixing, and quality control of samples. Training of additional cytotechnologists, especially in the provinces, and incentives for processing Pap smears in an appropriate, timely manner is also required.

Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

OBJECTIVE: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. METHODS: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. RESULTS: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. CONCLUSIONS AND IMPLICATIONS: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

The potential impact of smoke-free facilities on smoking cessation in people with mental illness.

OBJECTIVE: The aim of this paper was to estimate the degree to which smoke-free facilities may facilitate smoking cessation in smokers with mental illness by estimating the proportion of smokers with mental illness who receive inpatient treatment, their smoking rates and average durations of stay. METHOD: Smoking and hospitalization rates were estimated from the Australian National Survey of Mental Health and Wellbeing. Information on duration of inpatient treatment was calculated from the Western Australian Mental Health Information System. RESULTS: Of Australia's estimated 3,567,000 current adult smokers, 32.4% had a mental illness in the past 12 months, and 66.6% had a lifetime mental illness. However, only 1.4% of smokers were hospitalized for a mental health problem in the past 12 months, and 6.3% had ever been hospitalized for a mental health problem. Of those hospitalized for mental health treatment in the past 12 months, 61.2% were current smokers. In 2007 median duration of inpatient mental health admissions was 1 day, and 57% of admissions had duration of 2 days or less. CONCLUSIONS: The majority of smokers with mental illness are not treated in inpatient facilities, and where inpatient admissions occur they are generally of short duration. While smoking cessation is an important goal in treatment of smokers with mental illness, support after discharge from inpatient care is important for longer term cessation. Other strategies will be required to support smoking cessation efforts for the majority of smokers with mental illness not in contact with mental health services.

Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review.

AIM: This paper is a report of a scoping review of research on cognitive impairment in older adults who visit Emergency Departments of acute care hospitals, followed by an integrative review that included a quality assessment to determine the effectiveness of interventions for this population. BACKGROUND: Being old and cognitively impaired in the Emergency Department--a fast-paced intervention system--is a complex phenomenon that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large impact on healthcare systems. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium or dementia in non-institutionalized older people (65+ years) in the Emergency Department. REVIEW METHODS: Titles screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers completed independent data extraction and synthesis of included studies. Quality assessment occurred using the Critical Appraisal Skills Programme Tools. RESULTS: Fifteen studies met the inclusion criteria for integrative review. Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are needed. Contextual details and relevant features of an appropriate intervention are poorly explained. CONCLUSION: Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and programmatic responses remain elusive. Quality improvements require more thorough examination of emergency department context to identify modifiable influencing factors that are transferable across settings.

The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting.

BACKGROUND: A total environmental cleaning system based on microfiber technology was implemented within 2 intensive care units (ICUs). The efficacy of this modified cleaning program was assessed using adenosine triphosphate (ATP) bioluminescence. METHODS: A team of trained hygiene technicians cleaned all near-patient furniture and equipment twice a day using ultramicrofiber cloths. Every week for 40 weeks, 10 surfaces within a randomly selected bed area were sampled using the 3M Clean-Trace Clinical Hygiene Monitoring System (3M Health Care Ltd, Loughborough, United Kingdom). The ability of the modified cleaning program to reduce surface contamination to "acceptable" levels was measured against previously proposed benchmark ATP values. RESULTS: In comparison with normal cleaning procedures routinely carried out by the nurses, the modified cleaning program significantly reduced (P < .001) the ATP readings obtained from surfaces within the near-patient environment. In both ICUs, 95% of surfaces sampled after modified cleaning had relative light unit values of <500 and were deemed "clean." Almost 90% of the surfaces could also be "passed" using the more stringent benchmark value of 250 relative light units. However, regardless of benchmark value used, the majority of surfaces sampled could also be considered adequately clean prior to them being cleaned by the hygiene technicians. CONCLUSION: The use of ATP bioluminescence has been proposed as a means to improve the management of hospital cleaning. Use of benchmark values can help continually monitor the efficacy of existing cleaning programs. However, when evaluating novel or new cleaning practices, baseline cleanliness (ie, the level of cleanliness routinely achieved using normal cleaning procedures) must also be taken into consideration, or the efficacy of modified cleaning will be overestimated.