Dos años de historia clínica electrónica. Experiencia en un hospital comarcal / Two years experience of computerised medical records in a regional hospital

La implantación de dicho programa fue precedida de un curso acelerado de formación a todos los trabajadores del centro. En el momento de su inicio se decidió que la aplicación informática entraría en funcionamiento en todo el ámbito hospitalario relegando el papel de la historia escrita a mano. Se vivieron días de dificultades durante su desarrollo pero de forma progresiva la historia clínica electrónica ha sido bien aceptada por la mayor parte de los trabajadores del centro. Tras le etapa inicial de acostumbramiento se comenzaron a ver los problemas de diseño de la aplicación así como sus posibles soluciones. En el día de hoy el uso del programa SELENE permite una asistencia sanitaria fluida dentro del hospital aunque existen problemas que precisan de una solución que pasa por una financiación adecuada. La implantación de la historia clínica electrónica en los hospitales públicos es sin duda uno de los grandes cambios experimentados en la asistencia a los pacientes en estos últimos años. Se trata de un proceso progresivo y no exento de dificultades pero que sin duda marcará un hito en la forma de manejar la información en la sanidad. Siguiendo esta estela en noviembre de 2008 se adquirió en el centro donde desarrollamos nuestra actividad quirúrgica el programa informático SELENE perteneciente a la empresa multinacional Siemens (AU)

The introduction of computerised medical records in public hospitals is, without a doubt, one of the biggest changes made in patient health care in the last few years. It is a gradual process and is not exempt from difficulties, but it will surely set a challenge in the way information is handled in health care. Taking this path, in November 2008, the computer program SELENE, from the multinational company Siemens, was purchased in the centre were we carry out our surgical activities. The introduction of this program was preceded by an intensive training course for all the workers in the hospital. At the start, it was decided that the computer application would come into operation throughout the entire hospital, replacing the handwritten records. There were difficult days during its gradual introduction, but the computerised medical record has been well accepted by the great majority of the workers at the centre. After the initial stage of becoming accustomed, design problems started to be seen in the application, as well as their possible solutions. Currently, the use of the SELENE program has led to fluid health care within the hospital, although there are problems which can be resolved with adequate funding (AU)

[Two years experience of computerised medical records in a regional hospital]. / Dos años de historia clínica electrónica. Experiencia en un hospital comarcal.

The introduction of computerised medical records in public hospitals is, without a doubt, one of the biggest changes made in patient health care in the last few years. It is a gradual process and is not exempt from difficulties, but it will surely set a challenge in the way information is handled in health care. Taking this path, in November 2008, the computer program SELENE, from the multinational company Siemens, was purchased in the centre were we carry out our surgical activities. The introduction of this program was preceded by an intensive training course for all the workers in the hospital. At the start, it was decided that the computer application would come into operation throughout the entire hospital, replacing the handwritten records. There were difficult days during its gradual introduction, but the computerised medical record has been well accepted by the great majority of the workers at the centre. After the initial stage of becoming accustomed, design problems started to be seen in the application, as well as their possible solutions. Currently, the use of the SELENE program has led to fluid health care within the hospital, although there are problems which can be resolved with adequate funding.

[Integral management of the process of laparoscopic cholecystectomy]. / Gestión integral del proceso de colecistectomía laparoscópica.

INTRODUCTION: One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points. MATERIAL AND METHOD: We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results. RESULTS: A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high. CONCLUSIONS: Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy -showing good effectiveness and efficiency- the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surgery.

Gestión integral del proceso de colecistectomía laparoscópica / Integral management of the process of laparoscopic cholecystectomy

Introducción. Entre los objetivos básicos de la sanidad pública está garantizar la atención integral al paciente, y centrar la actividad en la gestión por procesos. El análisis de un proceso "clave" podría tener un efecto tanto desde el punto de vista sanitario como social y económico si se desarrollan medidas encaminadas a mejorar los resultados. El objetivo de este trabajo es el análisis del proceso de colecistectomía laparoscópica (CL) en nuestro hospital para determinar sus puntos fuertes y sus posibilidades de mejora. Material y método. Se realiza un estudio observacional y prospectivo del proceso de CL durante el período enero 2001-diciembre 2002. Mediante consenso de un grupo de trabajo se elaboró un diagrama de flujo y se realizó la evaluación de la gestión median-te indicadores de calidad: accesibilidad, eficiencia, efectividad, incluyendo el coste, la baja laboral y la satisfacción del paciente. Se consideraron como estándares los definidos por la Consejería de Salud de la Junta de Andalucía, los aceptados en bases bibliográficas y técnicas de grupo. Se exponen los intervalos de confianza del 95% de los resultados más relevantes. Resultados. Se evaluó a 86 pacientes intervenidos mediante CL. Existe variabilidad en la espera para la consulta, para la realización de cirugía y pruebas diagnósticas de urgencia, que exceden los estándares. La CL ha predominado sobre la cirugía abierta con tasas de morbimortalidad por debajo de los estándares y elevada adhesión a los protocolos de profilaxis. La estancia de la CL programada se aproxima mucho al objetivo, mientras que en la urgente las estancias preoperatorias son más elevadas de lo aceptable. En la satisfacción del paciente la puntuación global ha sido alta en los aspectos médicos y no médicos. Conclusiones. Destacan como puntos fuertes el elevado índice de cirugía laparoscópica, con una alta efectividad y eficiencia, la calidad del consentimiento informado y la satisfacción global de los pacientes. Como posibilidades de mejora: la demora en la cirugía de la colecistitis aguda, la priorización de las listas de espera, la orientación sobre el tiempo de baja laboral, suprimir el type-screen y la implantación del ingreso en el día (AU)

Introduction. One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points. Material and method. We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results. Results. A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high. Conclusions. Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy ­showing good effectiveness and efficiency­ the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surg (AU)