A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses.

OBJECTIVES: to investigate the reasons for low patient safety incident reporting among Indonesian nurses. METHODS: this qualitative case study was conducted among 15 clinical nurses selected purposively from a public hospital in Lampung, Indonesia. Interview guidelines were used for data collection through face-to-face in-depth interviews in July 2022. The thematic approach was used to analyze the data. RESULTS: in this present study, seven themes emerged (1) Understanding incident reporting; (2) The culture; (3) Consequences of reporting; (4) Socialization and training; (5) Facilities; (6) Feedback; and (7) Rewards and punishments. FINAL CONSIDERATIONS: these findings should be considered challenges for the patient safety committee and hospital management to increase patient safety incident reporting, particularly among nurses in the hospital.

Missed nursing care: A cross-sectional and multi-centric study from Turkey.

AIM: The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors. DESIGN: This was a descriptive, cross-sectional, multicentre study. METHODS: A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey. RESULTS: The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05). CONCLUSION: This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru.

Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.

Midwives' perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study.

BACKGROUND: Person-centred maternity care (PCMC) is acknowledged as essential for achieving improved quality of care during labour and childbirth. Yet, evidence of healthcare providers' perspectives of person-centred maternity care is scarce in Nigeria. This study, therefore, examined the perceptions of midwives on person-centred maternity care (PCMC) in Enugu State, South-east Nigeria. MATERIALS AND METHODS: This study was conducted in seven public hospitals in Enugu metropolis, Enugu State, South-east Nigeria. A mixed-methods design, involving a cross-sectional survey and focus group discussions (FGDs) was used. All midwives (n = 201) working in the maternity sections of the selected hospitals were sampled. Data were collected from February to May 2019 using a self-administered, validated PCMC questionnaire. A sub-set of midwives (n = 56), purposively selected using maximum variation sampling, participated in the FGDs (n = 7). Quantitative data were entered, cleaned, and analysed with SPSS version 20 using descriptive and bivariate statistics and multivariate regression. Statistical significance was set at alpha 0.05 level. Qualitative data were analysed thematically. RESULTS: The mean age of midwives was 41.8 years ±9.6 years. About 53% of midwives have worked for ≥10 years, while 60% are junior midwives. Overall, the prevalence of low, medium, and high PCMC among midwives were 26%, 49% and 25%. The mean PCMC score was 54.06 (10.99). High perception of PCMC subscales ranged from 6.5% (dignity and respect) to 19% (supportive care). Midwives' perceived PCMC was not significantly related to any socio-demographic characteristics. Respectful care, empathetic caregiving, prompt initiation of care, paying attention to women, psychosocial support, trust, and altruism enhanced PCMC. In contrast, verbal and physical abuses were common but normalised. Midwives' weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. Supportive care was constrained by restrictive policy on birth companion, poor working conditions, and cost of childbirth care. CONCLUSION: PCMC is inadequate in public hospitals as seen from midwives' perspectives. Demographic characteristics of midwives do not seem to play a significant role in midwives' delivery of PCMC. The study identified areas where midwives must build competencies to deliver PCMC.

A national survey of antibacterial consumption in Sri Lanka.

INTRODUCTION: Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. OBJECTIVES: To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. METHODS: The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. FINDINGS: From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. CONCLUSIONS: A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.

INTRODUCTION: Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. METHODS: This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider's knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. RESULTS: The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19-42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. CONCLUSION: This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

Determinants, reasons for choice and willingness to recommend birthing facility among mothers in public and private health facilities in Ebonyi, Nigeria.

INTRODUCTION: facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria. METHODS: this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection. RESULTS: the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others. CONCLUSION: regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.

Performance of quality improvement teams and associated factors in selected regional referral hospitals in Tanzania: a cross-sectional study.

INTRODUCTION: quality improvement teams facilitate improvement in the performance of the health facilities and simultaneously improving the quality of health services. There is scanty information on the factors associated with performance of quality improvement teams. This study aimed to assess the perceptions of members of the quality improvement teams on the factors influencing the performance of quality improvement teams in regional referral hospitals in Tanzania. METHODS: a cross-sectional study was conducted in four regional referral hospitals in Tanzania. We used self-administered questionnaires to collect data from 61 members of quality improvement teams. Descriptive statistics were used to assess the perceived factors influencing team performance. Bivariate and multivariate logistic regression was used to test the association between perceptions of the team members and factors associated with team performance. RESULTS: the overall mean perception score on team performance was high at 27.51 ± 4.62. Five factors namely: training (83.6%); communication (75.1%); team cohesiveness (71.5%); clarity of roles and responsibility (70.2%); team size and composition (65.5%); and self-assessment and learning (56.2%) were considered as the main drivers of team performance. Inadequate management support obtained the lowest score (36.1%). Multivariable regression analysis established a significant association between training, communication, clarity of roles and responsibilities, team size and composition, self-assessment and learning, management support and team performance. CONCLUSION: inadequate management support to the team was found to be a barrier to team performance. Managerial interventions should focus on provision of coaching and mentoring to the team while addressing resource challenges affecting the team performance.

Gynecologic oncology treatment modifications or delays in response to the COVID-19 pandemic in a publicly funded versus privately funded North American tertiary cancer center.

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.

Decision to delivery interval and associated factors for emergency cesarean section: a cross-sectional study.

BACKGROUND: Emergency cesarean section is a commonly performed surgical procedure in pregnant women with life-threatening conditions of the mother and/or fetus. According to the Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists, decision to delivery interval for emergency cesarean sections should be within 30 min. It is an indicator of quality of care in maternity service, and if prolonged, it constitutes a third-degree delay. This study aimed to assess the decision to delivery interval and associated factors for emergency cesarean section in Bahir Dar City Public Hospitals, Ethiopia. METHOD: An institution-based cross-sectional study was conducted at Bahir Dar City Public Hospitals from February to May 2020. Study participants were selected using a systematic random sampling technique. A combination of observations and interviews was used to collect the data. Data entry and analysis were performed using Epi-data version 3.1 and SPSS version 25, respectively. Statistical significance was set at p < 0.05. RESULT: Decision-to-delivery interval below 30 min was observed in 20.3% [95% CI = 15.90-24.70%] of emergency cesarean section. The results showed that referral status [AOR = 2.5, 95% CI = 1.26-5.00], time of day of emergency cesarean section [AOR = 2.5, 95%CI = 1.26-4.92], status of surgeons [AOR = 2.95, 95%CI = 1.30-6.70], type of anesthesia [AOR = 4, 95% CI = 1.60-10.00] and transfer time [AOR = 5.26, 95% CI = 2.65-10.46] were factors significantly associated with the decision to delivery interval. CONCLUSION: Decision-to-delivery intervals were not achieved within the recommended time interval. Therefore, to address institutional delays in emergency cesarean section, providers and facilities should be better prepared in advance and ready for rapid emergency action.

Factors and outcomes associated with the induction of labor in referral hospitals of Amhara regional state, Ethiopia: a multicenter study.

BACKGROUND: Induction of labor is an artificial initiation of uterine contractions after fetal viability with the aim of vaginal delivery prior to the onset of spontaneous labor. Prevalence of induction of labor is increasing worldwide with subsequent increase in failure rate. However, there is limited evidence on labor induction in Ethiopia. Therefore, this study was aimed at assessing the prevalence and associated factors of failed induction of labor among women undergoing induction of labor at referral hospitals of Amhara national regional state, Ethiopia, 2016. METHOD: A multicenter cross-sectional study was conducted at referral hospitals found in Amhara national regional state from February 01 to September 30, 2016. Multistage sampling technique was employed to select a total of 484 women who underwent labor induction. Pre-tested structured questionnaires and checklists were used to collect the data. Data were entered into EPI info version 7 and analyzed using SPSS version 20 software. Stepwise Binary Logistic regression model was fitted to identify factors associated with failed induction of labor. The level of significance was determined based on the adjusted odds ratio with 95% confidence interval at the p-value of ≤0.05. RESULT: The prevalence of failed induction of labor among women undergoing induction of labor was 31.4% (95% CI: 27.0, 36.0). Failed induction of labor was independently predicted by a Bishop score of ≤5 (AOR = 2.1; 95% CI: 1.3, 3.6), prolonged latent first stage of labor (AOR = 2.0; 95% CI: 1.2, 3.5), induction with oxytocin alone (AOR = 4.2; 95% CI: 2.2, 8.1), nulliparity (ARO = 1.9; 95% CI: 1.2, 2.9), post term pregnancy (AOR = 4.1; 95% CI: 1.8, 9.3) and hypertensive disorder of pregnancy (AOR = 2.4; 95% CI: 1.5, 5.1). CONCLUSION: Failed induction of labor was high in the study area compared to the reports of previous studies done in Ethiopia. The majority of the determinants of failed induction of labor were connected with unjustifiable and inconsistent indication of induction of labor. Thus, preparing standardized practical guidelines and preventing unjustifiable case selection may help reduce the current high failure rates.

Responsabilidad social corporativa en los centros de la red hospitalaria de utilización pública de Cataluña / Corporate social responsibility in the centers of the public hospital network of Catalonia (Spain)

La adopción de un enfoque de gestión que integra la responsabilidad social corporativa en las organizaciones es una tendencia en aumento que da respuesta a las demandas de la sociedad relacionadas con la sostenibilidad, la ética y la transparencia. Las organizaciones sanitarias están adoptando la responsabilidad social corporativa de forma asimétrica, lo que plantea el análisis de los modelos de implantación y las iniciativas desarrolladas. Mediante una investigación cualitativa, con el estudio en profundidad de cuatro casos del ámbito sanitario catalán, se analiza la necesidad de abordar este nuevo enfoque y se identifican buenas prácticas y los retos para su implementación

The adoption of a management approach that integrates corporate social responsibility in organizations is an increasing trend that responds to the demands of society related to sustainability, ethics and transparency. Health organizations are adopting corporate social responsibility asymmetrically, which raises the analysis of the implementation models and the developed initiatives. Through qualitative research, with four in-depth case studies of the Catalan health sector, this article analyzes the need to address this new approach and to identify good practices and the challenges for its implementation

Working on the Frontlines of the COVID-19 Pandemic: A Qualitative Study of Physical Therapists' Experience in Spain.

OBJECTIVE: Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help to identify specific professional duties focused on health assistance objectives. No qualitative study has yet been published, to our knowledge, describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. METHODS: A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers' field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. RESULTS: After identifying 3912 codes and 13 categories, 3 themes emerged. The first theme was "call of duty"; as COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. The second theme was "working in war time." Every day, therapists were given "the war report," receiving their orders, meeting protective personal equipment requirements, and confronting fear. The third theme was "when I arrive at home." Working during the pandemic had an impact on the therapists' families and the information shared with them. CONCLUSIONS: Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. IMPACT: To our knowledge, this is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic.

The effects of the COVID-19 pandemic on risk management practice: A report from the epicenter of the epicenter in New York City.

Health care organizations have had to respond to the Coronavirus disease 2019 (COVID-19) pandemic in unprecedented ways. In the United States, where health risk management is an established profession, health care risk managers (HRMs) contributed to the response by supporting organizations and frontline workers. HRMs advised administrative and clinical leadership on decisions and policies aimed at addressing the medico legal, ethical, and operational dilemmas raised by this public health emergency. This article describes these challenges from the perspective of a New York City (NYC) public hospital located in the "epicenter within the epicenter" of the pandemic and aims to provide practical guidance for HRMs on the front lines of this crisis.

A multicentre point prevalence survey of hospital antibiotic prescribing and quality indices in the Kurdistan regional government of Northern Iraq: the need for urgent action.

BACKGROUND: Rationale antibiotic use is crucial to address antimicrobial resistance (AMR) threats. No study has been undertaken in the Kurdistan Regional Government (KRG) to document current antibiotic use/areas for improvement given the high AMR rates. RESEARCH DESIGN AND METHODS: Point prevalence survey (PPS), using the Global PPS methodology, was conducted among the three major public hospitals in KRG/northern Iraq from September-December 2019. Prevalence and quality of antibiotic use were assessed using agreed indicators. RESULTS: Prevalence of antibiotic use was high (93.7%; n = 192/205); third-generation cephalosporins were the most commonly prescribed antibiotics (52.6%; n = 140/266). Reasons for treatment were recorded for only 61.7% (n = 164/266) of antibiotics and high use (89.9%) of parenteral therapy was observed. All therapy was empirical, no stop/review dates were recorded, and no treatment guidelines were available. The majority of the prescribed antibiotics (62%; n = 165/266) were from the WHO Watch list. CONCLUSION: Prevalence of antibiotic use was high not only versus other hospitals in the region but globally, coupled with significant evidence of sub-optimal prescribing. Swift action is needed to improve future prescribing to reduce AMR. One or two areas should initially be targeted for quality improvement including development of local guidelines, documentation of antibiotic indications, and/or stop/review dates.

Nurses' job stressors and social support behaviors: Comparing public, teaching, and private hospitals.

BACKGROUND: Different work environments may create different nurses' job stressors, and in turn, may need different social support behaviors to help nurses overcome these stressors. AIMS: This study aimed at comparing nurses' job stressors and social support behaviors in three different work environments (i.e., public, teaching, and private hospitals) in Jordan and examining the predictors of these stressors and social support behaviors. MATERIALS & METHODS: This was a descriptive comparative study in which data were collected using the Nursing Stress Scale and the Inventory of Social Supportive Behaviors from 139, 190, and 135 nurses from the public, teaching, and private hospitals, respectively. Descriptive and inferential statistics including comparative and multiple linear regression statistics were used. RESULTS: The results indicated that there were no significant differences in the total scores of job stressors and social support behaviors among nurses at the three types of hospitals. However, significant differences were reported in the subscales of job stressors in teaching and public hospitals and in individual items of both scales across the three kinds of hospitals. Controlling for nurses' characteristics, the scores of both scales were not predicted by the type of hospitals. CONCLUSION: Similar to public hospitals, teaching, and private hospitals, administrators should initiate various social support behaviors in their clinical settings, and should consider the predictors of job stressors to help nurses overcome their job stressors.

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation.

INTRODUCTION: Variation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation; (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations. METHODS AND ANALYSIS: This is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017-2018) and 2 years post Atlas (2021-2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter). ETHICS AND DISSEMINATION: The study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.

Implantación del Sistema Español de Triaje (SET) en los servicios de urgencias generales de los hospitales públicos de Andalucía (España) / Implementation of the Spanish Triage System in the emergency departments of public health service hospitals in Andalusia, Spain

OBJETIVO: Describir el proceso de implantación del Sistema Español de Triaje (SET) en los servicios de urgencias de un Sistema Público de Salud. MÉTODO: Estudio multicéntrico, transversal analítico, con 4 cortes temporales (6 meses preimplantación y 3 semestres siguientes) realizado sobre 29 servicios de urgencias de hospitales (SUH) públicos de Andalucía. Se recogió el tipo de hospital, la proporción de uso del SET, de pacientes clasificados según la prioridad, el tiempo de espera para la clasificación (TECLA) y de duración de esta (TICLA); la proporción de pacientes con TECLA menor de 10 min (PTECLA < 10 min) y con TICLA menor de 5 min (Pticla < 5 min); y la proporción de retornos a urgencias en las siguientes 72 horas, de fallecimientos en urgencias y de fugas del SUH. RESULTADOS: Se observó un incremento progresivo del uso del SET durante los sucesivos periodos, una disminución del TECLA y aumento de la PTECLA < 10 min. El TICLA disminuyó no significativamente con aumento de la pTICLA < 5 min. La proporción de fugas se incrementó globalmente y por tipo de hospital a lo largo de los sucesivos períodos. La proporción de fallecimientos en urgencias no se modificó significativamente y la proporción de retornos en las siguientes 72 horas solo se incrementó significativamente en los hospitales de mayor complejidad (p = 0,019). CONCLUSIONES: La implantación de un sistema estructurado de triaje como el SET es un proceso paulatino que requiere la monitorización de indicadores para conocer el impacto que va teniendo sobre la dinámica asistencial del SUH

OBJECTIVE: To describe the process of implementing the Spanish Triage System (SET, in its Spanish abbreviation) in nonspecialist hospital emergency departments (EDs) in the public health service. METHODS: Multicenter cross-sectional study at 4 time cut-points (6 months before implementation and at the end of 1, 2 and 3 semesters afterwards). The study was carried out in 29 public hospital EDs in Andalusia. We recorded the following data: type of hospital, proportion of cases in which the SET was applied, priority classifications assigned on triage, wait time before triage, and duration of the triage process. We also recorded the following proportions: patients waiting less than 10 minutes for the assigned priority, cases with a triage processing time less than 5 minutes, ED revisits within 72 hours, ED deaths, and patients leaving before discharge. RESULTS: We saw SET use increase progressively over the 3 semesters. The mean wait time decreased, and the proportion of patients waiting less than 10 minutes increased. The mean triage processing time tended to decrease nonsignificantly as the proportion of cases triaged in less than 5 minutes rose. The proportion of patients leaving before discharge increased with time; in overall and by hospital type. The proportion of ED deaths did not change significantly, and revisits within 72 hours increased only in more complex hospitals (P = .019). CONCLUSION: Implementing a structured triage approach like SET is a gradual process. Quality indicators must be followed over time so that the impact of a triage system on ED care processes can be assessed