Lessons from one year experience of pooled procurement of pharmaceuticals: exploration of indicators and assessing pharmacies` performance.

BACKGROUND: Joint procurement of medicines is a way to improve access and justice in developing countries. The aim of this study is to determine local indicators for assessing the performance of joint procurement agencies and compare the indicators in those pharmacies which use centralized purchasing before and after this change. METHODS: This was a mixed method study. In the first qualitative phase, 3 expert panels were held including 20 national experts who were selected through purposeful sampling. Data was analyzed applying a five-stage framework analysis using MAXQDA. In the second quantitative phase, financial, supply and procurement, physical and functional indicators of two hospitals affiliated with joint procurement were assessed and the satisfactions of patients from the pharmacy performance were compared applying a valid questionnaire. Data was analyzed using SPSS through independent test, Paired t-test and ANOVA. RESULTS: Results show that after settlement of joint procurement, the cost of transportation has increased by 54%, a part of the cost of overhead has increased by 30%, the cost of manpower has increased by 88.9% and cost of insurance of warehouses has increased by 71.85% in 2016 compared to 2015. In addition, the total costs of holding were 89.8% of selling revenue. In other words, the profit was about 10% of revenue in total. Moreover the average score of pharmacies under the Holding has been higher than similar ones in all aspects of satisfaction from the patients` points of view. CONCLUSION: The one-year experience of deploying centralized purchasing to supply medicine has led to increased income and patient satisfaction. However, increase in staffing costs, longevity, overhead and warehouse costs have been significant that need appropriate monitoring and interventions. Graphical abstract Graphical abstract of lessons from one year experience of pooled procurement of pharmaceuticals in south of Iran.

Bone cement usage modalities at a multi-site university hospital centre.

BACKGROUND: Although cements are widely used during arthroplasty procedures, few recommendations exist regarding their optimal usage modalities, which, nevertheless, govern the long-term surgical outcomes. No detailed information is available on how cements are used in French hospitals. The objectives of this questionnaire survey among surgeons working at a multi-site university hospital in France were to describe practices, determine whether these varied with surgeon experience, and look for differences compared to recommendations. HYPOTHESIS: Cementing techniques vary widely among surgeons at a university hospital. MATERIAL AND METHODS: A questionnaire was sent to the five orthopaedic departments of our university hospital to collect data on the surgeons (age, sex, years of experience), their practice (type of implants used, annual number of arthroplasties with each arthroplasty type and each indication, and proportion of cemented arthroplasties), the type of cement used, and the cementing technique. RESULTS: Of the 34 surgeons, 21 completed the questionnaire, 20 males and 1 female with a mean age of 41 years (range, 31-59 years) and a mean of 11 years (range, 1-29 years) of experience. High-viscosity antibiotic-loaded cement was preferred by 20 (95%) surgeons, notably for knee arthroplasties, of which the median annual numbers were 55 (range, 0-218) and 8 (range, 1-40) for primary and revision cemented procedures, respectively. Various cementing techniques in ambient air were used: 12/21 (57%) surgeons used pulsed lavage to prepare the bone before cementation and 18/21 (86%) applied the cement to both the bone cuts and the implant. Of the 18 surgeons who performed knee arthroplasties, 12 used pulsed lavage, including 9 of the 11 surgeons with more than 5 years of experience and only 3 of the 7 less experienced surgeons. Similarly, of the 12 surgeons who used pulsed lavage for cemented arthroplasties, 11 were among the 12 surgeons who performed more than 15 cemented arthroplasties annually and 1 was among the 6 who performed fewer cemented arthroplasties. DISCUSSION: Cementing techniques varied widely, reflecting the dearth of recommendations and controversial results of published studies. In our centre, the use of pulsed lavage to improve bone preparation and cement application to both the bone and the implant should be promoted, as both techniques are universally advocated. Our study demonstrates the need to provide surgeons with opportunities to exchange their experiences about the other aspects of cementing in order to harmonise practices and to optimise the use of cement. LEVEL OF EVIDENCE: IV, questionnaire survey.

Percepção da gestação de risco por um grupo de gestantes hipertensas hospitalizadas / Perception of pregnancy risk by a group of pregnant women hypertensive hospitalized

Neste estudo, objetivou-se compreender a percepção da gestação de risco para um grupo de gestantes hipertensas, descrever o significado da gestação de alto risco para elas e identificar suas dificuldades durante o período de internação e suas necessidades de cuidado. Trata-se de um estudo de caráter exploratório, descritivo e qualitativo, realizado em uma maternidade regional do norte do Paraná, com sete gestantes hipertensas de todas as idades, primíparas e multíparas, no 3º trimestre de gestação. Os dados foram coletados de julho a dezembro de 2013, por meio de entrevista semiestruturada, e submetidos à análise de conteúdo. As sete gestantes, com idade entre 25 e 38 anos, eram multíparas, estavam internadas havia mais de sete dias, relataram preocupação com o bem-estar do filho e dificuldade em permanecer hospitalizadas e ausentes do convívio familiar. Demonstraram sentimentos de medo, ansiedade e indignação perante a infraestrutura hospitalar e o atendimento da equipe. Considera-se que as gestantes tiveram dificuldades em verbalizar o significado da gestação, porém expuseram com facilidade suas necessidades de cuidado. À vista disso, é necessário compreender o processo psicológico dessas mulheres para melhorar a assistência oferecida a elas.

This study aimed to understand the perception of the risk of pregnancy to a group of hypertensive pregnant women, describe the meaning of high-risk pregnancy for them and identify their difficulties during the hospital stay and their care needs. This is an exploratory, descriptive and qualitative, held in a regional maternity northern Paraná, with seven hypertensive pregnant women of all ages, primiparous and multiparous, in the 3rd trimester. Data were collected from July to December 2013, through semi-structured interviews and submitted to content analysis. The seven pregnant women, aged 25 and 38, were multiparous, were interned for more than seven days, reporting concern with the child welfare and difficulty staying hospitalized and away from family. They showed feelings of fear, anxiety and anger at the hospital infrastructure and the service of the medical care team. It is considered that pregnant women had difficulty verbalizing the meaning of pregnancy, but exposed to ease their care needs. In view of this, it is necessary to understand the psychological process of these women to improve the care provided to them.

Especificidades contextuais do cuidado de enfermagem à criança em condição crônica hospitalizada / Contextual specificities of nursing care to hospitalized children with chronic condition

Objetivou-se compreender as especificidades contextuais do cuidado de enfermagem à criança em condição crônica hospitalizada. Foi utilizada a abordagem qualitativa apoiando-se nos referenciais teórico e metodológico, respectivamente, o Pensamento Complexo e a Grounded Theory. Os dados foram coletados entre julho e novembro de 2012 por meio da entrevista semiestruturada. Participaram do estudo 18 sujeitos organizados em três grupos amostrais: enfermeiros, técnicos de enfermagem e familiares. A categoria Revelando especificidades contextuais que influenciam o cuidado de enfermagem à criança em condição crônica hospitalizada e suas respectivas subcategorias apresentam os significados do cuidado de enfermagem, aspectos relacionados à hospitalização da criança em condição crônica e as percepções dos participantes acerca do contexto de cuidado. Conclui-se que as relações de cuidado e a hospitalização da criança em condição crônica configuram-se como fenômenos complexos, solicitando do enfermeiro e de sua equipe a valorização do contexto e a articulação de múltiplos saberes e práticas.

This study aimed to understand the contextual specificities of nursing care givento the hospitalized children with chronic conditions. The qualitative approach was usedbased on the theoretical and methodological frameworks, respectively, the Complex Thought and the Grounded Theory. Data were collected from July to November 2012 through semi-structured interviews. The study included 18 subjects arrangedin three sample groups: nurses, nursing technicians and family. The category Revealing contextual specificities that influence nursing care given to hospitalized children with chronic conditionsand its subcategories present the meanings of nursing care, aspects about the hospitalization of children with chronic conditions and perceptions of participants about the care context. We concluded that the care relationships and the hospitalization of children with chronic condition are characterized as complex phenomena, requiring from the nurse and the nursing team the appreciation of the context and articulation of multiple knowledge and practices.

Saberes instrumentais e ideológicos no processo de trabalho de enfermeiros na vigilância epidemiológica hospitalar / Instrumental and ideological knowing in nurses' work process at hospital epidemiologic surveillance

Estudo exploratório, com abordagem qualitativa, cujo objetivo foi identificar os saberes instrumentais e ideológicos presentes nos processos de trabalho de enfermeiros denúcleos hospitalares de epidemiologia. Desenvolvido junto a nove enfermeiros que atuam em Núcleo Hospitalar de Epidemiologia de cinco instituições hospitalares da cidade de Curitiba/PR. Para coleta dos dados, realizada entre março e maio de 2012, utilizou-se roteiro de entrevista aberta, analisados pela análise do discurso. Constatou-se centralidade dos discursos dos enfermeiros nos saberes instrumentais inerentes ao processo de trabalho em vigilância epidemiológica hospitalar e foi evidenciada influência significativa dos saberes instrumentais no cotidiano das ações dos enfermeiros, que buscam espaço de atuação e autonomia nas instituições para consolidação da vigilância epidemiológica hospitalar, mas necessitam de maior reflexão acerca das políticas públicas e de seu processo de trabalho. Acredita-se que este estudo possibilitará a construção de novos caminhos para a atuação dos enfermeiros dos núcleos hospitalares, menos centrados em tarefas, mas na interpretação crítica e na proposição de políticas públicas condizentes com as necessidades de saúde da população e capazes de integrar os diferentes níveis de atenção à saúde.

Exploratory qualitative study, which objectified identify instrumental and ideological knowing present in nurses' work process at Hospital Epidemiologic Centers. It carried out in five hospital institutions with hospital epidemiologic centers in Curitiba, Paraná State/Brazil from March to May/2012. Data collection carried out by means of a closed-ended instrument and secondary sources, with further discourse analysis. From the interviews, empirical categories built: nurses' work process in hospital epidemiologic centers and knowing to work at hospital epidemiologic surveillance, which compared with two previously defined analytical categories: ideological and instrumental knowing. It evidenced that nurses' discourses on instrumental knowing inherent from the work process on hospital epidemiologic surveillance were central due to its recent implementation. Even though work process is an ideological knowing, according to the theoretical background adopted, it was observed a meaningful influence of instrumental knowing in nurses' daily actions, which is still to be set up in the institutions in order to consolidate hospital epidemiologic surveillance, and require more reflection on ideological knowing, represented by public policies and the work process itself.

"The balancing act"--licensed practical nurse experiences of falls and fall prevention: a qualitative study.

BACKGROUND: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. METHODS: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. RESULTS: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. CONCLUSIONS: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

Método de implantación de una acción de mejora en el Servicio de Ginecología del Hospital Universitario Nuestra Sra. de Candelaria / No disponible

En el sector sanitario asistimos a un creciente número de experiencias de autoevaluación deacuerdo al modelo EFQM. Este trabajo muestra el proceso seguido en un hospital público de 900camas localizado en Tenerife, Islas Canarias, en la aplicación de los criterios del modelo EFQM y elproceso para dinamizar el centro donde una experiencia similar había fracasado 5 años antes.Material y métodos. Tras una autoevaluación con el modelo EFQM se identificaron un conjuntode puntos fuertes y áreas de mejora. De las 10 priorizadas, la selección de indicadores para evaluarel core business del centro fue la más destacada. Después de valorar diferentes alternativas, segúnlos criterios impacto, esfuerzo y resultados, se focalizó en los principales procesos del centro que cursarancon hospitalización. Dado que dos de esos procesos estaban vinculados al Servicio de Ginecología,se constituyó un grupo entre facultativos, enfermería, gestores y técnicos para la selección deindicadores de parto, cesárea e histerectomía.Resultados. Siguiendo los criterios de accesibilidad, adecuación, riesgo, eficiencia, satisfacción yefectividad, el equipo de trabajo seleccionó 14 indicadores para la evaluación de parto, cesárea e histerectomía.Conclusiones. La aplicación del modelo EFQM requiere realizar cambios previos en los serviciosde soporte a la gestión. Nos permitió encontrar un foro común, donde facultativos, enfermería,gestores y técnicos pudieron encontrar no sólo nuevos indicadores, sino una nueva forma de ver lascosas para trabajar con un método

An increasing number of self-evaluation experiences developed in the health care sector in Spainwith the application of the European Foundation for Quality Management Excellence Model –EFQMis being seen.This work shows the process of applying the EFQM criteria to a 900 beds public hospitalin Tenerife, Canary Islands as well as the process to dynamize the hospital where a previous processin the same model had failed five years before.Methods. After a self-evaluation with the EFQM model, the organization identified a combinationof strong points and areas of improvement. A total of 10 areas of improvement were selectedto be carried out, that of the selection of indicators to evaluate “core business” of the site standingout the most.After evaluating the different alternatives, according to the criteria of impact, effortand results, focus was placed on the main processes with hospitalization of the site. Given thatthese processes belonged to the Gynecology Department of the hospital, a team formed by doctors,managers, nurses and technicians was formed to select the indicators for delivery, caesareanand hysterectomy.Results. According to accessibility, adequacy, risk, efficiency, satisfaction and effectivity, the workteam selected 14 indicators for evaluation of the caesarean, delivery and hysterectomy.Conclusions. Application of the European Foundation for Quality Management Excellence Modelrequires previous changes in the clinical management support. It allows us to find a common panelwhere doctors, nurses, managers and technicians not only can find new indicators but also a newpoint of view in order to work with a method

Patología cutánea benigna banal y sistema público. Experiencia en el Departamento de Salud 19 de la Comunidad Valenciana / Treatment of minor and benign skin lesions in the spanish public health system: experience in health Area 19 of the Autonomous Community of Valencia

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Pain characteristics and demographics of patients attending a university-affiliated pain clinic in Toronto, Ontario.

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices. OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario. METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto. RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral. CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

Quality or equality? The Norwegian experience with medical monopolies.

BACKGROUND: In order to maintain both quality and efficiency of health services in a small country with a scattered population, Norway established a monopoly system for 38 highly specialized medical services. The geographical distributions of these services, which are provided by one or two university hospitals only, were analysed. METHODS: The counties of residence for 2,711 patients admitted for the first time in 2001 to these 31 monopolies and 7 duopolies were identified. RESULTS: The general tendency observed was that with increasing distance from residential home to monopoly hospitals there was a declining coverage of these health services. The same pattern was found even with regard to explicit diagnoses or treatments such as organ transplantations (except renal transplantations). Duopolies seemed to yield a more even geographical distribution of the services. CONCLUSION: Monopolies may serve as a useful means for maintaining quality in highly specialized medical services, but seem to have an inherent tendency to do this at the expense of geographical equality.

Proyecto de mejora continua en el Complejo Hospitalario Universitario de Albacete / The quality of Health Care Services. Project of Continuing Improvement in the Complejo Hospitalario Universitario of Albacete

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Condições de vida e trabalho de médicos em um hospital universitário / Life and working conditions among physicians at a university hospital

Este trabalho avaliou as condições de vida e trabalho de médicos que trabalhavam em um hospital universitário. Utilizou-se um questionário contendo dados ocupacionais e o Medical Outcomes Study 36 – Item Short-Form Health Survey (SF-36). Participaram 91 cirurgiões e 95 clínicos, predominantemente do sexo masculino. A média da idade dos cirurgiões foi de 44,5 e dos clínicos, de 46 anos. A carga horária média total de trabalho foi 51,8 para cirurgiões e 44,1 horas/semana para clínicos. Referiram trabalhar em outros locais 87,9 por cento dos cirurgiões e 51,6 por cento dos clínicos. O domínio Aspectos Físicos apresentou diferença estatística significante, sendo menor entre os clínicos

Uso inadecuado de la hospitalización en cirugía general. Magnitud, factores asociados y causas / Inappropriate hospitalization use in general surgery wards. Magnitude, associated factors and causes

Objetivo. Identificar la proporción de estancias inadecuadas en los servicios de cirugía general de 3 hospitales universitarios, los factores asociados a la inadecuación y sus causas. Material y método. Revisión concurrente de 596 estancias, durante una semana en el año 2000, utilizando el Appropriateness Evaluation Protocol. Se analizó la asociación entre la inadecuación de la estancia y diversas variables independientes, mediante análisis bivariable y multivariable. Tambien se describen las causas de inadecuación. Resultados. El 17,6% de las estancias fueron evaluadas como inadecuadas, sin diferencias significativas entre hospitales (el 21,5, el 12,5 y el 17,5%). La inadecuación se asoció a los fines de semana (odds ratio = 2,1), ingreso programado (odds ratio = 2,9), ingresos de más de una semana de duración (odds ratio = 2,3), último tercio de la estancia (odds ratio = 3,7) y a la inadecuación del día de ingreso (odds ratio = 2,1). Las principales causas de estancias inadecuadas fueron los problemas organizativos del hospital y del manejo clínico del alta hospitalaria. Conclusiones. Las estancias inadecuadas suponen un importante componente de la duración de la estancia, y se deben fundamentalmente a problemas de programación quirúrgica y, sobre todo, de la gestión médica de las altas, aspectos que dependen de la propia organización de los servicios quirúrgicos y los servicios hospitalarios relacionados (AU)

Objective. To determine the proportion of inappropriate days of hospitalization in the general surgery wards of three university hospitals, its causes, and associated factors. Material and method. We concurrently reviewed 596 days of hospitalisation during a 1-week period in 2000, using the Appropriateness Evaluation Protocol (AEP). The association among inappropriate days of hospital stay and independent variables was evaluated using bivariable and multivariable methods. Finally, the causes for inappropriate hospitalization use were analyzed. Results. The percentage of inappropriate days was 17.6%, with no significant differences among the hospitals (21.5%, 12.5% and 17.5%). Inappropriate days were associated with the weekend (odds ratio [OR] = 2.1, scheduled admissions (OR = 2.9), hospital stay of more than 1 week (OR:2.3), the last third of the hospital stay (OR: 3.7), and inappropriate admission (OR: 2.1). The main causes of inappropriate hospital stays were organizational problems in the hospital or in the clinical management of discharge. Conclusions. Inappropriate days of hospitalization represent a considerable percentage of hospitalization in surgery wards. The main reasons for inappropriate days are problems with surgical and discharge planning and factors that depend on the organization of the surgery departments and other related departments in the hospital (AU)

La antibioterapia en monodosis: una opción de mejora en las neumonías adquiridas en la comunidad / Single-dosse antibiotic therapy: an option for improvement in community-acquired pneumonias

Introducción: El tratamiento de las neumonías adquiridas en la comunidad (NAC) con antibióticos en monoterapia y monodosis (MM) ha demostrado la misma efectividad clínica que las pautas clásicas de antibioterapia fraccionada, a la vez que disminuye la estancia hospitalaria. Esto hace que la MM constituya una opción de mejora. Objetivo: Comprobar sí las características del tratamiento de las NAC con MM eran exportables a un hospital diferente de aquellos en los que se habían descrito inicialmente. Material y método. Estudio de intervención para la mejora de la calidad, en el período de enero a mayo de 1999. Tipo de muestreo: consecutivo. Datos recogidos: edad, sexo, puntuación APACHE II e índice de Charlson para comorbilidades, tiempo de estancia, mortalidad a 30 días, reingresos en los 10 días siguientes del alta hospitalaria, tiempos de enfermería en preparar y suministrar el tratamiento. En la etapa I se compararon las pautas de MM con levofloxacino o ceftriaxona frente a la pauta clásica de cefotaxima cada 6 h acompañada de un macrólido cada 12 h. En la etapa II se compararon entre sí las pautas de MM: levofloxacino frente a ceftriaxona. Durante todo el estudio se aplicaron guías de práctica clínica comunes a todos los pacientes con NAC. En la etapa III, según los resultados obtenidos y a las evidencias bibliográficas, el grupo de expertos seleccionó la pauta definitiva. Resultados: En la etapa I el tiempo medio ñ desviación estándar (DE) de estancia de las NAC tratadas con MM fue de 151 ñ 80,6 h frente a 204 ñ 110,4 horas en el tratamiento clásico, siendo la diferencia estadísticamente significativa y clínicamente relevante. No se detectaron diferencias en la mortalidad y reingresos; el tiempo de enfermería fue de 4 min/paciente/día en la MM frente a 16 minutos en el tratamiento clásico. En la segunda etapa no se detectaron diferencias entre los dos tipos de MM empleadas; si bien no se alcanzó el tamaño adecuado de la muestra. El grupo de expertos seleccionó la MM con levofloxacino por permitir un tratamiento secuencia¡ sin cambio de fármaco y porque su biodisponibilidad oral próxima al cien por cien permite iniciar el tratamiento oral rápidamente. Comentario: Nuestros resultados ponen de manifiesto que la MM supone una opción de mejora en nuestro hospital, dado que al disminuir los tiempos de estancia por paciente junto con un ahorro en el tiempo de enfermería mejora la utilización de las camas sin incrementar los riesgos para el paciente (AU)

Gerência de enfermagem em hospital universitário: o planejamento como política de ação / The manager nurse's planning practice to the intern units of a federal public academic hospital

A temática central deste estudo é a prática de planejamento de enfermeiras gerentes de unidades de internação de um hospital universitário público federal. Os objetivos se propõem analisar, a partir do ponto de vista de enfermeiras, dentro da ótica processual, e discutir as evidências empíricas da prática de planejamento em suas ações e ênfase dada a elas tendo por base componentes organizacionais. A coleta de dados foi realizada por entrevista semi-estruturada aberta complementada pela observação de campo direta do cotidiano de trabalho da enfermeira em seis unidades de internação. Trata-se de uma investigação de natureza qualitativa, buscando compreender, numa perspectiva dialética, o saber e o fazer da enfermeira sobre planejamento....

An audit of blood cross-match ordering practices at the Aga Khan University Hospital: first step towards a Maximum Surgical Blood Ordering Schedule.

OBJECTIVE: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines. METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio (C/T ratio) and Transfusion Index (Ti) for each of the elective surgical procedures was performed during the study period. C/T ratio is used as a measure of the efficiency of blood ordering practice. It should ideally be between 2 and 2.5. We compared our results with the ideal. RESULTS: Data was analyzed for 32 elective surgical procedures in 2131 patients. Majority (2079) (97.56%) of the patients had C/T ratios higher than 2.5. Only 12 in 450 (21.11%) patients, had a Transfusion Index (Ti) higher than 0.5. There were 13 procedures in which both C/T ratio was greater than 2.5 and Ti less than or equal to 0.5. CONCLUSION: In vast majority of elective surgical procedures routine cross match is not necessary. We propose a draft Maximum Surgical Blood Ordering Schedule (MSBOS). It provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively. Implementation of MSBOS will result in about 60% reduction of cost to the patients.

Estrenamos servicio de urgencias, ¿mejora la satisfacción de los pacientes? / We inaugurate an emergency service: this improves satisfation of patients?

Objetivo: Evaluar si se modifica la satisfacción de los pacientes que acuden al Servicio de Urgencias de un hospital de agudos, al cambiar su emplazamiento y su estructura física. Metodología: Dos encuestas telefónicas a usuarios del Servicio de Urgencias. La primera en 1997 y la segunda en 1998. Entre ambos periodos se estrena un nuevo Servicio de Urgencias. Se obtienen datos de opinión en relación a tiempos de espera, trato, información recibida, organización y estructura del servicio. Se comparan las proporciones o medias de estas variables entre las dos encuestas. Resultados: Se realizaron 135 y 143 encuestas. Las variables que muestran diferencias estadísticamente significativas son el tiempo medio hasta el triage, el tiempo medio hasta que llega el resultado de las pruebas, así como las que hacen referencia a la estructura física del servicio. El resto de las variables, relacionadas con el trato y la información que recibe el enfermo o la organización del servicio no muestran diferencias significativas. La calidad global media del servicio se puntúa de forma muy similar (8,15 frente a 8,45), así como el porcentaje que considera que se resolvió su problema o que volvería a usar el mismo servicio en caso necesario. Conclusiones: La reestructuración efectuada en el Servicio de Urgencias sí ha influido de manera positiva en el grado de satisfacción, mejorando la opinión de los pacientes sobre la estructura física y disminuyendo algunos tiempos de espera. No han variado las opiniones sobre el resto de las variables, lo que apunta a la búsqueda de nuevas estrategias para mejorar la calidad del servicio prestado (AU)