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1.
Isr Med Assoc J ; 21(10): 644-648, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599503

RESUMO

BACKGROUND: Surgery is a core activity in hospitals. Operating rooms have some of the most important and vital functions in medical centers. The operating rooms and their staff are a valuable infrastructure resource and their availability and preparedness affect human life and quality of care. OBJECTIVES: To prepare operational suggestions for improving operating room utilization by mapping current working processes in the operating rooms of a large private medical center. METHODS: Data on 23,585 surgeries performed at our medical center between August 2016 and March 2017 were analyzed by various parameters including utilization, capacity, working hours, and surgery delays. RESULTS: Average operating room utilization was 79%, while 21% was considered lost operating room time. The two major factors that influenced the lost operating room time were the time intervals between planned usage blocks and the partial utilization of operating room time. We calculated that each percent of utilized operating room time translates into 440 surgeries annually, resulting in a potential annual increase in income. CONCLUSIONS: Increasing operating room utilization would result in an improvement of operating room availability and an increased number of procedures. Our analysis shows that operating room utilization in the private healthcare system is efficient compared to the public healthcare system in Israel. Therefore the private healthcare system should be treated as a contributing factor to help lower surgery waiting times and release bottlenecks, rather than being perceived as contributing to inequality.


Assuntos
Hospitais Privados , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Humanos , Israel
2.
Bone Joint J ; 101-B(9): 1081-1086, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474135

RESUMO

AIMS: The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon's cases and the total time spent in the operating theatre per day. MATERIALS AND METHODS: A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared. RESULTS: A total of 3633 TKAs were performed (1782 on nonoverlapping days; 1851 on overlapping days). There were no differences between the two groups for length of inpatient stay, payments, mortality, emergency room visits, or readmission during the 90-day postoperative period. The overlapping group had 0.74 fewer skilled nursing days (95% confidence interval (CI) -0.26 to -1.22; p < 0.01), and 0.66 more home health visits (95% CI 0.14 to 1.18; p = 0.01) than the nonoverlapping group. On overlapping days, surgeons performed more cases per day (5.01 vs 3.76; p < 0.001) and spent more time operating (484.55 minutes vs 357.17 minutes; p < 0.001) than on nonoverlapping days. CONCLUSION: The study shows that the practice of alternating operating theatres for TKA has no adverse effect on the clinical outcome or economic utilization variables measured. Furthermore, there is opportunity to increase productivity with alternating theatres as surgeons with overlapping cases perform more cases and spend more time operating per day. Cite this article: Bone Joint J 2019;101-B:1081-1086.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos , Duração da Cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/economia , Boston/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Humanos , Tempo de Internação , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Salas Cirúrgicas/organização & administração , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
3.
Med Ref Serv Q ; 38(3): 252-259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379281

RESUMO

Librarians gather data on multiple aspects of their work. Much of the data collection revolves around the library's resources, but what may be passed over during this data collection is information on how librarians are expending their time and effort. A group of librarians from a community hospital system designed a Microsoft Access database to collect such data and has been recording librarians' efforts for more than three years. The librarians use the data in annual reports and can track trends to evaluate service priorities and maximize effective use of the librarians' time.


Assuntos
Coleta de Dados/métodos , Eficiência Organizacional/estatística & dados numéricos , Bibliotecários/estatística & dados numéricos , Bibliotecas Hospitalares/organização & administração , Bibliotecas Médicas/organização & administração , Papel Profissional , Humanos , Indiana , Estudos de Casos Organizacionais
4.
Med Care ; 57(9): 688-694, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31335757

RESUMO

OBJECTIVE: Applied to value-based health care, the economic term "individual productivity" refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient's likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. RESEARCH DESIGN: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. SUBJECTS: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. MEASURES: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. RESULTS: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (-0.48 absolute percentage points, P<0.001) and an ED visit (-0.29 absolute percentage points, P=0.042). CONCLUSIONS: Variability in individual clinician productivity can have implications for acute care quality patient outcomes.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Alta do Paciente/normas , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Análise por Conglomerados , Feminino , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/normas , Adulto Jovem
5.
Am J Health Syst Pharm ; 76(6): 353-359, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361842

RESUMO

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.


Assuntos
Call Centers/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Erros de Medicação/prevenção & controle , Segurança do Paciente , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Implementação de Plano de Saúde , Humanos , Auditoria Administrativa/estatística & dados numéricos , Comportamento Multitarefa , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/organização & administração , Técnicos em Farmácia/psicologia , Técnicos em Farmácia/estatística & dados numéricos , Papel Profissional/psicologia , Avaliação de Programas e Projetos de Saúde , Gestão da Segurança/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Telefone , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
6.
JAMA Netw Open ; 2(6): e196201, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31225894

RESUMO

Importance: There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention. Objective: To examine organizational characteristics associated with trust. Design, Setting, and Participants: This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016. Main Outcomes and Measures: Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more. Results: The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04). Conclusions and Relevance: Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.


Assuntos
Pessoal de Saúde/psicologia , Organizações/normas , Atenção Primária à Saúde/normas , Confiança , Local de Trabalho/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comunicação , Eficiência Organizacional/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Saúde do Trabalhador/normas , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/etiologia , Cultura Organizacional , Organizações/estatística & dados numéricos , Lealdade ao Trabalho , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional , Estudos Prospectivos , Responsabilidade Social , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
7.
Br J Nurs ; 28(10): 619-627, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31116591

RESUMO

BACKGROUND: nurse-led telephone advice line (TAL) services have been endorsed by the Royal College of Nursing (RCN) and provide patients and their carers with expert advice and self-management strategies. Identified helpline shortfalls in one rheumatology TAL included a high number of inappropriate calls, calls not recorded in patients' records, and no formal process for assigning calls to nurses. Using RCN guidelines, the service was redesigned by specialist rheumatology nurses to address these issues. METHOD: troubleshooting sessions were used to identify solutions to shortcomings in the helpline processes. Following service redesign, nurse/user feedback was collated, and efficiency savings achieved from reducing face-to-face appointments were calculated. RESULTS: the new TAL received fewer inappropriate calls, was received positively by staff and patients, and saved approximately £354 890 a year for the local clinical commissioning group. CONCLUSION: rheumatology nurses successfully improved a TAL using RCN guidance. The approach could be used by other trusts to improve patient helplines and contribute to the NHS drive for efficiency.


Assuntos
Consulta Remota , Doenças Reumáticas/enfermagem , Medicina Estatal/organização & administração , Telefone , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Satisfação do Paciente/estatística & dados numéricos , Medicina Estatal/economia , Reino Unido
8.
J Surg Res ; 241: 103-106, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31018168

RESUMO

BACKGROUND: Research is a vital component of a plastic surgery residency. Residents participating in research are better able to critically evaluate literature, allowing them to stay current throughout their careers. Programs benefit from increased research by increasing their academic reputation and attracting stronger applicants. To discuss ongoing research projects, foster collaboration, and encourage resident involvement, a quarterly research meeting was implemented within our division. We report the effectiveness of a dedicated division-wide quarterly research meeting in increasing the academic productivity of plastic surgery residents. MATERIALS AND METHODS: Beginning in 2015, the Division of Plastic Surgery at our institution implemented a dedicated quarterly research meeting. Academic productivity was assessed by the number of publications in peer-reviewed journals, oral presentations at national meetings, and oral presentations at regional meetings. We examined the change in productivity before and after the implementation of the quarterly meeting. Unpaired t-test was used to compare temporal differences. A direct temporal comparison was made between the 3 y of data before the implementation of the quarterly meetings and the 2 y of data after implementation. RESULTS: In the 2 y after the implementation of the research meeting, residents published significantly more often with an average of 2 peer-reviewed journal articles published per year per resident compared with 0.47 peer-reviewed publications in the 3 y before implementation (2 versus 0.47 publications per resident per year, P = 0.009). Residents were also more likely to present at national (0 versus 0.75 presentations per resident per year, P = 0.028) and regional meetings (0 versus 1 presentations per resident per year, P = 0.001). CONCLUSIONS: Implementation of a formal quarterly research meeting significantly improves resident research productivity. Residents demonstrated more publications and oral presentations. These results suggest that a more formal quarterly discussion of division-wide research can improve resident research productivity.


Assuntos
Pesquisa Biomédica/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Internato e Residência/organização & administração , Cirurgia Plástica/educação , Pesquisa Biomédica/estatística & dados numéricos , Comunicação , Congressos como Assunto/estatística & dados numéricos , Processos Grupais , Humanos , Internato e Residência/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Editoração/estatística & dados numéricos
9.
Am J Med ; 132(8): 907-911, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30928345

RESUMO

Thirty-two percent of US health care spending goes to hospital care, and 20% goes to physicians' charges. The cost of hospital care in the United States is 2-3 times greater than in most similar countries. A large part of the high cost is due to a very large administrative overhead. Both higher quality and lower cost would be achieved if complex procedures were done in fewer centers. Hospitals with a geographic or prestige monopoly receive higher payments than warranted. As physicians are increasingly employed by hospitals rather than independent, costs go up with no added benefit to patients. The United States has too many specialists and too few primary care physicians. Practice guidelines are slanted to favor expensive treatments, often with little solid evidence behind the recommendations.


Assuntos
Assistência à Saúde/normas , Hospitais/tendências , Médicos/economia , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Eficiência Organizacional/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Hospitais/estatística & dados numéricos , Humanos , Prática Associada/economia , Prática Associada/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estados Unidos
10.
J Med Syst ; 43(5): 139, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30972511

RESUMO

Hospital scheduling presents huge challenges for the healthcare industry. Various studies have been conducted in many different countries with focus on both elective and non-elective surgeries. There are important variables and factors that need to be taken into considerations. Different methods and approaches have also been used to examine hospital scheduling. Notwithstanding the continuous changes in modern healthcare services and, in particular, hospital operations, consistent reviews and further studies are still required. The importance of hospital scheduling, particularly, has become more critical as the trade-off between limited resources and overwhelming demand is becoming more evident. This situation is even more pressing in a volatile country where shootings and bombings in public areas happened. Hospital scheduling for elective surgeries in volatile country such as Iraq is therefore often interrupted by non-elective surgeries due to war-related incidents. Hence, this paper intends to address this issue by proposing a hospital scheduling model with focus on neuro-surgery department. The aim of the model is to maximize utilization of operating room while concurrently minimizing idle time of surgery. The study focused on neurosurgery department in Al-Shahid Ghazi Al-Hariri hospital in Baghdad, Iraq. In doing so, a Mixed-integer linear programming (MILP) model is formulated where interruptions of non-elective surgery are incorporated into the main elective surgery based model. Computational experiment is then carried out to test the model. The result indicates that the model is feasible and can be solved in reasonable times. Nonetheless, its feasibility is further tested as the problems size and the computation times is getting bigger and longer. Application of heuristic methods is the way forward to ensure better practicality of the proposed model. In the end, the potential benefit of this study and the proposed model is discussed.


Assuntos
Agendamento de Consultas , Conflitos Armados/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Salas Cirúrgicas/organização & administração , Algoritmos , Hospitais Públicos/organização & administração , Humanos , Iraque , Modelos Teóricos , Admissão e Escalonamento de Pessoal/organização & administração , Estudos Prospectivos , Melhoria de Qualidade/organização & administração , Fatores de Tempo
11.
Artigo em Inglês | MEDLINE | ID: mdl-30832384

RESUMO

We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures of clinical scores, as well as a rich set of covariates, we found that the relationship was indeed hump-shaped. At the two extremes, departments with an insufficient (excessive) number of physicians may gain a substantial increase in healthcare quality by the addition (dismissal) of a single physician. The marginal elasticity of healthcare quality with respect to the number of physicians, although positive and significant, was much smaller than the marginal contribution of other factors. Moreover, research quality conducted at the ward level was shown to be an important moderator. Our results suggest that studying the relationship between the number of physicians per bed and the quality of healthcare at an aggregate level may lead to bias. Framing the problem at the ward-level may facilitate a better allocation of physicians.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
Indian J Dent Res ; 30(1): 117-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30900669

RESUMO

Background: School based dental screening has been a popular public health intervention. However, literature provides contrasting evidence regarding effectiveness of such programs on the utilization of dental services. Objectives: We designed this review to understand the differences in dental attendance rates of children below 15 years of age, receiving a school based dental screening versus those not receiving it. Material and Methods: The standard methodological procedures prescribed by The Cochrane Collaboration for Systematic review and meta-analysis was employed. An electronic (MEDLINE via PUBMED, Cochrane trial registry, and Google scholar) and a manual search (2016) were made to identify studies. Results: Five studies met the inclusion criteria, covering a population of 28208 school children of which 21447 were included in the meta-analysis. The review concludes that school based dental screening marginally increases the dental attendance by 16 percent as opposed to a non-screening group (RR 1.16 (95% CI 1.11, 1.21). The quality of evidence was found to be low. Conclusions: There is evidence of marginally increased dental attendance rate of 16 % following screening. As the quality of evidence was found to be low, the results of this review may be used with caution.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde , Instituições Acadêmicas/estatística & dados numéricos , Doenças Estomatognáticas/prevenção & controle , Adolescente , Criança , Pré-Escolar , Bases de Dados Bibliográficas , Feminino , Humanos , Masculino
13.
N Z Med J ; 132(1490): 10-16, 2019 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789884

RESUMO

BACKGROUND: Electronic whiteboards have largely replaced the use of traditional whiteboards in many hospital departments. They are used to electronically record and display a variety of patient information to streamline the admission process and the quality of handover between relevant staff. We assessed the impact of such a system upon the patient admission process in a busy general surgery department. METHODS: A survey of 12 qualitative questions was completed by surgical registrars working within a general surgery department in 2013 prior to the introduction of electronic whiteboards and again in 2016 after introduction. The questions compared the satisfaction of the admission process before and after its introduction. RESULTS: There was an improvement in staff satisfaction with the admissions process after the introduction of electronic whiteboards (78% vs 9% high level of satisfaction, p<0.05). A statistically non-significant rise was also seen in individual areas of the admissions and handover process. No change was seen in staff attitude to security of patient details (50% vs 42% high level of satisfaction, p=0.671). CONCLUSION: Electronic whiteboards assist in the process of admitting patients to a general surgical department. This strengthens the case for the introduction of electronic whiteboards across a range of hospital departments.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Admissão do Paciente/normas , Centro Cirúrgico Hospitalar , Atitude do Pessoal de Saúde , Sistemas de Informação Hospitalar/normas , Humanos , Comunicação Interdisciplinar , Nova Zelândia , Melhoria de Qualidade , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/normas , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-30641889

RESUMO

Housing adaptation is a rehabilitation intervention that removes environmental barriers to help older people accommodate changing needs and age in place. In the UK, funding application for home adaptations to local authorities is subject to several procedural steps, including referral, allocation, assessment, funding and installation. The five stages need to complete in a sequential manner, often cause long delays. This study aims to investigate the timelines across these key stages of the adaptation process and examine the main causes of delays in current practice. A mixed-methods research strategy was employed. A questionnaire survey was first undertaken with all 378 local authorities in England, Scotland and Wales; it was followed by 5 semi-structured interviews and 1 focus group meeting with selected service providers, and 2 case studies of service users. The results showed that the average length of time taken to complete the whole process is relatively long, with the longest waiting time being observed at the funding decision stage. Delays were found in each of the key stages. Main causes of delay include insufficient resources, lack of joint work, legal requirements, shortage of competent contractors and the client's decisions. These issues need to be addressed in order to improve the efficiency and effectiveness of future housing adaptation practice.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Envelhecimento Saudável , Habitação para Idosos/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões Gerenciais , Humanos , Masculino , Medicina Estatal/organização & administração , Inquéritos e Questionários , Fatores de Tempo , Reino Unido
15.
Curr Probl Diagn Radiol ; 48(1): 37-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29397269

RESUMO

With integration of the Radiological Information Systems (RIS), Picture Archiving and Communication systems (PACS), and reporting systems, patient identifiers and examination information can automatically map into examination reports. There are many potential benefits of report automation to radiologists including improvements in efficiency, accuracy, and fatigue. In this article we describe a 2 part study, with the first part being an anonymous survey of radiologists concerning report automation. A total of 13 staff radiologists and 9 radiology residents at a single institution completed an anonymous survey. Respondents were asked if automatic population of examination description, comparison examination data, indications, computed tomography dose, technique, and copy to physician data saved time, decreased fatigue, and increased accuracy. Respondents were asked if a "copy findings" function saved time. The second objective part of the study was a mock examination experiment to assess time savings of report automation and to assess error rates. Of all, 9 radiologists were asked to dictate fields for 8 mock examinations. Subjects were timed and reporting errors monitored. Estimated daily time savings and error rates were calculated assuming a mix of 80 studies. A total of 95% surveyed responded that report automation saved time; 91% that report automation improved accuracy of dictations; 82% that report automation decreased fatigue. Furthermore, 83% of copy finding function users reported time savings. Average time to dictate these prepopulated fields was 51 seconds per study. Average error rate per report was 0.86, with an average of 0.26 errors remaining uncorrected upon report completion. Estimated average time per day saved per radiologist from report automation was 68 minutes. Estimated average corrected errors was 48 per day. Estimated average uncorrected or missed errors was 21 per day. These estimated benefits from report automation result from tight integration of RIS, PACS, and reporting systems.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Radiologistas/psicologia , Sistemas de Informação em Radiologia/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Atitude Frente aos Computadores , Automação , Humanos , Inquéritos e Questionários , Fatores de Tempo
16.
Health Promot J Austr ; 30(2): 228-237, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30168878

RESUMO

BACKGROUND: "Workplace health promotion and protection" broadly refers to an integrated approach to workplace health and safety initiatives. There are substantial benefits to adopting such an approach, including the potential for: improvements to individual employees' health and well-being; increased productivity; and reduced safety risks and expenses. Yet many employers remain reluctant to shift from traditional safety initiatives and spending. This paper aims to demonstrate the value of investing in an integrated health promotion and protection approach by calculating the productivity costs associated with 11 modifiable health risks and 14 chronic conditions in an Australian mining company. METHOD: Eight hundred and ninety-seven employees participated in a self-report health survey aimed at investigating employee health behaviours, health conditions and productivity. RESULTS: Overall, modifiable health risks and chronic health conditions were calculated to contribute to an estimated $22.15 million (AUD) and $7.95 million (AUD) in lost productivity per 1000 employees per annum, respectively. Although employee stress was identified as the third highest prevalence health risk across the employee sample (at 42%), it accounted for the highest financial burden. CONCLUSION: Employee health plays a vital role in the profitability, productivity, and safety outcomes of an organisation. For modifiable health risks and chronic conditions, ailments that affected cognition resulted in the highest financial burden (ie, stress and migraine headaches). SO WHAT?: These findings make a strong financial and business case for the integration of preventative health and safety initiatives, with particular emphasis on modifiable health risk behaviours.


Assuntos
Análise Custo-Benefício/economia , Eficiência Organizacional/economia , Promoção da Saúde/economia , Promoção da Saúde/métodos , Saúde do Trabalhador/economia , Local de Trabalho/economia , Adolescente , Adulto , Austrália , Doença Crônica , Análise Custo-Benefício/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mineração/economia , Saúde do Trabalhador/estatística & dados numéricos , Adulto Jovem
17.
Ophthalmology ; 126(3): 347-354, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30312629

RESUMO

PURPOSE: To improve clinic efficiency through development of an ophthalmology scheduling template developed using simulation models and electronic health record (EHR) data. DESIGN: We created a computer simulation model of 1 pediatric ophthalmologist's clinic using EHR timestamp data, which was used to develop a scheduling template based on appointment length (short, medium, or long). We assessed its impact on clinic efficiency after implementation in the practices of 5 different pediatric ophthalmologists. PARTICIPANTS: We observed and timed patient appointments in person (n = 120) and collected EHR timestamps for 2 years of appointments (n = 650). We calculated efficiency measures for 172 clinic sessions before implementation vs. 119 clinic sessions after implementation. METHODS: We validated clinic workflow timings calculated from EHR timestamps and the simulation models based on them with observed timings. From simulation tests, we developed a new scheduling template and evaluated it with efficiency metrics before vs. after implementation. MAIN OUTCOME MEASURES: Measurements of clinical efficiency (mean clinic volume, patient wait time, examination time, and clinic length). RESULTS: Mean physician examination time calculated from EHR timestamps was 13.8±8.2 minutes and was not statistically different from mean physician examination time from in-person observation (13.3±7.3 minutes; P = 0.7), suggesting that EHR timestamps are accurate. Mean patient wait time for the simulation model (31.2±10.9 minutes) was not statistically different from the observed mean patient wait times (32.6±25.3 minutes; P = 0.9), suggesting that simulation models are accurate. After implementation of the new scheduling template, all 5 pediatric ophthalmologists showed statistically significant improvements in clinic volume (mean increase of 1-3 patients/session; P ≤ 0.05 for 2 providers; P ≤ 0.008 for 3 providers), whereas 4 of 5 had improvements in mean patient wait time (average improvements of 3-4 minutes/patient; statistically significant for 2 providers, P ≤ 0.008). All of the ophthalmologists' examination times remained the same before and after implementation. CONCLUSIONS: Simulation models based on big data from EHRs can test clinic changes before real-life implementation. A scheduling template using predicted appointment length improves clinic efficiency and may generalize to other clinics. Electronic health records have potential to become tools for supporting clinic operations improvement.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Agendamento de Consultas , Eficiência Organizacional/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Adolescente , Criança , Pré-Escolar , Simulação por Computador , Humanos , Lactente , Recém-Nascido , Oftalmologia/organização & administração , Fatores de Tempo , Fluxo de Trabalho
18.
Int J Health Plann Manage ; 34(1): e679-e693, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30298949

RESUMO

BACKGROUND: Previous performance evaluations among community health service centres (CHSCs) have been mainly based on absolute indicators, while the operation index, a more comprehensive evaluation method, has been rarely used in evaluation. This study aimed to develop a set of operation index suitable for the evaluation of CHSCs in Pudong. METHODS: The operation index system, developed based on a literature review, focus group, and factor analysis, was applied to all 45 CHSCs in Pudong. The data were mainly derived from the Pudong Health Statistics Information System from 2010 to 2014. The analysis included a descriptive analysis, t tests, variance analysis, and repeated measures analysis of variance. RESULTS: Different aspects of the operation index showed different developing trends during 2010 to 2014. The overall operation, service operation, management condition, and comprehensive satisfaction index were significantly different in different years (P < 0.05). However, the differences in the development foundation index were not obvious (P > 0.05). Moreover, the regional factor and medical association influenced the performance of service operation index, and the informatization level affected the performance of overall operation and management condition index (P < 0.05), with different family GP programmes level affecting management condition index (P < 0.05). CONCLUSION: Changes in the management condition index led to fluctuations in overall operation in the CHSCs. Since regional factors, family GP programmes, and medical associations promoted the operation of CHSCs, we advocate a multi-dimensional evaluation combining horizontal performance appraisal and vertical index evaluation to focus on these factors.


Assuntos
Centros Comunitários de Saúde/organização & administração , Eficiência Organizacional , Indicadores de Qualidade em Assistência à Saúde , China , Eficiência Organizacional/estatística & dados numéricos , Grupos Focais , Reforma dos Serviços de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
19.
Psychol Serv ; 16(1): 134-142, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30431307

RESUMO

In response to the growing awareness of the high rates of potentially traumatic experiences and their potential adverse impacts, health and human service providers have increasingly focused on implementing trauma-informed care (TIC). However, studies focusing on effective implementation have been limited. In this study, we explored the relationship of individual and agency characteristics to the level of organizational TIC. With data collected from a sample of 345 providers from 67 agencies, we used the TICOMETER, a brief measure of organizational TIC with strong psychometric properties, to determine these associations. We found weak relationships between individual factors and TICOMETER scores and stronger associations for agency-level factors. These included agency type, time since last trauma training, and involvement of service users. These findings highlight the importance of robust cultural changes, service user involvement at all levels of the organization, flattening power differentials, and providing ongoing experiential training. This analysis fills an important gap in our knowledge of how best to ensure agency-wide provision of TIC. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Eficiência Organizacional , Órgãos Governamentais , Pessoal de Saúde , Competência Profissional , Trauma Psicológico/terapia , Psicometria/instrumentação , Desenvolvimento de Pessoal , Adulto , Eficiência Organizacional/estatística & dados numéricos , Feminino , Órgãos Governamentais/estatística & dados numéricos , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Pessoal/estatística & dados numéricos
20.
Int J Health Plann Manage ; 34(1): 414-442, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30303272

RESUMO

FUNDAMENTALS: The study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public-private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public-private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS). METHODS: The study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index. RESULTS: In all the analysis models carried out in the analyzed period, the hospitals managed based on public-private collaboration were more efficient than the hospitals under traditional management. CONCLUSIONS: The greater efficiency of hospitals managed based on public-private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility.


Assuntos
Eficiência Organizacional , Administração Hospitalar/normas , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Parcerias Público-Privadas/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Modelos Organizacionais , Propriedade , Política Pública , Espanha
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