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1.
GMS J Med Educ ; 37(7): Doc79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33364358

RESUMO

Objective: Against the background of the current pandemic crisis, this case report presents the experiences made from interprofessional teamwork with group members from different medical qualification levels. Our objectives were to identify areas of shared knowledge regarding efficient collaboration; to improve effective teamwork based on mutual respect; to develop innovative teaching methods tailored to the needs of COVID-19 interprofessional response teams. Methods: Field notes from numerous team discussions and improvised internal training sessions were compiled into a checklist. Each author edited and revised the checklist and a consensus has been reached after an in-person discussion. Feedback from an academic expert in emergency services has been incorporated into the final version of the checklist. Results: Three main topics were identified: the need for quality-assured professional training, the clarification of role expectations including assigned responsibilities, opportunities to contribute and participate in the team building process, and the development of area-related ethical competence in the sense of shared moral public health literacy. Hence, we developed the following ad - hoc teaching methods: use of online teaching videos, practical exercises on intubation models and the collective development of an annotated, detailed checklist for all relevant work processes of the mobile corona unit based on everyday debriefings. Summary: The need for interprofessional team building in the context of the current health crisis provides a beneficial learning environment for all participants. We propose to conceptually refine this approach into a cross-professional, innovative method of teaching.


Assuntos
/epidemiologia , Educação Médica/organização & administração , Ética Médica/educação , Equipe de Assistência ao Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Comportamento Cooperativo , Processos Grupais , Humanos , Relações Interprofissionais , Estudos de Casos Organizacionais , Papel do Médico
2.
Rev Esp Salud Publica ; 942020 Dec 16.
Artigo em Espanhol | MEDLINE | ID: mdl-33323924

RESUMO

Neonatal Screening Programs (PCN) have widely demonstrated their benefits since Dr. Guthrie published his developments on Phenylketonuria (PKU) in 1961. This paper describes how a simple and effective organization, which incorporates all the fundamental actors under the responsibility of the Public Health Directorate (DSP), has managed to ensure that the PCN of the Basque Country meets all the objectives required for a population screening. The acceptance by Basque society of the PCN allowed it to exceed 95% coverage in its second year of operation. Likewise, the limited negative social impact of PCN is evidenced by its low number of false positives and incorrect samples. Excellent response times allow every newborn with a positive result to have an early diagnosis and optimal initiation of treatment. There are two relevant experiences that support the importance of the effective exercise of the responsibility of the DSP. Congenital adrenal hyperplasia (CAH) was incorporated into the PCN in 1991 meeting all technical and clinical criteria. At the request of the experts, the DSP ordered in 1993 to cease this activity showing that it did not provide the expected benefits. The problems of organically integrating the PCN into the healthcare system were also experienced. The need to compete for resources put public health activities, including the PCN, at risk and led to their return to direct dependence on the DSP. The availability of this structure, in addition to facilitating the incorporation of other screenings, allows facing the future challenges.


Assuntos
Órgãos Governamentais/organização & administração , Triagem Neonatal/organização & administração , Administração em Saúde Pública , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Diagnóstico Precoce , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Espanha , Governo Estadual
3.
Biochem Med (Zagreb) ; 30(3): 030403, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33071554

RESUMO

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral , Cidades , Sistemas de Informação em Laboratório Clínico/organização & administração , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Sistemas de Informação Hospitalar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Laboratórios Hospitalares/organização & administração , Recursos Humanos em Hospital/educação , Pneumonia Viral/epidemiologia , Testes Imediatos/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Espanha , Manejo de Espécimes
6.
Ann Biol Clin (Paris) ; 78(4): 363-382, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753365

RESUMO

The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.


Assuntos
Técnicas de Laboratório Clínico , Saúde Global , Laboratórios/estatística & dados numéricos , Laboratórios/normas , Testes Imediatos , Acreditação , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , França/epidemiologia , Saúde Global/normas , Saúde Global/estatística & dados numéricos , História do Século XXI , Humanos , Internacionalidade , Ensaio de Proficiência Laboratorial/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Testes Imediatos/organização & administração , Testes Imediatos/normas , Testes Imediatos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inquéritos e Questionários
7.
Ann Biol Clin (Paris) ; 78(5): 574-580, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716002

RESUMO

Laboratories need to set up effective overall management of their internal quality control (IQC) and external quality assessment (EQA) results as key elements in statistical process control. Quality targets need to be defined, with methods to ensure durable control with respect to the relevant specifications. The hemostasis laboratory of the Lyon Hospitals Board (HCL, Lyon, France) uses model 3 from the Milan consensus conference, which is the state of the art in terms of quality targets, and uses a common EQA provider supplying as many real patient samples as possible. Giving priority to adopted methods, the lab optimizes the use of manufacturers' prior data: maximum acceptable inter assay coefficient of variation (CV) and prior IQC target values. Bayesian inference brings the method under control with respect to the manufacturers' prior data without the need for a preliminary phase. It links the IQC and EQA plans by the maximum acceptable CVs defined by the manufacturer.


Assuntos
Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/normas , Laboratórios Hospitalares/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Teorema de Bayes , Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Testes de Coagulação Sanguínea/estatística & dados numéricos , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , França/epidemiologia , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Hemostasia/fisiologia , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Ensaio de Proficiência Laboratorial/organização & administração , Ensaio de Proficiência Laboratorial/normas , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Controle de Qualidade , Estudos Retrospectivos
9.
Emerg Med Clin North Am ; 38(3): 663-680, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616286

RESUMO

Quality assurance (QA) of care in the emergency department encompasses activities ensuring that the care provided meets applicable standards. Health care delivery is complex and many factors affect quality of care. Thus, quantification of health care quality is challenging, especially with regard to attribution of outcomes to various factors contributing to such care. A critical component of the process of QA is determination of quality health care and the concept of (unjustified) deviation from the reference applicable standard of care.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde
10.
Indian J Public Health ; 64(Supplement): S91-S93, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496232

RESUMO

Some nations in the world and some states in India have had more success in containing this pandemic. Recent efforts in strengthening the health sector have focused largely on reforms in modes of financing, but as the pandemic brings home to us, the main challenge in India remains the challenge of the organization of public services using a health systems understanding. A close to community comprehensive primary health care, quality assurance, and planned excess capacity in public health systems, a more robust disease surveillance systems that can integrate data on new outbreaks and the indigenous technological capacity to scale up innovation and manufacture of essential health commodities are some of our most important requirements for both epidemic preparedness and response.


Assuntos
Infecções por Coronavirus/epidemiologia , Planejamento em Desastres/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Betacoronavirus , Fortalecimento Institucional , Serviços de Saúde Comunitária/organização & administração , Humanos , Índia/epidemiologia , Atenção Primária à Saúde/organização & administração , Administração em Saúde Pública , Vigilância em Saúde Pública , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Determinantes Sociais da Saúde
11.
Br J Nurs ; 29(8): 484-485, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32324454

RESUMO

Professor Alan Glasper, from the University of Southampton, discusses how the Care Quality Commission and the Nursing and Midwifery Council are working during the COVID-19 pandemic.


Assuntos
Comitês Consultivos , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Infecções por Coronavirus/enfermagem , Enfermagem de Cuidados Críticos , Humanos , Pneumonia Viral/enfermagem , Medicina Estatal , Reino Unido/epidemiologia
12.
Gac. sanit. (Barc., Ed. impr.) ; 34(2): 120-126, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196047

RESUMO

OBJETIVO: Identificar factores de los profesionales que se relacionan con el grado de orientación de la atención primaria de salud en el control de la lepra. MÉTODO: Estudio realizado en 70 unidades de la Estrategia de Salud Familiar de una capital de Brasil, entre julio y septiembre de 2014. Se utilizó un instrumento de evaluación aplicado a 408 profesionales de la salud. Se aplicó el modelo de regresión lineal múltiple-bootstrap para analizar la asociación de la puntuación general, esencial y derivada con los factores explicativos de los profesionales (tiempo de trabajo en la unidad y en servicios de atención primaria, realización de acciones de control, atención de caso y formación en lepra). RESULTADOS: En el análisis descriptivo, la mayoría de los profesionales no atendieron casos y no recibieron formación para realizar acciones contra la lepra. Se observó una fuerte orientación en la puntuación esencial y general de la atención primaria y la asociación con la formación en lepra. En la puntuación derivada, se observó una débil orientación y asociación con la formación de la enfermedad para médicos y agentes comunitarios de salud. CONCLUSIÓN: La experiencia profesional en la Estrategia de Salud Familiar y en la asistencia a la lepra es determinante para que el servicio sea proveedor de acciones de control orientadas según los atributos esenciales y derivados de la atención primaria de salud. Aunque Brasil ha avanzado en la reducción de la incidencia de la lepra, hay que aumentar la eficacia de la vigilancia en salud como forma de detección precoz y formación de los profesionales


OBJECTIVE: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. METHOD: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). RESULTS: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. CONCLUSION: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals


Assuntos
Humanos , Hanseníase/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Controle de Doenças Transmissíveis/organização & administração , Atenção Primária à Saúde/organização & administração , Hanseníase/epidemiologia , Médicos de Atenção Primária/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/classificação , Melhoria de Qualidade/tendências , Brasil/epidemiologia , Estudos Transversais
13.
J Crohns Colitis ; 14(9): 1330-1333, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32211765

RESUMO

The outbreak of the COVID-19 caused by coronavirus SARS-CoV2, is rapidly spreading worldwide. This is the first pandemic caused by a coronavirus in history. More than 150 000 confirmed cases worldwide are reported involving the SARS-CoV2, with more than 5000 COVID-19-related deaths on March 14, 2020. Fever, chills, cough, shortness of breath, generalised myalgia, malaise, drowsiness, diarrhoea, confusion, dyspnoea, and bilateral interstitial pneumonia are the common symptoms. No therapies are available, and the only way to contain the virus spread is to regularly and thoroughly clean one's hands with an alcohol-based hand rub or wash them with soap and water, to maintain at least 1 m [3 feet] distance from anyone who is coughing or sneezing, to avoid touching eyes, nose, and mouth, and to stay home if one feels unwell. No data are available on the risk of COVID-19 and outcomes in inflammatory bowel disease [IBD] patients. Outbreak restrictions can impact on the IBD care. We aim to give a viewpoint on how operationally to manage IBD patients and ensure quality of care in the current pandemic era.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Doenças Inflamatórias Intestinais , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Garantia da Qualidade dos Cuidados de Saúde , Betacoronavirus , Gestão de Mudança , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Itália/epidemiologia , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/normas , Administração dos Cuidados ao Paciente/tendências , Educação de Pacientes como Assunto , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Comportamento de Redução do Risco
14.
Int J Qual Health Care ; 32(Supplement_1): 22-34, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026931

RESUMO

OBJECTIVE: The aim of this study was to develop and refine indices to measure organization and care pathway-level quality management systems in Australian hospitals. DESIGN: A questionnaire survey and audit tools were derived from instruments validated as part of the Deepening Our Understanding of Quality improvement in Europe (DUQuE) study, adapted for Australian hospitals through expert opinion. Statistical processes were used to explore the factor structure, reliability and non-redundancy and descriptive statistics of the scales. SETTING: Thirty-two large Australian public hospitals. PARTICIPANTS: Audit of quality management processes at organization-level and care pathway processes at department level for three patient conditions (acute myocardial infarction (AMI), hip fracture and stroke) and senior quality manager, at each of the 32 participating hospitals. MAIN OUTCOME MEASURE(S): The degree of quality management evident at organization and care pathway levels. RESULTS: Analysis yielded seven quality systems and strategies scales. The three hospital-level measures were: the Quality Management Systems Index (QMSI), the Quality Management Compliance Index (QMCI) and the Clinical Quality Implementation Index (CQII). The four department-level measures were: Specialised Expertise and Responsibility (SER), Evidence-Based Organisation of Pathways (EBOP), Patient Safety Strategies (PSS) and Clinical Review (CR). For QMCI, and for seven out of eight subscales in QMSI, adequate internal consistency (Cronbach's $\alpha$ >0.8) was achieved. For CQII, lack of variation and ceiling effects in the data resulted in very low internal consistency scores, but items were retained for theoretical reasons. Internal consistency was high for CR (Cronbach's $\alpha$ 0.74-0.88 across the three conditions), and this was supported by all item-total correlations exceeding the desired threshold. For EBOP, Cronbach's $\alpha$ was acceptable for hip fracture (0.80) and stroke (0.76), but only moderate for AMI (0.52). PSS and SER scales were retained for theoretical reasons, although internal consistencies were only moderate (SER) to poor (PSS). CONCLUSIONS: The Deepening our Understanding of Quality in Australia (DUQuA) organization and department scales can be used by Australian hospital managers to assess and measure improvement in quality management at organization and department levels within their hospitals and are readily modifiable for other health systems depending on their needs.


Assuntos
Hospitais Públicos/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Austrália , Procedimentos Clínicos/normas , Estudos Transversais , Assistência à Saúde/normas , Fraturas do Quadril , Humanos , Infarto do Miocárdio , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Acidente Vascular Cerebral , Inquéritos e Questionários
15.
Int J Qual Health Care ; 32(Supplement_1): 35-42, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026933

RESUMO

OBJECTIVE: Little is known about the influence that hospital quality systems have on quality at department level, in Australia and elsewhere. This study assessed the relationships between organizational-level quality management systems, and the extent to which hospital-level quality management systems and department-level quality management strategies are related. DESIGN: A multi-level, cross-sectional, mixed-method study. SETTING AND PARTICIPANTS: As part of the Deepening our Understanding of Quality in Australia (DUQuA) project, we invited all large hospitals in Australia (~200 or more beds) which provided acute myocardial infarction (AMI), hip fracture and stroke care. The quality managers of these hospitals were the respondents for one of seven measures of hospital quality management systems and strategies. Data across the six remaining measures were collected through site visits by external surveyors assessing the participating hospitals. MAIN OUTCOME MEASURES: Relationships were assessed between three organization-level quality management system measures: a self-report measure assessing organization-level quality activities (quality management systems index, QMSI); externally assessed organization-level compliance to procedures used to plan, monitor and improve quality of care (quality management compliance index, QMCI); and externally assessed implementation of quality systems (clinical quality implementation index, CQII). Associations were also assessed between organization-level quality management systems and department-level quality management strategies: how clinical responsibilities are assigned for a particular condition; whether department organization processes are organized to facilitate evidence-based care recommendations; compliance with selected recommendations of international agencies; and whether clinical reviews are performed systematically. RESULTS: Of 78 invited hospitals, 32 participated in the study. QMSI was positively associated with QMCI and CQII, but after controlling for QMSI, no relationship was found between QMCI and CQII. There appears to be a cluster of relationships between QMSI and department-level measures, but this was not consistent across all departments. CONCLUSION: This is the first national study undertaken in Australia to assess relationships within and between organization-level and department-level quality management systems. These quality management system tools align with many components of accreditation standards and may be useful for hospitals in continuously monitoring and driving improvement.


Assuntos
Administração Hospitalar , Departamentos Hospitalares/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Austrália , Estudos Transversais , Assistência à Saúde , Departamentos Hospitalares/organização & administração , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos
16.
Int J Qual Health Care ; 32(Supplement_1): 89-98, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026934

RESUMO

OBJECTIVE: Healthcare accreditation surveyors are well positioned to gain access to hospitals and apply their existing data collection skills to research. Consequently, we contracted and trained a surveyor cohort to collect research data for the Deepening our Understanding of Quality in Australia (DUQuA) project. The aim of this study is to explore and compare surveyors' perceptions and experiences in collecting quality and safety data for accreditation and for health services research. DESIGN: A qualitative, comparative study. SETTING AND PARTICIPANTS: Ten surveyors participated in semi-structured interviews, which were audio recorded, transcribed and coded using Nvivo11. Interview transcripts of participants were analysed thematically and separately, providing an opportunity for comparison and for identifying common themes and subthemes. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Topics addressed data collection for healthcare accreditation and research, including preparation and training, structure, organization, attitudes and behaviours of staff and perceptions of their role. RESULTS: Five themes and ten subthemes emerged from the interviews: (1) overlapping facilitators for accreditation and research data collection, (2) accreditation-specific facilitators, (3) overlapping barriers for accreditation and research data collection, (4) research data collection-specific barriers and (5) needs and recommendations. Subthemes were (1.1) preparation and training availability, (1.2) prior knowledge and experiences; (2.1) ease of access, (2.2) high staff engagement, (3.1) time, (4.1) poor access and structure, (4.2) lack of staff engagement, (4.3) organizational changes; (5.1) short-notice accreditation and (5.2) preparation for future research. CONCLUSIONS: Although hospital accreditation and research activities require different approaches to data collection, we found that suitably trained accreditation surveyors were able to perform both activities effectively. The barriers surveyors encountered when collecting data for research provide insight into the challenges that may be faced when visiting hospitals for short-notice accreditation.


Assuntos
Acreditação/métodos , Pesquisa sobre Serviços de Saúde/métodos , Hospitais Públicos/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Adulto , Idoso , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/métodos
17.
Int J Qual Health Care ; 32(Supplement_1): 60-66, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026935

RESUMO

OBJECTIVE: This study aimed to explore the associations between the organization-level quality arrangements, improvement and implementation and department-level safety culture and leadership measures across 32 large Australian hospitals. DESIGN: Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems and clinician safety culture and leadership. SETTING: Thirty-two large Australian public hospitals. PARTICIPANTS: Quality audit at organization level, senior quality manager at each participating hospital, 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURES: Associations between organization-level quality measures and department-level clinician measures of teamwork climate, safety climate and leadership for acute myocardial infarction (AMI), hip fracture and stroke treatment conditions. RESULTS: We received 1332 valid responses from participants. The quality management systems index (QMSI, a questionnaire-based measure of the hospitals' quality management structures) was 'positively' associated with all three department-level scales in the stroke department, with safety culture and leadership in the emergency department, but with none of the three scales in the AMI and hip fracture departments. The quality management compliance index (QMCI, an external audit-based measure of the quality improvement activities) was 'negatively' associated with teamwork climate and safety climate in AMI departments, after controlling for QMSI, but not in other departments. There was no association between QMCI and leadership in any department, after controlling for QMSI, and there was no association between the clinical quality implementation index (CQII, an external audit-based measure of the level of implementation of quality activities) and any of the three department-level scales in any of the four departments, after controlling for both QMSI and QMCI. CONCLUSIONS: The influence of organization-level quality management systems on clinician safety culture and leadership varied depending on the hospital department, suggesting that whilst there was some consistency on patient safety attitudes and behaviours throughout the organizations, there were also other factors at play.


Assuntos
Liderança , Recursos Humanos em Hospital/psicologia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão da Segurança , Atitude do Pessoal de Saúde , Austrália , Fraturas do Quadril , Administração Hospitalar , Departamentos Hospitalares/organização & administração , Hospitais Públicos/organização & administração , Humanos , Infarto do Miocárdio , Cultura Organizacional , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/organização & administração , Acidente Vascular Cerebral , Inquéritos e Questionários
18.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 545-549, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32029528

RESUMO

OBJECTIVE: In a previous audit, we demonstrated poor compliance with the neonatal resuscitation algorithm. Training can improve guideline compliance and performance. We aimed to prospectively collect detailed data on delivery room resuscitations to identify needs for educational interventions. DESIGN: Observational study using video recordings of neonatal resuscitations. We analysed episodes where chest compressions (CCs) were provided. SETTING: A Norwegian university hospital. PATIENTS: All delivery room resuscitations August 2014 to November 2016. INTERVENTIONS: The recordings were transcribed using Interact V.9 software (Mangold Int GmbH, Arnstorf, Germany). Supplementary information was collected from the patient electronic records. MAIN OUTCOME MEASURES: Heart rate (HR) assessment, provision of positive pressure ventilation (PPV) and CC, endotracheal intubation and team communication. RESULTS: Twenty-nine CC episodes were analysed. We identified team discordance in the decisions to perform CC and only 6 (21%) were retrospectively judged to be in need for CC: 8 (28%) infants had adequate spontaneous respiration, 18 (62%) infants received ineffective PPV and 5 (17%) had a HR >60 bpm. Only one infant was intubated before CC, and we could not identify a consistent pattern of ventilation corrective actions. One infant received CC without prior HR assessment. In some infants, CC duration was exceedingly short, and 11 (38%) of the infants that received CC were not admitted to the NICU. Six (21%) infants had no documentation of CPR in the delivery record. CONCLUSIONS: Education and training should focus on team function and communication, correct and timely HR assessment, effective PPV, and indications for endotracheal intubation.


Assuntos
Manuseio das Vias Aéreas/normas , Reanimação Cardiopulmonar/normas , Salas de Parto/organização & administração , Frequência Cardíaca/fisiologia , Equipe de Assistência ao Paciente/organização & administração , Comunicação , Salas de Parto/normas , Feminino , Processos Grupais , Fidelidade a Diretrizes , Hospitais Universitários , Humanos , Recém-Nascido , Intubação Intratraqueal/normas , Masculino , Noruega , Equipe de Assistência ao Paciente/normas , Respiração com Pressão Positiva/normas , Guias de Prática Clínica como Assunto , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
19.
Int J Qual Health Care ; 32(Supplement_1): 8-21, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-31725882

RESUMO

OBJECTIVE: The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. DESIGN: We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. SETTING, PARTICIPANTS AND OUTCOME MEASURES: The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). RESULTS: We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. CONCLUSIONS: We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.


Assuntos
Hospitais Públicos/normas , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Resultados da Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Austrália , Estudos Transversais , Assistência à Saúde/normas , Administração Hospitalar , Humanos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade/organização & administração , Inquéritos e Questionários
20.
Int J Qual Health Care ; 32(Supplement_1): 1-7, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-31821447

RESUMO

With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improvement in Europe (DUQuE) research programme, also published as a Supplement in this Journal, in 2014. First, we briefly discuss key data about Australia, the health of its population and its health system. Then, to provide context for the work, we discuss previous activities on the quality of care and improvement leading up to the DUQuA studies. Next, we present a selection of key interventional studies and policy and institutional initiatives to date. Finally, we conclude by outlining, in brief, the aims and scope of the articles that follow in the Supplement. This first article acts as a framing vehicle for the DUQuA studies as a whole. Aggregated, the series of papers collectively attempts an answer to the questions: what is the relationship between quality strategies, both hospital-wide and at department level? and what are the relationships between the way care is organised, and the actual quality of care as delivered? Papers in the Supplement deal with a multiplicity of issues including: how the DUQuA investigators made progress over time, what the results mean in context, the scales designed or modified along the way for measuring the quality of care, methodological considerations and provision of lessons learnt for the benefit of future researchers.


Assuntos
Hospitais/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade , Austrália , Política de Saúde , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos
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