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1.
Nat Commun ; 10(1): 1641, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967539

RESUMO

We characterize the ecological, economic, and community performance of 21 major tuna fisheries, accounting for at least 77% of global tuna production, using the Fishery Performance Indicators. Our analysis reveals that the biggest variations in performance among tuna fisheries are driven by the final markets that they target: international sashimi market tuna fisheries considerably outperform a comparison set of 62 non-tuna fisheries in the Fishery Performance Indicator database, international canned tuna market fisheries perform similarly to the comparison set, and tuna fisheries supplying local markets in coastal states considerably underperform the comparison set. Differences among regional fishery management organizations primarily reflect regional species composition and market access, despite stark variation in governance, management, and other enabling conditions. With a legacy of open access, tuna's harvest sector performance is similar across all fisheries, reflecting only a normal return on the capital and skill invested: industrial vessels slightly outperform semi-industrial and artisanal vessels. Differences emerge in the post-harvest sector however, as value chains able to preserve quality and transport fish to high value markets outperform others.


Assuntos
Pesqueiros/organização & administração , Alimentos Marinhos/estatística & dados numéricos , Gestão da Qualidade Total/estatística & dados numéricos , Atum , Animais , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Pesqueiros/economia , Pesqueiros/estatística & dados numéricos , Alimentos Marinhos/economia , Gestão da Qualidade Total/economia
2.
Gesundheitswesen ; 81(12): 1037-1047, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30808047

RESUMO

INTRODUCTION: Since 1 January 2004, all physicians, psychotherapists and medical care centres on contracts with statutory healthcare in Germany are obliged according to § 135a section 2, no. 2 of the Fifth Social Security Statute Book to introduce and develop an intra-institutional quality management system. Thus, physicians are faced with the question of which quality management system is best suited to their own practice. METHODS: A total of 24 medical practices were chosen by random sampling. The sample was collected in Saxony because the Health Insurance Physicians Unification Saxony provided the necessary information. First, 2 primary units were determined from the basic population. In the following step, a sample was taken for each primary unit using 3 quality management systems. The analysis was carried out with the help of three specially developed questionnaires (physician, employee and patient). The individual questions were developed independently of a quality management system. The basis was formed by the guidelines of the Federal Joint Committee, which describes the concrete contents of the quality categories. A total of 26 quality categories with different questions were available in the 3 survey groups. For the analysis of the data, the arithmetic mean was formed in the individual question complexes. Subsequently, a variance analysis was used to test whether the systems differed statistically significantly on average. Taking into account the costs of the individual quality management systems and their introduction, the effect size was finally analyzed according to η2 and Cohen's d. Finally, a cost-benefit analysis was carried out by researching the direct/indirect costs of the various quality management systems through a literature study. RESULTS: Based on model documents and process support, the "Quality and Development in Practices" had the highest score. Due to a specific family practitioner specialty, "Quality management systems in Saxony medical practices" had the next best scores. The individual quality categories such as the 'range of services' or 'treatment pathways and guidelines' indicate significant differences and sustained effect sizes between quality management systems. CONCLUSION: The assessment of quality management systems shows significant differences. The specific differences between the systems can be explained by the differences in process tools.


Assuntos
Assistência à Saúde , Qualidade da Assistência à Saúde , Gestão da Qualidade Total , Análise Custo-Benefício , Alemanha , Humanos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Gestão da Qualidade Total/organização & administração , Gestão da Qualidade Total/estatística & dados numéricos
3.
Anesth Analg ; 128(2): 374-382, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30531221

RESUMO

A novel intervention or new clinical program must achieve and sustain its operational and clinical goals. To demonstrate successfully optimizing health care value, providers and other stakeholders must longitudinally measure and report these tracked relevant associated outcomes. This includes clinicians and perioperative health services researchers who chose to participate in these process improvement and quality improvement efforts ("play in this space"). Statistical process control is a branch of statistics that combines rigorous sequential, time-based analysis methods with graphical presentation of performance and quality data. Statistical process control and its primary tool-the control chart-provide researchers and practitioners with a method of better understanding and communicating data from health care performance and quality improvement efforts. Statistical process control presents performance and quality data in a format that is typically more understandable to practicing clinicians, administrators, and health care decision makers and often more readily generates actionable insights and conclusions. Health care quality improvement is predicated on statistical process control. Undertaking, achieving, and reporting continuous quality improvement in anesthesiology, critical care, perioperative medicine, and acute and chronic pain management all fundamentally rely on applying statistical process control methods and tools. Thus, the present basic statistical tutorial focuses on the germane topic of statistical process control, including random (common) causes of variation versus assignable (special) causes of variation: Six Sigma versus Lean versus Lean Six Sigma, levels of quality management, run chart, control charts, selecting the applicable type of control chart, and analyzing a control chart. Specific attention is focused on quasi-experimental study designs, which are particularly applicable to process improvement and quality improvement efforts.


Assuntos
Interpretação Estatística de Dados , Projetos de Pesquisa/estatística & dados numéricos , Desenho de Programas de Computador , Gestão da Qualidade Total/estatística & dados numéricos , Humanos , Projetos de Pesquisa/normas , Gestão da Qualidade Total/normas
4.
Healthc (Amst) ; 6(4): 245-252, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29246539

RESUMO

BACKGROUND: An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. METHODS: The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record. Data on lead time (time between receiving a request and sending the completed request to the Health Information Management department) and process time (amount of time the staff worked on the request) were collected via manual pre- and post-time studies. RESULTS: Following implementation of interventions, the median lead time for processing durable medical equipment and supply requests decreased from 50 days to 3 days (p < 0.0001). Median processing time decreased from 14min to 9min (p < 0.0001). The decrease in processing time realized annual cost savings of approximately $11,000. CONCLUSIONS: Collaborative leadership and multidisciplinary training in Lean methods allowed the CCC staff to incorporate common sense, standardize practices, and adapt their work environment to improve the timely and reliable provision of equipment and supplies that are essential for their patients. IMPLICATIONS: The application of Lean methodologies to processing requests for DME and supplies could also result in a natural spread to other paperwork and requests, thus avoiding delays and potential risk for clinical instability or deterioration.


Assuntos
Equipamentos Médicos Duráveis/provisão & distribução , Gestão da Qualidade Total/métodos , Análise Custo-Benefício , Equipamentos Médicos Duráveis/estatística & dados numéricos , Equipamentos Médicos Duráveis/tendências , Eficiência Organizacional/normas , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pediatria/métodos , Pediatria/tendências , Melhoria de Qualidade , Gestão da Qualidade Total/estatística & dados numéricos
5.
J Healthc Qual ; 40(3): e46-e53, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28346244

RESUMO

INTRODUCTION: We analyze the assembly of surgical trays in a hospital's sterile services department. The department assembles 520 different tray setups. However, tray assembly times are unknown, imposing a challenge to production planners. To respond to demand, workers from other departments are often called, leading to higher operational costs and more frequent quality problems due to workers' poor training and inconsistency. METHODS: Conducting traditional time-motion studies is infeasible in such a high variety production setting. Thus, we used design of experiments to optimize the data acquisition. Assembly times of 36 trays were sampled using a 2-factor nested factorial design. Through regression analysis, we built a model to estimate completion times of trays not sampled in the experiment. RESULTS: A prediction model with 90.8% accuracy was obtained from the experimental data. The model was validated with assembly times from several trays not included in the experiment. Predicted assembly times had an absolute error of 7.83% on average compared with observed assembly times. CONCLUSIONS: Design of experiments and regression analysis combined were able to optimize time data acquisition using a small sample of trays, resulting in a model that predicted assembly times within an acceptable margin of error.


Assuntos
Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Equipamentos Cirúrgicos/estatística & dados numéricos , Estudos de Tempo e Movimento , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/estatística & dados numéricos , Humanos
6.
J Healthc Qual ; 40(1): 36-43, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27902532

RESUMO

OBJECTIVE: Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. DESIGN: Before-and-after cohort study. SETTING: Multidisciplinary intensive care unit (ICU) in an academic medical center. PATIENTS: Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). METHODS: We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. RESULTS: Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). CONCLUSION: We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.


Assuntos
Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Respiração Artificial/economia , Respiração Artificial/estatística & dados numéricos , Gestão da Qualidade Total/economia , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Grupos Diagnósticos Relacionados , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gestão da Qualidade Total/estatística & dados numéricos , Estados Unidos
7.
Int J Health Care Qual Assur ; 30(5): 467-476, 2017 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-28574324

RESUMO

Purpose The purpose of this paper is to describe the current research on hospital continuous improvement projects (CIPs) from an author characteristics' perspective. This work addresses the following questions: who are the predominant research authors in hospital CIPs? To what extent are the research communities collaborating in distinct research groups? How internationalized has hospital CIPs research become with respect to author location? Design/methodology/approach A systematic literature review was conducted, identifying 302 academic publications related to hospital CIPs. Publications were analyzed using: author, quantity, diversity, collaboration, and impact. Findings Hospital CIPs are increasingly attracting new scholars each year. Based on the authors' analysis, authors publishing in this area can be described as a relatively new international community given the countries represented. Originality/value This paper describes the current hospital CIP research by assessing author characteristics. Future work should examine additional attributes to characterize maturity such as how new knowledge is being created and to what extent new knowledge is being disseminated to practitioners.


Assuntos
Bibliometria , Administração Hospitalar/normas , Melhoria de Qualidade/estatística & dados numéricos , Gestão da Qualidade Total/estatística & dados numéricos , Comportamento Cooperativo , Humanos , Internacionalidade , Fator de Impacto de Revistas
8.
Med Pr ; 67(3): 365-73, 2016.
Artigo em Polonês | MEDLINE | ID: mdl-27364110

RESUMO

BACKGROUND: Managerial knowledge and skills as well as profound understanding of goals and objectives of management determine the effectiveness and efficiency in all areas of managerial activities. In particular, this applies to the quality of healthcare services, perceived as a compliance between the effects (of medical treatment) and the assumed relevant objectives (defined/desired health condition). The aim of the research was to distinguish and define the way the health service quality is perceived by the hospital managerial personnel. MATERIAL AND METHODS: The questionnaire was mailed to 836 members of the managerial personnel of public hospitals in the Lódz province. Of this number 122 questionnaires were returned. RESULTS: Only 22 (18.49%) of respondents presented the definition of quality. Attempts to meet patients' expectations and to satisfy them were found to be the prevailing perception of the healthcare quality and 96.64% of respondents considered competences of medical staff contributory. Almost 64% of respondents disagree with the opinion that the number of medical staff does not affect the service quality. According to the respondents, a 46% increase in financial resources on average could significantly improve the quality of healthcare services. More than half (66.76%) of respondents claim that healthcare services that are available cover 82% of patients' needs. Almost 57% (56.52%) of respondents consider that the subordinate- superior relationship influences their work involvement. According to 42.61% of respondents, the offered incentives encourage actions for the quality improvement. CONCLUSIONS: The results of the research indicate the need to develop a clear cut definition of the health service quality by the managerial personnel of public hospitals and to change their understanding, perception and treatment of the discussed issue, which provides a basis for the effective and efficient hospital management. Med Pr 2016;67(3):365-373.


Assuntos
Atitude do Pessoal de Saúde , Administradores Hospitalares/estatística & dados numéricos , Hospitais Públicos/organização & administração , Serviços de Saúde do Trabalhador/métodos , Gestão da Qualidade Total/estatística & dados numéricos , Feminino , Humanos , Masculino , Polônia , Administração em Saúde Pública
9.
J Am Coll Radiol ; 13(9): 1088-1095.e7, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27209599

RESUMO

PURPOSE: Preventable yet clinically significant rates of medical error remain systemic, while health care spending is at a historic high. Industry-based quality improvement (QI) methodologies show potential for utility in health care and radiology because they use an empirical approach to reduce variability and improve workflow. The aim of this review was to systematically assess the literature with regard to the use and efficacy of Lean and Six Sigma (the most popular of the industrial QI methodologies) within radiology. METHODS: MEDLINE, the Allied & Complementary Medicine Database, Embase Classic + Embase, Health and Psychosocial Instruments, and the Ovid HealthStar database, alongside the Cochrane Library databases, were searched on June 2015. Empirical studies in peer-reviewed journals were included if they assessed the use of Lean, Six Sigma, or Lean Six Sigma with regard to their ability to improve a variety of quality metrics in a radiology-centered clinical setting. RESULTS: Of the 278 articles returned, 23 studies were suitable for inclusion. Of these, 10 assessed Six Sigma, 7 assessed Lean, and 6 assessed Lean Six Sigma. The diverse range of measured outcomes can be organized into 7 common aims: cost savings, reducing appointment wait time, reducing in-department wait time, increasing patient volume, reducing cycle time, reducing defects, and increasing staff and patient safety and satisfaction. All of the included studies demonstrated improvements across a variety of outcomes. However, there were high rates of systematic bias and imprecision as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. CONCLUSIONS: Lean and Six Sigma QI methodologies have the potential to reduce error and costs and improve quality within radiology. However, there is a pressing need to conduct high-quality studies in order to realize the true potential of these QI methodologies in health care and radiology. Recommendations on how to improve the quality of the literature are proposed.


Assuntos
Redução de Custos/estatística & dados numéricos , Diagnóstico por Imagem/economia , Erros Médicos/economia , Melhoria de Qualidade/economia , Radiologia/economia , Radiologia/normas , Gestão da Qualidade Total/normas , Redução de Custos/normas , Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Diagnóstico por Imagem/normas , Diagnóstico por Imagem/estatística & dados numéricos , Eficiência Organizacional , Internacionalidade , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Objetivos Organizacionais/economia , Segurança do Paciente/economia , Segurança do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Gestão da Qualidade Total/estatística & dados numéricos , Estados Unidos , Listas de Espera , Fluxo de Trabalho
10.
BMC Res Notes ; 9: 244, 2016 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-27121107

RESUMO

BACKGROUND: Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning recommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments' common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded. RESULTS: Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument. CONCLUSIONS: Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.


Assuntos
Protocolos Clínicos/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Inquéritos e Questionários , Humanos , Controle de Qualidade , África do Sul , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/estatística & dados numéricos
11.
Klin Padiatr ; 228(1): 11-6, 2016 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-26766668

RESUMO

BACKGROUND: Based on an increasing number of outpatient treatments, an extensive demand planning is necessary to ensure the quality of medical care. University outpatient clinics are special parts of this sector and therefore it is necessary that a research demonstrates the nearly uninvestigated position of a paediatric outpatient clinic. PATIENTS: The research at the university hospital for children and adolescents in Leipzig started in 2009 to survey 2283 of in total 9391 patients and the physicians. METHODS: Sociodemographic data as well as economic and medical facts were determined by using questionnaires. In each case a questionnaire was answered by the children or their accompanying persons and a separate one was completed by the respective doctor. RESULTS: The results created a foundation, on the basis of patient volume per day and per daytime. Less than 20% of the children admitted to consult the clinic for their first time. The majority of patients visit them because of a letter of referral. Most of the patients (58%) were younger than 6 years old. Approximately 35% of patients did not come from the city region of Leipzig. CONCLUSION: The investigation evidenced the necessity of a day and night operating institution for children in the region of Leipzig as well as the high specialisation of the outpatient clinic. In need of further investigation is the cooperation between several physicians to find out if this lots of medical examination are necessary or if there took place overlapping.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Hospitais Universitários/normas , Ambulatório Hospitalar/estatística & dados numéricos , Ambulatório Hospitalar/normas , Pediatria/normas , Gestão da Qualidade Total/estatística & dados numéricos , Gestão da Qualidade Total/normas , Adolescente , Plantão Médico/normas , Plantão Médico/estatística & dados numéricos , Criança , Pré-Escolar , Comportamento do Consumidor , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
12.
Klin Padiatr ; 228(1): 17-23, 2016 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-26466200

RESUMO

BACKGROUND: Disproportionate short stature may impair the quality of life (QoL) of patients and their families. This study aimed to evaluate a self-help supported counseling concept to increase the QoL of the participants. METHODS: QoL data from 58 children/adolescents (8-17 years) with a diagnosis of achondroplasia was collected at 2 measurement points during one year using the the QoLISSY questionnaire (self-/parental report). Differences before and after participation vs. non-participation in the intervention were evaluated using a linear mixed model. RESULTS: The longitudinal results show a greater increase of QoL in the active intervention group compared to a passive control group (p=0,005). The increase in the self-reported QoL of affected patients was significantly higher than for the parent-report (p=0,048). CONCLUSIONS: The study shows that patients with achondroplasia benefit from a self-help supported counseling concept. However, this should be tested in a randomized trial.


Assuntos
Aconselhamento , Nanismo/terapia , Ambulatório Hospitalar/estatística & dados numéricos , Ambulatório Hospitalar/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/tendências , Grupos de Autoajuda , Adolescente , Criança , Pré-Escolar , Nanismo/diagnóstico , Nanismo/etiologia , Feminino , Alemanha , Pesquisa sobre Serviços de Saúde , Hospitais Universitários , Humanos , Masculino , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Gestão da Qualidade Total/normas , Gestão da Qualidade Total/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde/tendências
16.
BMC Res Notes ; 8: 145, 2015 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-25884186

RESUMO

BACKGROUND: The cold chain must be monitored continuously in order to guarantee vaccines' quality. From field reports and previous studies, cold chain monitoring for expanded program on immunization (EPI) is still not satisfactory in Cameroon. This study was conducted to evaluate the availability and functioning of cold chain equipment as well as knowledge. RESULTS: It was a cross-sectional study involving a multistage sampling. 3urban and 5rural districts were selected randomly from the 19 health districts of the North West region. In each district all the health facilities taking part in the EPI were targeted. Data were collected using a questionnaire administered face to face to health personnel and with an observational grid to assess availability, functioning, and monitoring of cold chain equipment and power supply. The data were analyzed using the epi-info software. A total of 70 health facilities were contacted and 65(88.6%) of them included in the study. Fifty-three (81.5%) out of 65 health facilities had at least one functional vaccine refrigerator. The national guideline of EPI was not present in 21(33.9%) health facilities. Temperature chart was complete/correctly filled in 25(50.0%) of the 50(96.2%) facilities having it. About 14 (26.9%) of the health facilities record at least one abnormal temperature during the last 2 months following data collection. Seventeen (28.3%) personnel did not know the correct vaccine storage temperature. CONCLUSION: The availability of vaccine storage equipment for EPI is acceptable in the North West Region of Cameroon but the capacity of those in charge to properly monitor it in all health facilities is still limited. To ensure that vaccines administered in the North West Region are stored at the recommended temperature, all District Health Services should train and regularly supervise the health personnel in charge of cold chain monitoring.


Assuntos
Armazenamento de Medicamentos/normas , Refrigeração/normas , Gestão da Qualidade Total/estatística & dados numéricos , Vacinas/normas , Camarões , Estudos Transversais , Guias como Assunto , Instalações de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/organização & administração , Vacinas/provisão & distribução
17.
J Hosp Med ; 10(4): 220-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25483409

RESUMO

BACKGROUND: Data suggest that delays in discharges from inpatient units affect hospital throughput and contribute to emergency department crowding. Lean/Six Sigma (LSS) has been shown to improve inefficiencies in other industries. There are no published data on what impact LSS can have on advancing and sustaining earlier patient discharges. OBJECTIVE: Determine the impact LSS has on advancing times of placement of discharge order and patient discharge compared to control. Secondary outcomes were length of stay (LOS) and readmission rates. DESIGN: Prospective quality study with concurrent controls. SETTING: Academic medical center. PATIENTS: Hospitalized pediatric patients compared to remainder of the children's hospital services. INTERVENTIONS: Staff reallocation, creation of standard workflow, multidisciplinary predischarge planning, and creation of a discharge checklist. MEASUREMENTS: Median time of discharge order entry and median time of actual patient discharge, proportion of patients discharged before noon and 2 pm, and LOS and readmission rates. RESULTS: The median time of order entry was 10:45 compared to 14:05, and the median time of discharge was 14:15 compared to 15:48. The LOS and the readmission rates remained the same in both cohorts. The control group had faster baseline discharge order entry and patient discharge, but discharge performance did not improve, despite a significantly lower average daily census. CONCLUSIONS: We determined that Lean approaches can have an immediate and sustained impact on advancing patient discharges, with no negative affect on LOS or readmission rates. Our intervention generated consistent results independent of personnel during the busiest months of the year at a tertiary care children's hospital.


Assuntos
Eficiência Organizacional/normas , Hospitais Pediátricos/normas , Tempo de Internação , Readmissão do Paciente/normas , Gestão da Qualidade Total/estatística & dados numéricos , Gestão da Qualidade Total/normas , Humanos , Estudos Prospectivos
18.
Am J Med Qual ; 30(5): 447-53, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24934127

RESUMO

The authors examined faculty's compliance with a hospital-approved neuroradiology critical findings (CFs) policy, which requires urgent verbal communication with the clinical team when 17 specific critical pathologies are identified. During June 2011 to July 2013, 50 random neuroradiology reports were sampled monthly for the presence of CFs and appropriate action. Faculty were provided ongoing feedback, and at the end of 2 years, the medical records for cases with noncommunicated CFs were reviewed to identify potential adverse outcomes. Of the 1200 reviewed reports, 195 (16.3%) had and 1005 (83.8%) did not have a CF. A total of 176 of 195 (90.3%) cases with CFs were communicated, and compliance increased from 77.4% to 85.6% (P = .027) since the monthly sampling was instituted; 1 of 19 (5.3%) noncommunicated CFs resulted in a potential adverse event. The ongoing monthly feedback resulted in improved faculty compliance with the CF policy. However, a small number of cases with CFs are still not being communicated.


Assuntos
Comunicação em Saúde/métodos , Neurorradiografia/métodos , Melhoria de Qualidade , Gestão da Qualidade Total/métodos , Comunicação em Saúde/normas , Humanos , Erros Médicos/estatística & dados numéricos , Neurologia/métodos , Neurologia/estatística & dados numéricos , Neurorradiografia/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Radiologia/métodos , Radiologia/estatística & dados numéricos , Fatores de Tempo , Gestão da Qualidade Total/estatística & dados numéricos
19.
Z Evid Fortbild Qual Gesundhwes ; 108(8-9): 465-9, 2014.
Artigo em Alemão | MEDLINE | ID: mdl-25523844

RESUMO

For several years, the use of administrative data in mandatory quality measurement has been requested by several stakeholders in Germany. Main advantages of using administrative data include the reduction of documentary expenditures and the possibility to perform longitudinal quality analyses across different healthcare units. After a short introduction, a brief overview of the current use of administrative data for mandatory quality assurance as well as current developments is given, which will then be further exemplified by decubital ulcer prophylaxis. By using administrative data coding expenditures in this clinical area could be reduced by nine million data fields. At the same time the population analysed was expanded resulting in a more than tenfold increase in potentially quality-relevant events. Finally, perspectives, further developments, possibilities as well as limits of quality measurement with administrative data are discussed.


Assuntos
Coleta de Dados/estatística & dados numéricos , Órgãos Governamentais/organização & administração , Órgãos Governamentais/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Alemanha , Órgãos Governamentais/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Reembolso de Incentivo , Gestão da Qualidade Total/legislação & jurisprudência , Gestão da Qualidade Total/organização & administração , Gestão da Qualidade Total/estatística & dados numéricos
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