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1.
Am J Infect Control ; 48(8): 918-921, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32504761

RESUMO

It is currently a critical period for the prevention and control of the COVID-19 pandemic. Since the medical waste disposal could be an important way to control the source of infection, standardization, and strict implementation of the management of COVID-19 related medical waste should be with careful consideration to reduce the risk of epidemic within hospitals. This study illustrates the practice of medical waste disposal responding to the 2019-2020 novel coronavirus pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Eliminação de Resíduos de Serviços de Saúde/normas , Resíduos de Serviços de Saúde/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Hospitais Gerais/normas , Humanos
3.
Ann R Coll Surg Engl ; 102(6): 451-456, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347738

RESUMO

INTRODUCTION: UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. METHODS: All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). RESULTS: Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. CONCLUSIONS: All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.


Assuntos
Colonoscopia/instrumentação , Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Protocolos Clínicos/normas , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Estudos Transversais , Inglaterra , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/normas , Hospitais de Distrito/estatística & dados numéricos , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Stents Metálicos Autoexpansíveis/normas , Inquéritos e Questionários/estatística & dados numéricos
4.
J Trauma Acute Care Surg ; 87(2): 289-296, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349347

RESUMO

BACKGROUND: There is a longstanding interest in the field of management science to study high performance organizations. Applied to medicine, research on hospital performance indicates that some hospitals are high performing, while others are not. The objective of this study was to identify a cluster of high-performing emergency general surgery (EGS) hospitals and assess whether high performance at one EGS operation was associated with high performance on all EGS operations. METHODS: Adult patients who underwent one of eight EGS operations were identified in the California State Inpatient Database (2010-2011), which we linked to the American Hospital Association database. Beta regression was used to estimate a hospital's risk-adjusted mortality, accounting for patient- and hospital-level factors. Centroid cluster analysis grouped hospitals by patterns of mortality rates across the eight EGS operations using z scores. Multinomial logistic regression compared hospital characteristics by cluster. RESULTS: A total of 220 acute care hospitals were included. Three distinct clusters of hospitals were defined based on assessment of mortality for each operation type: high-performing hospitals (n = 66), average performing (n = 99), and low performing (n = 55). The mortality by individual operation type at the high-performing cluster was consistently at least 1.5 standard deviations better than the low-performing cluster (p < 0.001). Within-cluster variation was minimal at high-performing hospitals compared with wide variation at low-performing hospitals. A hospital's high performance in one EGS operation type predicted high performance on all EGS operation types. CONCLUSION: High-performing EGS hospitals attain excellence across all types of EGS operations, with minimal variability in mortality. Poor-performing hospitals are persistently below average, even for low-risk operations. These findings suggest that top-performing EGS hospitals are highly reliable, with systems of care in place to achieve consistently superior results. Further investigation and collaboration are needed to identify the factors associated with high performance. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Hospitais Gerais/normas , Procedimentos Cirúrgicos Operatórios/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Análise por Conglomerados , Emergências , Feminino , Mortalidade Hospitalar , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto Jovem
5.
Diabetes Metab Syndr ; 13(2): 1657-1660, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336537

RESUMO

AIMS: Diabetes mellitus is a commonly encountered diagnosis in hospitalised patients that is associated with prolonged admissions and mortality. One in six hospital beds in the UK are occupied by diabetes patients. Therefore, healthcare providers need to have a sound knowledge in managing in-patients with diabetes. Thus the aim of this clinical survey was to assess the diabetes-related knowledge of healthcare professionals in a district general hospital. METHODS: A 24-item questionnaire, based on the 'Think Check Act (TCA)' diabetes modules implemented by the Healthcare Improvement Scotland was issued to the medical and nursing staff. Simple statistics were used for data collation and analysis. RESULTS: 30 questionnaires were completed by 10 doctors at varying stages of training, 17 nurses, 1 physician associate and 2 healthcare assistants. The mean percentage score of the participants were 57.4%. 22 (73.3%) correctly defined hypoglycaemia and 27 (90%) knew the location of hypo box and 7 (23.3%) were aware of TCA. Responses to other management related to diabetes emergencies were average. The responses between doctors and nurses were insignificant except for hypo box location (p = 0.0413). CONCLUSION: Knowledge about managing inpatient diabetes problems amongst healthcare professional at a district general hospital appears mediocre. Significant gaps have been identified which would be targeted for future educational events.


Assuntos
Diabetes Mellitus/terapia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Hospitais Gerais/normas , Hipoglicemia/prevenção & controle , Pacientes Internados/estatística & dados numéricos , Padrões de Prática Médica/normas , Estudos Transversais , Humanos , Inquéritos e Questionários
6.
BMJ Open Qual ; 8(2): e000478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206055

RESUMO

Sierra Leone has a high tuberculosis (TB) burden with a prevalence of 441 cases per 100 000 population. As a result of the Global Fund, some facilities in the country have access to improved diagnostics, including Xpert MTB/RIF testing, of particular use in diagnosing those at risk of drug resistance, in the form of rifampicin-resistant (RR) TB. This quality improvement project describes how a small, rural district general hospital in Masanga village improved the diagnosis of TB and RR-TB by creating a formal link with the regional hospital in Makeni city. In an effort to improve diagnosis, all patients with a suspicion of TB and one of the following would have a sample sent for Xpert MTB/RIF testing: previous TB treatment (of any course length), HIV positive or known contact of a RR-TB case. The samples were transported by the logistics team, who already drove weekly from Masanga to Makeni for supplies, and the results were texted to the clinician in charge of the medical ward. Over the course of the first 4 months of this intervention, 34 samples had Xpert MTB/RIF testing performed compared with two samples in the previous 12 months since the machine had been installed. This yielded nine additional diagnoses of TB (in patients with negative or unavailable smear results) and five diagnoses of RR-TB with subsequent appropriate isolation and transfer to the central tertiary centre. This study shows that it is feasible to centralise Xpert MTB/RIF testing in low-resource settings using creative methods for sample transfer and results dissemination, leading to both improved diagnostics and infection control.


Assuntos
Resistência a Medicamentos , Tuberculose/diagnóstico , Adulto , Feminino , Hospitais Gerais/organização & administração , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Sensibilidade e Especificidade , Serra Leoa , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos
7.
BMC Health Serv Res ; 19(1): 221, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971244

RESUMO

BACKGROUND: Given the increased attention to sepsis at the population level there is a need to assess hospital performance in the care of sepsis patients using widely-available administrative data. The goal of this study was to develop an administrative risk-adjustment model suitable for profiling hospitals on their 30-day mortality rates for patients with sepsis. METHODS: We conducted a retrospective cohort study using hospital discharge data from general acute care hospitals in Pennsylvania in 2012 and 2013. We identified adult patients with sepsis as determined by validated diagnosis and procedure codes. We developed an administrative risk-adjustment model in 2012 data. We then validated this model in two ways: by examining the stability of performance assessments over time between 2012 and 2013, and by examining the stability of performance assessments in 2012 after the addition of laboratory variables measured on day one of hospital admission. RESULTS: In 2012 there were 115,213 sepsis encounters in 152 hospitals. The overall unadjusted mortality rate was 18.5%. The final risk-adjustment model had good discrimination (C-statistic = 0.78) and calibration (slope and intercept of the calibration curve = 0.960 and 0.007, respectively). Based on this model, hospital-specific risk-standardized mortality rates ranged from 12.2 to 24.5%. Comparing performance assessments between years, correlation in risk-adjusted mortality rates was good (Pearson's correlation = 0.53) and only 19.7% of hospitals changed by more than one quintile in performance rankings. Comparing performance assessments after the addition of laboratory variables, correlation in risk-adjusted mortality rates was excellent (Pearson's correlation = 0.93) and only 2.6% of hospitals changed by more than one quintile in performance rankings. CONCLUSIONS: A novel claims-based risk-adjustment model demonstrated wide variation in risk-standardized 30-day sepsis mortality rates across hospitals. Individual hospitals' performance rankings were stable across years and after the addition of laboratory data. This model provides a robust way to rank hospitals on sepsis mortality while adjusting for patient risk.


Assuntos
Benchmarking/normas , Hospitais Gerais/normas , Sepse/mortalidade , Doença Aguda , Adulto , Idoso , Benchmarking/estatística & dados numéricos , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Estudos Retrospectivos , Risco Ajustado
8.
Int J Health Care Qual Assur ; 32(2): 459-469, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31017068

RESUMO

PURPOSE: The purpose of this paper is to analyze two process standardization theoretical conceptual constructs: process variants unification; and distinction between standard, routine and non-routine processes. DESIGN/METHODOLOGY/APPROACH: The authors analyze two conceptual constructs based on a single case study representing a general hospital's (GH) process standardization, approach and results. The authors research whether process standardization implemented in a GH conforms to the process variants unification concept approach and its assumed benefits and whether implemented process standardization enables process management improvement based on distinguishing standard, routine and non-routine processes. FINDINGS: In accordance with the process variants unification conceptual construct, the hospital task force determined a uniform basic patient comprehensive treatment process at the hospital level, which allows synergy among departments. Uniform process activities reflect the differences between standard, routine and non-routine processes. PRACTICAL IMPLICATIONS: Process standardization through unification improves performance by establishing a common framework enabling shared experience based on improved process understanding. Distinguishing standard, routine and non-routine processes is useful for analyzing process management. This distinction provides guidelines for process implementation and measurement improvement. The paper also shows that increased routinization and standardization represent levers for process improvement. ORIGINALITY/VALUE: The authors analyze theoretical constructs based on a single case study and confirm that theoretical conceptual construct application can provide better process management, which is important for practitioners.


Assuntos
Hospitais Gerais/organização & administração , Melhoria de Qualidade/organização & administração , Hospitais Gerais/normas , Humanos , Estudos de Casos Organizacionais , Avaliação de Processos em Cuidados de Saúde/normas
9.
Rev Gaucha Enferm ; 40(spe): e20180150, 2019 Jan 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30652800

RESUMO

OBJECTIVE: To describe the experience of implementing the patient safety nucleus and the strategies developed to ensure safer care. METHOD: Experience report on the implementation of the nucleus and strategies for patient safety in a hospital in the south of Brazil, from 2009 to 2017. RESULTS: The concern with patient safety was made official in 2009 with the creation of a specific service for risk management and in 2015 it was named the patient safety nucleus. Eight strategies were implemented in order to disseminate the patient safety policy. CONCLUSION: An improvement was observed in the processes related to patient safety in the institution. Top management support and leadership engagement were key to this journey.


Assuntos
Hospitais Gerais/normas , Segurança do Paciente , Brasil , Humanos
10.
Intern Med J ; 49(7): 859-866, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30525299

RESUMO

BACKGROUND: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. AIM: To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. METHODS: A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. RESULTS: A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. CONCLUSION: Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.


Assuntos
Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Auditoria Médica/normas , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/terapia , Estudos Transversais , Feminino , Hospitalização/tendências , Hospitais Gerais/normas , Hospitais Gerais/tendências , Hospitais Pediátricos/normas , Hospitais Pediátricos/tendências , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Masculino , Auditoria Médica/tendências , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/tendências , Estudos Retrospectivos , Inquéritos e Questionários/normas , Adulto Jovem
11.
Rev. gaúch. enferm ; 40(spe): e20180150, 2019. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-978512

RESUMO

Resumo OBJETIVO Descrever a experiência da implantação do núcleo de segurança do paciente e as estratégias desenvolvidas para garantir uma assistência mais segura. MÉTODO Relato de experiência da implantação do núcleo e das estratégias para segurança do paciente em um hospital no sul do Brasil, de 2009 a 2017. RESULTADOS A preocupação com a segurança do paciente foi oficializada em 2009 com a criação um serviço específico para gerenciamento dos riscos assistenciais e em 2015 foi nomeado o núcleo de segurança do paciente. Oito estratégias foram implantadas visando disseminar a política de segurança do paciente. CONCLUSÃO Foi observado um avanço na melhoria dos processos relacionados a segurança do paciente na instituição. Apoio da alta direção e engajamento das lideranças foram fundamentais nesta caminhada.


Resumen OBJETIVO Describir la experiencia de la implantación del núcleo de seguridad del paciente y las estrategias desarrolladas para garantizar una asistencia más segura. MÉTODO Relato de experiencia de la implantación del núcleo y de las estrategias para la seguridad del paciente en un hospital en el sur de Brasil, en el período de 2009 a 2017. RESULTADOS La preocupación por la seguridad del paciente fue oficializada en 2009 con la creación de un servicio específico para la gestión de los riesgos asistenciales, y en 2015 se nombró el núcleo de seguridad del paciente. Se implantaron ocho estrategias para diseminar la política de seguridad del paciente. CONCLUSIÓN Se observó un avance en la mejora de los procesos relacionados con la seguridad del paciente en la institución. El apoyo de la alta dirección y el compromiso de los líderes fueron fundamentales en este trayecto.


Abstract OBJECTIVE To describe the experience of implementing the patient safety nucleus and the strategies developed to ensure safer care. METHOD Experience report on the implementation of the nucleus and strategies for patient safety in a hospital in the south of Brazil, from 2009 to 2017. RESULTS The concern with patient safety was made official in 2009 with the creation of a specific service for risk management and in 2015 it was named the patient safety nucleus. Eight strategies were implemented in order to disseminate the patient safety policy. CONCLUSION An improvement was observed in the processes related to patient safety in the institution. Top management support and leadership engagement were key to this journey.


Assuntos
Humanos , Segurança do Paciente , Hospitais Gerais/normas , Brasil
12.
Rev Esc Enferm USP ; 52: e03406, 2018 Dec 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30569957

RESUMO

OBJECTIVE: To analyze the active failures and the latent conditions related to errors in intensive nursing care and to discuss the reactive and proactive measures mentioned by the nursing team. METHOD: Qualitative, descriptive, exploratory study conducted at the Intensive Care Unit of a general hospital. Data were collected through interviews, participant observation and submitted to lexical analysis in the ALCESTE® software and to ethnographic analysis. RESULTS: 36 professionals of the nursing team participated in the study. The analysis originated three lexical classes: Error in intensive care nursing; Active failures and latent conditions related to errors in the intensive care nursing team; Reactive and proactive measures adopted by the nursing team regarding errors in intensive care. CONCLUSION: Reactive and proactive measures influenced the safety culture, in particular, the recognition of errors by professionals, contributing to their prevention, safety and quality care.


Assuntos
Enfermagem de Cuidados Críticos/normas , Erros Médicos/estatística & dados numéricos , Equipe de Enfermagem/normas , Segurança do Paciente , Adulto , Feminino , Hospitais Gerais/normas , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Gestão da Segurança/métodos
13.
PLoS One ; 13(10): e0203780, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30281620

RESUMO

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies.


Assuntos
Eficiência Organizacional/normas , Hospitais Gerais/normas , Hospitais Públicos/normas , China/epidemiologia , Humanos
15.
Gen Hosp Psychiatry ; 55: 27-37, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30296675

RESUMO

OBJECTIVE: To define generic quality indicators for general hospital psychiatry from the perspectives of patients, professionals (physicians, nurses, and managers), and payers (health insurance companies). METHODS: Quality variables were identified by reviewing the relevant literature. A working. group consisting of patients', professionals' and payers' representatives was mandated by their respective umbrella organizations. The working group prioritized the quality variables that were identified. Core values were defined and subsequently linked to preliminary quality indicators. These were tested for feasibility in ten hospitals in a four-week period. Stakeholder consultation took place by means of two invitational conferences and two written commentary rounds. RESULTS: Forty-one quality variables were identified from the literature. After prioritization, seven core values were defined and translated to 22 preliminary indicators. Overall, the feasibility study showed high relevance scores and good implementability of the preliminary quality indicators. A final set of twenty-two quality indicators (17 structure, 3 process and 2 outcome indicators) was then established using a consensus-based approach. CONCLUSION: Consensus on a quality framework for general hospital psychiatry was built by incorporating the perspectives of relevant stakeholders. Results of the feasibility study suggest broad support and good implementability of the final quality indicators. Structural indicators were broadly defined, and process and outcome indicators are generic to facilitate quality measurement across settings. The quality indicator set can now be used to facilitate quality and outcome assessment, stimulate standardization of services, and help demonstrate (cost-) effectiveness.


Assuntos
Hospitais Gerais/normas , Psiquiatria/normas , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta/normas , Adulto , Estudos de Viabilidade , Serviços de Saúde , Humanos , Países Baixos , Medicina Psicossomática/normas
16.
Clin Respir J ; 12(11): 2581-2589, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232836

RESUMO

INTRODUCTION: China has a very high tuberculosis (TB) burden. The interferon-gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. OBJECTIVES: To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. METHODS: A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross-sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self-administered questionnaire. RESULTS: The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045-2.723, P = .0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. CONCLUSIONS: Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.


Assuntos
Hospitais Gerais/normas , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Adulto , Vacina BCG/uso terapêutico , China/epidemiologia , Efeitos Psicossociais da Doença , Estudos Transversais , Programas de Triagem Diagnóstica/normas , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Testes de Liberação de Interferon-gama/estatística & dados numéricos , Tuberculose Latente/imunologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Prevalência , Fatores de Risco
17.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 43(1): 22-27, 2018 Jan 28.
Artigo em Chinês | MEDLINE | ID: mdl-30154287

RESUMO

OBJECTIVE: In order to apply the index system for clinical evaluation of implementation effect in hospitals.
 Methods: A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366). The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment. The index system was used for clinical evaluation of implementation effect.
 Results: There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P<0.05). The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital. The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033). The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052). As for clinical implementation effect, the secondary hospitals were better than the tertiary hospital, and the general hospitals were better than the specialized hospitals.
 Conclusion: The index system for clinical evaluation could quantify the implementation effect, and compare the implementation effect in different hospitals, which provides reference for the management of clinical pathway.


Assuntos
Procedimentos Clínicos , Parto Obstétrico/normas , Parto , Feminino , Hospitais Gerais/normas , Humanos , Centros de Cuidados de Saúde Secundários/normas , Centros de Atenção Terciária/normas
18.
J Eval Clin Pract ; 24(4): 726-730, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29786937

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: A reduction in the provision of hospital services on the weekend probably explains higher mortality for patients who are either admitted to hospital or undergo procedures on the weekend. The aim was to examine the effect of the day of the week of admission (DOWOA) upon the efficiency and quality of care for a cohort of General Medical inpatients. METHODS: Electronic records were selected for unplanned adult admissions to 2 large public hospitals in Adelaide, South Australia, July 2012 to June 2017. RESULTS: The cohort consisted of 50 323 records. The number of admissions on each day of the week differed significantly from 6389 on Sundays to 7548 on Thursdays (P < 0.001). Discharges were most frequent on Fridays, and fewest occurred on weekends (P < 0.001) especially if aged over 80 years, if they had significant comorbidity or if they were discharged to a residential aged care facility. The DOWOA did not significantly influence the proportion of cases who died in hospital (5.6% to 6.4%; P = 0.47). The DOWOA significantly affected median inpatient length of stay (IPLOS; 3.1 to 3.9 days; P < 0.001). The median inpatient length of stay (IPLOS) matched the number of days from the ensuing weekend to the DOWOA with the longest median IPLOS. CONCLUSIONS: General Medicine has an inpatient mortality unaffected by the DOWOA. Care efficiency, however, follows a weekly cycle. The "weekend effect" for General Medical inpatients is a prolongation in their IPLOS as a result of fewer weekend discharges.


Assuntos
Hospitalização/estatística & dados numéricos , Hospitais Gerais , Administração dos Cuidados ao Paciente , Alta do Paciente/normas , Adulto , Idoso de 80 Anos ou mais , Austrália , Assistência à Saúde/organização & administração , Feminino , Mortalidade Hospitalar , Hospitais Gerais/organização & administração , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/normas , Readmissão do Paciente/estatística & dados numéricos , Fatores de Tempo
19.
BMC Pediatr ; 18(1): 167, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29764391

RESUMO

BACKGROUND: About three - quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital. METHODS: Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi - square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics. RESULTS: Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08-7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22-8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12-0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10-1.75) were associated with newborn outcome at 1 h. CONCLUSIONS: Mentorship and regular cost - effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR.


Assuntos
Asfixia Neonatal/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Gerais/normas , Tocologia , Recursos Humanos de Enfermagem no Hospital , Avaliação de Resultados da Assistência ao Paciente , Ressuscitação/métodos , Adulto , Asfixia Neonatal/mortalidade , Lista de Checagem , Protocolos Clínicos , Estudos Transversais , Humanos , Recém-Nascido , Capacitação em Serviço , Quênia , Corpo Clínico Hospitalar/educação , Pessoa de Meia-Idade , Tocologia/educação , Recursos Humanos de Enfermagem no Hospital/educação , Respiração Artificial/métodos , Adulto Jovem
20.
BMC Pediatr ; 18(1): 128, 2018 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-29625600

RESUMO

BACKGROUND: Paediatric Early Warning Scores (PEWS) are increasingly being used for early identification and management of clinical deterioration in paediatric patients. A PEWS system includes scores, cut-off points and appropriate early intervention. In 2011, The Dutch Ministry of Health advised hospitals to implement a PEWS system in order to improve patient safety in paediatric wards. The objective of this study was to examine the results of implementation of PEWS systems and to gain insight into the attitudes of professionals towards using a PEWS system in Dutch non-university hospitals. METHODS: Quantitative data were gathered at start, midway and at the end of the implementation period through retrospective patient record review (n = 554). Semi-structured interviews with professionals (n = 8) were used to gain insight in the implementation process and experiences. The interviews were transcribed and analysed using an inductive approach. RESULTS: Looking at PEWS systems of the five participating hospitals, different parameters and policies were found. While all hospitals included heart rate and respiratory rate, other variables differed among hospitals. At baseline, none of the hospitals used a PEWS system. After 1 year, PEWS were recorded in 69.2% of the patient records and elevated PEWS resulted in appropriate action in 49.1%. Three themes emerged from the interviews: 1) while the importance of using a PEWS system was acknowledged, professionals voiced some doubts about the effectiveness and validity of their PEWS system 2) registering PEWS required little extra effort and was facilitated by PEWS being integrated into the electronic patient record 3) Without a national PEWS system or guidelines, hospitals found it difficult to identify a suitable PEWS system for their setting. Existing systems were not always considered applicable in a non-university setting. CONCLUSIONS: After 1 year, hospitals showed improvements in the use of their PEWS system, although some were decidedly more successful than others. Doubts among staff about validity, effectiveness and communication with other hospitals during transfer to higher level care hospital might hinder sustainable implementation. For these purposes the development of a national PEWS system is recommended, consisting of a "core set" of PEWS, cut-off points and associated early intervention.


Assuntos
Protocolos Clínicos/normas , Diagnóstico Precoce , Intervenção Médica Precoce , Hospitais Gerais/normas , Hospitais de Ensino/normas , Adulto , Atitude do Pessoal de Saúde , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Recursos Humanos de Enfermagem no Hospital/psicologia , Pediatras/psicologia , Estudos Retrospectivos
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