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1.
Reprod Health ; 18(1): 183, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526056

RESUMO

BACKGROUND: Obstetric fistula occurs in all developing countries but it is confined to the "fistula belt" across the northern half of Sub-Saharan Africa from Mauritania to Eritrea and in the developing countries of the Middle East and Asia. Ending obstetric fistula is critical to achieving Sustainable Development by 2030. So creating awareness on obstetrics fistula among women in the reproductive age group have a crucial role in reducing morbidity, mortality, and social stigma. OBJECTIVE: To assess awareness on obstetric fistula and its associated factors among reproductive-age women attending governmental hospitals in southwest Ethiopia, 2021. METHODS: An Institutional based cross-sectional study design was conducted among 413 women. The sample size was estimated by using a single population proportion formula. The collected data were coded and entered into EPI-data version 3.1 then exported to SPSS version 24 for descriptive and inferential analysis. Adjusted odds ratio (AOR) along with 95% confidence level was estimated to assess the strength of the association and variables with a p-value < 0.05 were considered to declare the statistical significance in the multivariable analysis in this study. RESULTS: In this study, a total of 400 clients have participated in the study. The mean ages of participants were 30.26 (SD ± 8.525) years old. Education of women who cannot read and write are 85% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.162; 95% CI (0.081-0.364)]. While Women who have primary education level are 83% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.170; 95% CI (0.085-0.446)]. In addition, This study shows women who have not heard about obstetric complications are 54% less likely to have awareness of obstetric fistula than those who heard about obstetric complications [AOR = 0.458; 95% CI (0.368-0.643)]. CONCLUSION: This study identifies that the educational level of women, history of pregnancy, distance to the nearby health institution, and awareness of obstetrics complications were the factors associated with awareness of reproductive age women on obstetrics fistula. Hence, increasing awareness on obstetric fistula plays a key role in averting this problem.


Assuntos
Fístula , Instalações de Saúde , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Públicos , Humanos , Gravidez
2.
Rev Med Chil ; 149(3): 458-463, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479325

RESUMO

BACKGROUND: The recognition of ethical problems in medical practice and the potential harmful effects that they may have on patients, underscores the importance of the ethical training of professionals as well as the development of Ethics Committees in Healthcare institutions. However, there is a paucity of national studies about the type of problems faced by professionals and the role of Ethics Committees in hospitals. AIM: To explore the perception about ethical problems in clinical practice of Chilean physicians of different specialties of two public teaching hospitals. MATERIAL AND METHODS: Physicians of both sexes and different specialties working in two teaching hospitals of Metropolitan Santiago, were invited to participate in focus groups of seven to eight participants. They discussed the ethical problems faced during their clinical practice. A content analysis based on the Grounded Theory was performed with the obtained information. RESULTS: Different types of ethical problems could be distinguished according to their content and the actors involved. The data obtained shows that the ethical dimension is present in the daily work of physicians. The evolution of the narrative throughout the interviews corroborated the importance of installing ethical issues and culture in the working routine of health care professionals. CONCLUSIONS: Human resources and an adequate institutional environment are required to promote the discussion about ethical issues such as the relationship between physicians and patient, the role of teaching in health care and institutional decisions.


Assuntos
Médicos , Atenção à Saúde , Feminino , Pessoal de Saúde , Hospitais Públicos , Humanos , Masculino , Princípios Morais
3.
Ethiop J Health Sci ; 31(3): 467-474, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483603

RESUMO

Background: Obstructed labor the major cause of adverse feto-maternal outcomes. Hence, the study assessed adverse fetomaternal outcomes of obstructed labor and associated factors among women who gave birth in public Hospitals of West Shoa Zone. Methods: Cross-sectional study design was conducted among 277 respondents. The required data were extracted from the mothers' chart by using a systematic random sampling method. Checklists were used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with feto-maternal outcomes. The odds ratio with 95%CI and p-value were used to identify the significant variables. Results: In this study, 145(52.3%) and 157(56.7%) of the respondents had adverse maternal and fetal outcomes respectively. Mothers who were referred from the health center (AOR: 3.96, 95%CI: 1.61-9.8) and who had a trial of labor at the health center and home had a more likelihood of adverse maternal outcomes than those who were referred and had trial of labor at hospital respectively. In addition, mothers who were not followed by partograph and in labor for >24hrs had also a more likelihood of adverse maternal outcomes than their counterparts. Likewise, newborns whom their mothers were not followed by partograph and mothers in labor for >24 hrs had also a more likelihood of adverse fetal outcomes than their counterparts. Hence, health professionals should give special attention to early diagnosis and referral of obstructed labor to higher facilities.


Assuntos
Mães , Parto , Estudos Transversais , Etiópia , Feminino , Hospitais Públicos , Humanos , Recém-Nascido , Gravidez
4.
Ethiop J Health Sci ; 31(3): 543-552, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483611

RESUMO

Background: The Burnout syndrome has been defined as a response to the chronic work-related stress typically found in professionals working in care service organizations. Therefore, this study aimed at assessing the prevalence of burnout syndrome and factors associated with burnout syndrome among nurses in public hospitals, Southwest Ethiopia, 2018. Method: An institutional-based cross-sectional study was conducted from February 1st, 2018 to April 1st, 2018. Total number of nurses who fulfill the inclusion criterias were enrolled. Data was collected using the predesigned tool. Data were entered using EPI INFO version 7 and was exported to statistical packages for social science (SPSS) version 21.0 for analysis. Logistic regression was employed and odds ratio with a 95% confidence interval was used. Variables with a P value of less than 0.05 was considered statistically significant. Results: A total of 282 eligible nurses were enrolled in the study with a mean age of 28.71 [SD ±7.047]. The prevalence of burnout syndrome among nurses was 96(34%). Predictor variables like; educational status, job title, work experience, fatigue, and social support were found to be strong predictor variables for burnout syndrome. Conclusion: This study revealed that a considerable proportion of nurses had burnout syndrome. Therefore, improved educational status and strong social support should be encouraged among nurses working in the health setting for the betterment of health care services, job satisfaction and quality of care in general.


Assuntos
Esgotamento Profissional , Enfermeiras e Enfermeiros , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/etiologia , Esgotamento Psicológico , Estudos Transversais , Etiópia/epidemiologia , Hospitais Públicos , Humanos , Satisfação no Emprego , Prevalência , Inquéritos e Questionários
5.
Rev Saude Publica ; 55: 56, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495253

RESUMO

OBJECTIVE: Evaluating safety culture in the perception of professionals working in public hospitals of the Unified Health System (SUS) of Distrito Federal, Brazil, three years after the implementation of the National Patient Safety Program (PNSP). METHODS: Analytical cross-sectional study conducted in eleven public hospitals using the Safety Attitudes Questionnaire (SAQ) in electronic format. Stratified sampling was estimated according to the proportion of the total number of professionals in each hospital, as well as the representativeness of each professional group. The results of the total score and domains equal to or greater than 75 were considered positive. Descriptive and inferential analyses of professional groups and hospitals were carried out. RESULTS: 909 professionals participated. The total score by professional group was negative (62.5 to 69.5) and the domains differed statistically in all cases. The eleven hospitals had a negative total score (61.5 to 68.6). The domains to attain positive performance were job satisfaction, stress recognition and teamwork climate. The lowest results were in working conditions and management perception domains, for which none of the hospitals had an average above 75. Differences were also found for domain means across hospitals, except in management perception. DISCUSSION: Three years after the implementation of PNSP, the safety culture in eleven hospitals evaluated was weak, although the domains of job satisfaction, stress recognition and teamwork climate had positive results. The results can contribute to decision-making by managers, as safety culture is an essential element in the implementation of patient safety policy.


Assuntos
Atitude do Pessoal de Saúde , Cultura Organizacional , Brasil , Estudos Transversais , Hospitais Públicos , Humanos , Satisfação no Emprego , Segurança do Paciente , Percepção , Gestão da Segurança , Inquéritos e Questionários
6.
BMC Health Serv Res ; 21(1): 917, 2021 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482842

RESUMO

BACKGROUND: Significant resources are spent on hospital accreditation worldwide. However, documentation of the effects of accreditation on processes, quality of care and outcomes in healthcare remain scarce. This study aimed to examine changes in the delivery of patient care in accordance with clinical guidelines (recommended care) after first-time accreditation in a care setting not previously exposed to systematic quality improvement initiatives. METHODS: We conducted a before and after study based on medical record reviews in connection with introducing first-time accreditation. We included patients with stroke/transient ischemic attack, bleeding gastric ulcer, diabetes, chronic obstructive pulmonary disease (COPD), childbirth, heart failure and hip fracture treated at public, non-psychiatric Faroese hospitals during 2012-2013 (before accreditation) or 2017-2018 (after accreditation). The intervention was the implementation of a modified second version of The Danish Healthcare Quality Program (DDKM) from 2014 to 2016 including an on-site accreditation survey in the Faroese hospitals. Recommended care was assessed using 63 disease specific patient level process performance measures in seven clinical conditions. We calculated the fulfillment and changes in the opportunity-based composite score and the all-or-none score. RESULTS: We included 867 patient pathways (536 before and 331 after). After accreditation, the total opportunity-based composite score was marginally higher though the change did not reach statistical significance (adjusted percentage point difference (%): 4.4%; 95% CI: - 0.7 to 9.6). At disease level, patients with stroke/transient ischemic attack, bleeding gastric ulcer, COPD and childbirth received a higher proportion of recommended care after accreditation. No difference was found for heart failure and diabetes. Hip fracture received less recommended care after accreditation. The total all-or-none score, which is the probability of a patient receiving all recommended care, was significantly higher after accreditation (adjusted relative risk (RR): 2.32; 95% CI: 2.03 to 2.67). The improvement was particularly strong for patients with COPD (RR: 16.22; 95% CI: 14.54 to 18.10). CONCLUSION: Hospitals were in general more likely to provide recommended care after first-time accreditation.


Assuntos
Acreditação , Insuficiência Cardíaca , Dinamarca , Hospitais Públicos , Humanos , Melhoria de Qualidade
7.
Glob Health Action ; 14(1): 1968124, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34493163

RESUMO

BACKGROUND: In 2017 hundreds of thousands of 'Rohingya' fled to camps for Forcefully Displaced Myanmar Nationals (FDMN) in Cox's Bazar, Bangladesh. OBJECTIVE: To describe the FDMNs presenting for care at public health facilities in Bangladesh so as to understand the health problems faced by the FDMNs and the burden on these public health facilities. METHODS: This study combined a retrospective review of existing hospital and clinic data with prospective surveillance in government health care centres. FINDINGS: The retrospective data showed a 26% increase in the number of consultations at the Kutupalong community clinic, the primary health facility closest to the camps, from 19,567 in 2015 to 26,309 in 2019. There was a corresponding 11% increase in admissions to health facilities in the area, from 80,991 in 2017 to 91,424 in 2019. Prospective surveillance of 9,421 FDMNs seeking health care from July 2018 to December 2019 showed that 29% had an infectious disease, 20% nutritional problems, 12% pregnancy-related conditions and 7% trauma or injury. CONCLUSIONS: Great uncertainty remains regarding the return of FDMN to their home country of Myanmar. The current on-going protests following the military coup adds further insecurity to the status of the Rohingya. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector. Continued support by the international public health community and civil society organizations is needed.


Assuntos
Saúde Pública , Refugiados , Bangladesh , Hospitais Públicos , Humanos , Mianmar , Estudos Prospectivos , Estudos Retrospectivos
8.
Rev Peru Med Exp Salud Publica ; 38(2): 214-223, 2021.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34468567

RESUMO

OBJECTIVE: To describe the clinical, laboratory and treatment characteristics of COVID-19 patients and to determine the factors associated with mortality during hospital stay. Materials and Methods: Retrospective cohort study of adult COVID-19 inpatients. The clinical, laboratory and treatment data were obtained from the medical records of patients from the Hospital Nivel III Daniel Alcides Carrión in Tacna. For the survival analysis we used the Cox proportional hazards model, and we calculated crude and adjusted hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS: We evaluated 351 patients; 74.1% of them were men. The most common comorbidities were obesity (31.6%), hypertension (27.1%) and diabetes mellitus (24.5%). The median time of hospitalization was 8 days (IQR: 4-15). From the total of patients, 32.9% died during follow-up. The multivariate analysis showed an increased risk of dying associated with the following: age ≥65 years, HR = 3.55 (95% CI: 1.70-7.40); increase in lactate dehydrogenase >720 U/L, HR = 2.08 (95% CI: 1.34-3.22); and oxygen saturation less than 90%, mainly when it was less than 80%, HR = 4.07 (95% CI: 2.10-7.88). In addition, the use of colchicine during treatment showed a protective effect, HR = 0.46 (95% CI: 0.23-0.91). CONCLUSIONS: Risk factors for mortality due to COVID-19 included being older than 65 years, having oxygen saturation less than 90%, and elevated lactate dehydrogenase >720 U/L; colchicine treatment could improve the prognosis of patients.


Assuntos
COVID-19 , Adulto , Idoso , Comorbidade , Mortalidade Hospitalar , Hospitalização , Hospitais Públicos , Humanos , Masculino , Peru/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
9.
Cien Saude Colet ; 26(suppl 2): 3447-3457, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468641

RESUMO

The general objective of this study was to assess the technical efficiency of Brazil's teaching hospitals using data envelopment analysis (DEA). To this end, a quantitative exploratory study was conducted with secondary data from the national health information system (DATASUS) using an output-oriented DEA model. The study population consisted of 29 large-sized teaching hospitals located in the country's Center-West, South, Southeast, and North regions. Twelve hospitals were shown to be on the efficient frontier (technically efficient) and 17 were off the frontier. Absolute efficiency values were calculated for the hospitals that were off the frontier, using benchmarks with weighting for benchmarking. Private for-profit hospitals were shown to be the most efficient, followed by private not-for-profit and public facilities. The findings of this study suggest that DEA has potential for assessing technical efficiency in hospital settings in relation to operational capacity.


Assuntos
Eficiência Organizacional , Hospitais de Ensino , Benchmarking , Brasil , Hospitais Públicos , Humanos
10.
Rev Lat Am Enfermagem ; 29: e3467, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34468624

RESUMO

OBJECTIVE: to characterize surgical hospitalizations, length of stay, cost and mortality, according to the legal nature (public and private) of the hospital institution linked to the Unified Health System (Sistema Único de Saúde, SUS). Method: a descriptive study, of the survey type, with retrospective data collection (2008 to 2017) and a quantitative approach. The dependent variables surgical hospitalizations in Brazil, costs, length of stay and mortality and the independent variables regime/legal nature (public and private) were obtained from the Informatics Department of the Unified Health System. The Mann-Whitney test was used for analysis. RESULTS: the average number of hospitalizations through the Unified Health System was 4,214,083 hospitalizations/year, 53.5% occurred in private hired hospitals and 46.5% in public hospitals (p=0.001). The financial transfer was greater for the private sector (60.6%) against 39.4% for the public (p=0.001). The average stay was 4.5 days in the public hospital and 3.1 days in its private counterpart (p<0.001). Mortality was higher in the public (1.8%) than in the private hospital (1.4%) (p<0.001). CONCLUSION: there was predominance of surgical hospitalizations through the Unified Health System in private hospitals with greater financial transfer to this sector, to the detriment of the public. The diverse evidence produced contributes to the debate and actions to avoid budgetary asphyxiation in the public sector in favor of the private sector.


Assuntos
Hospitalização , Hospitais Privados , Brasil , Hospitais Públicos , Humanos , Setor Público , Estudos Retrospectivos
11.
Rev Esc Enferm USP ; 55: e20210072, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34533561

RESUMO

OBJECTIVE: To relate self-reported health symptoms and the impacts of work in terms of physical, social, and psychological illness in nursing professionals. METHOD: Cross-sectional, correlational study carried out in a public hospital in the southern region of Brazil. A sample of nursing professionals who worked in direct care participated in the study. A social-occupational questionnaire of self-reported health symptoms and the Work-Related Damage Assessment Scale were used. The analysis was descriptive and analytical. Chi-square test and Spearman's correlation coefficient were used, with a significance level of 5%. RESULTS: A total of 308 professionals participated, with a prevalence of physical illness and higher means for pain in the body, legs and back. Significant relations were identified among the social-occupational variables, health symptoms, and physical, social or psychological illness. High and moderate correlations among the factors investigated were evidenced. CONCLUSION: The impact of work on nursing professionals' health is evidenced by the association between self-reported health symptoms and illness, especially the physical or social one, and reinforces the need for professional awareness over situations that are harmful to health.


Assuntos
Hospitais Públicos , Brasil/epidemiologia , Estudos Transversais , Humanos , Inquéritos e Questionários
12.
East Mediterr Health J ; 27(7): 656-664, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34369579

RESUMO

Background: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs. Aims: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare. Methods: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients' hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics. Results: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services. Conclusion: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.


Assuntos
Serviços de Assistência Domiciliar , Hospitalização , Adulto , Estudos Transversais , Hospitais Públicos , Humanos , Irã (Geográfico)/epidemiologia , Tempo de Internação
13.
BMC Med Inform Decis Mak ; 21(1): 229, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340685

RESUMO

BACKGROUND: Telepathology is the practice of reviewing and exchanging pathological images through telecommunication systems to obtain diagnoses remotely. Studying the factors that make such a system successful and favourable is important to ensure the merits of its implementation in clinical practice. OBJECTIVE: This study aims to evaluate the success of a telepathology system from the users' perspectives, using specific evaluation criteria, namely: system quality, information quality, technical service quality, user satisfaction, and benefits. METHODS: A sequential explanatory mixed methods design was adopted in this study, which consists of two phases. Initially, a questionnaire was distributed via WhatsApp to all of the pathologists (total: 45) working at governmental hospitals in Kuwait. Followed by, semi-structured interviews with ten senior pathologists. RESULTS: Forty pathologists responded to the questionnaire, giving an 89% response rate. There were 42.5% of the respondents aged between 35-44 years old, and 52.5% were male. The quantitative results reveal that most of the respondents were satisfied with the quality of the telepathology system with a mean of 2.6025 (Standard Deviation (SD) = 0.47176), whereas they were dissatisfied with the quality of the information with a mean of 2.4100 (SD = 1.580) and the technical support services with a mean of 2.2750 (SD = 0.99535). In addition, there was disagreement on the benefits of telepathology in clinical practice among the pathologists with a mean of 2.4667 (SD = 0.77552). The qualitative results indicate that the lack of interest in and little experience with using the system were behind the general dissatisfaction of most of the respondents. All of the interviewees were satisfied with the performance of the telepathology system and considered it successful; however, the quality of the technical support services, including training workshops, was deemed deficient. CONCLUSION: This study concluded that telepathology system in Kuwait is functioning well and has been successful in its implementation; however, pathologists are dissatisfied with it, mainly due to the deficient quality of the technical support services provided. In addition, the successful implementation of such advanced technologies requires careful steps to be taken on multiple levels: technical, organisational, and managerial. Recommendations were suggested.


Assuntos
Telepatologia , Adulto , Hospitais Públicos , Humanos , Kuweit , Masculino
14.
Ann Palliat Med ; 10(7): 8203-8214, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353103

RESUMO

BACKGROUND: Medical staff is the main force behind the construction of a healthy China. As a result of increasing social pressure, doctors are at high risk for diseases such as "sudden death" and "overwork death". It is essential that the physical and mental health of medical staff be assessed and long-term mechanisms be introduced to care for medical staff. This study sought to investigate the health status, work pressure, and occupational environments of medical staff at level A tertiary public hospitals in Shanghai to provide a basis for exploring the establishment of long-term mechanisms for the exquisite and precise care of medical staff. METHODS: A questionnaire was administered to employees at 10 level A tertiary public hospitals in Shanghai using a random sampling method; 50 medical staff were surveyed at each hospital. A descriptive analysis of the data was conducted using R language. RESULTS: A total of 478 questionnaires were collected; thus, the recovery rate was 95.6%. The analysis revealed that 61% of the medical staff surveyed believed that their health was "good," and 57% believed that they were under high pressure. Over 50% of medical staff were moderately satisfied with their practice environment and salary; however, staff's satisfaction evaluations were affected by their academic qualifications (degrees), work positions, and other factors. Reasonable salary is the primary motivating and demotivating factor. CONCLUSIONS: The party organization can play a leading role in contacting and serving employees. Further, 4 caring systems for health protection, welfare benefits, safety protection, and career planning should be offered to medical staff to ensure they are cared for with elaboration and precision.


Assuntos
Nível de Saúde , Corpo Clínico , China , Hospitais Públicos , Humanos , Inquéritos e Questionários , Centros de Atenção Terciária
15.
BMC Health Serv Res ; 21(1): 876, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445972

RESUMO

BACKGROUND: Engaging consumers - patients, families, carers and community members who are current or potential service users - in the planning, design, delivery, and improvement of health services is a requirement of public hospital accreditation in Australia. There is evidence of social media being used for consumer engagement in hospitals internationally, but in Australia this use is uncommon and stakeholders' experiences have not been investigated. The aim of the study was to explore the experiences and beliefs of key Australian public hospital stakeholders around using social media as a consumer engagement tool. This article focuses on the study findings relating to methods, risks, and benefits of social media use. METHODS: Semi-structured interviews were conducted with Australian public hospital stakeholders in consumer representative, consumer engagement/patient experience, communications or quality improvement roles. Qualitative data were analysed using a deductive content analysis method. An advisory committee of consumer and service provider stakeholders provided input into the design and conduct of this study. RESULTS: Twenty-six Australian public hospital service providers and consumers were interviewed. Participants described social media being used to: recruit consumers for service design and quality improvement activities; as an online space to conduct consultations or co-design; and, to gather feedback and patient experience data. The risks and benefits discussed by interview participants were grouped into five themes: 1) overcoming barriers to engagement, 2) consumer-initiated engagement; 3) breadth vs depth of engagement, 4) organisational transparency vs control and 5) users causing harm. CONCLUSIONS: Social media can be used to facilitate consumer engagement in hospital service design and quality improvement. However, social media alone is unlikely to solve broader issues commonly experienced within health consumer engagement activities, such as tokenistic engagement methods, and lack of clear processes for integrating consumer and patient feedback into quality improvement activities.


Assuntos
Melhoria de Qualidade , Mídias Sociais , Austrália , Hospitais Públicos , Humanos , Medição de Risco
16.
Rev Esc Enferm USP ; 55: e20200521, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34448804

RESUMO

OBJECTIVE: To analyze, from an organizational perspective, the problem of nurse burnout in highly complex public hospitals in Chile. METHOD: Multicenter, observational, cross-sectional study. According to established inclusion criteria, the universe of hospitals and nurses was the object of work. Data collection was carried out through a nurse survey. Work environment was measured with the instrument Practice Environment Scale of the Nursing Work Index, staffing through the nurses' report on patient load, and burnout with the Maslach Burnout Inventory emotional exhaustion subscale. RESULTS: Thirty-four hospitals (92%) and 1,395 nurses (75.3%) participated in the study. The prevalence of burnout was 34.7%, being higher in Santiago than in other regions of the country (p = 0.001). The logistic regression analyses showed a significant association between work environment and burnout (OR 0.57, 95% CI 0.41-0.79, p = 0.001). No association was established between staffing, skill mix and burnout. CONCLUSION: A high percentage of nurses in Chile has burnout, which is significantly associated with the quality of the environment. The implementation of organizational strategies to improve work environments could reduce burnout and improve the quality of care.


Assuntos
Esgotamento Profissional , Recursos Humanos de Enfermagem no Hospital , Esgotamento Profissional/epidemiologia , Chile/epidemiologia , Estudos Transversais , Hospitais Públicos , Humanos , Satisfação no Emprego , Inquéritos e Questionários , Carga de Trabalho
17.
S Afr Med J ; 111(7): 685-688, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-34382554

RESUMO

BACKGROUND: The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, and health facilities reduced non-essential activity, including many surgical services. PRIMARY OBJECTIVE: to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020 general surgery operative volume and proportion at six district and regional hospitals. SECONDARY OBJECTIVE: to compare the operative volume of appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. METHODS: This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data were obtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. RESULTS: Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p<0.001). Elective operations decreased by 74% (n=1 379 v. n=362; p<0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68% (p<0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p<0.001) and trauma operations by 42% (n=325 v. n=190; p<0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog for elective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospital can do one additional operation per weekday. CONCLUSIONS: The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear and structured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recovers from this unprecedented pandemic.


Assuntos
COVID-19 , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Feminino , Hospitais Públicos , Humanos , Masculino , Estudos Retrospectivos , África do Sul , Fatores de Tempo
18.
Artigo em Inglês | MEDLINE | ID: mdl-34444448

RESUMO

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions-a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the "number of days from previous non-elective admission", which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission-a key predictor in other models-since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation-an "art" that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.


Assuntos
Inteligência Artificial , Hospitalização , Idoso , Hospitais Públicos , Humanos , Tempo de Internação , Alta do Paciente , Singapura
19.
Lancet Haematol ; 8(9): e637-e647, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34450101

RESUMO

BACKGROUND: 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS: PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS: Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION: A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING: The College of Nurses of the Balearic Islands. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Cateterismo Periférico/efeitos adversos , Flebite/etiologia , Adulto , Idoso , Obstrução do Cateter/etiologia , Cateterismo Periférico/métodos , Feminino , Hospitais Públicos , Humanos , Masculino , Modelos de Riscos Proporcionais , Espanha
20.
Artigo em Inglês | MEDLINE | ID: mdl-34444379

RESUMO

In Latin American and Caribbean countries, the main concern of public health care managers has been traditionally placed on problems related to funding, payment mechanisms, and equity of access. However, more recently, there is a growing interest in improving the levels of efficiency and reducing costs in the provision of health services. In this paper we focus on measuring the technical efficiency and productivity change of public hospitals in Panama using bootstrapped Malmquist indices, which allows us to assess the statistical significance of changes in productivity, efficiency, and technology. Specifically, we are interested in comparing the performance of hospitals belonging to the two different management schemes coexisting in the country, the Social Security Fund (SSF) and the Ministry of Health (MoH). Our dataset includes data about 22 public hospitals (11 for each model) during the period between 2005 and 2015. The results showed that the productivity growth of hospitals belonging to the SSF has been much higher than that of the hospitals belonging to the Ministry of Health over the evaluated period (almost 4% compared to 1.5%, respectively). The main explanation for these divergences is the superior growth of technological change in the former hospitals, especially in the final years of the evaluated period.


Assuntos
Eficiência Organizacional , Hospitais Públicos , Panamá , Tecnologia
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