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3.
Dis Colon Rectum ; 63(1): 84-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31633600

RESUMO

BACKGROUND: There is increased focus on the value of surgical care. Postoperative complications decrease value, but it is unknown whether high-value hospitals spend less than low-value hospitals in cases without complications. Previous studies have not evaluated both expenditures and validated outcomes in the same patients, limiting the understanding of interactions between clinical performance, efficient utilization of services, and costliness of surgical episodes. OBJECTIVE: This study aimed to identify payment differences between low- and high-value hospitals in colectomy cases without adverse outcomes using a linked data set of multipayer claims and validated clinical outcomes. DESIGN: This is a retrospective observational cohort study. We assigned each hospital a value score (ratio of cases without adverse outcome to mean episode payment). We stratified hospitals into tertiles by value and used analysis of variance tests to compare payments between low- and high-value hospitals, first for all cases, and then cases without adverse outcome. SETTING: January 2012 to December 2016, this investigation used clinical registry data from 56 hospitals participating in the Michigan Surgical Quality Collaborative, linked with 30-day episode payments from the Michigan Value Collaborative. PATIENTS: A total of 2947 patients undergoing elective colectomy were selected. MAIN OUTCOME MEASURES: The primary outcome measured was risk-adjusted, price-standardized 30-day episode payments. RESULTS: The mean adjusted complication rate was 31% (±10.7%) at low-value hospitals and 14% (±4.6%) at high-value hospitals (p < 0.001). Low-value hospitals were paid $3807 (17%) more than high-value hospitals ($22,271 vs $18,464, p < 0.001). Among cases without adverse outcome, payments were still $2257 (11%) higher in low-value hospitals ($19,424 vs $17,167, p = 0.04). LIMITATIONS: This study focused on outcomes and did not consider processes of care as drivers of value. CONCLUSIONS: In elective colectomy, high-value hospitals achieve lower episode payments than low-value hospitals for cases without adverse outcome, indicating mechanisms for increasing value beyond reducing complications. Worthwhile targets to optimize value in elective colectomy may include enhanced recovery protocols or other interventions that increase efficiency in all phases of care. See Video Abstract at http://links.lww.com/DCR/B56. LOGRANDO LA COLECTOMÍA DE ALTO VALOR: PREVINIENDO COMPLICACIONES O MEJORANDO LA EFICIENCIA: Hay un mayor enfoque en el valor de la atención quirúrgica. Las complicaciones postoperatorias disminuyen el valor, pero se desconoce si en los casos sin complicaciones, los hospitales de alto valor gastan menos que los hospitales de bajo valor. Estudios anteriores no han evaluado ambos gastos y validado resultados en los mismos pacientes, limitando la comprensión de las interacciones entre el rendimiento clínico, utilización eficiente de los servicios y costos de los episodios quirúrgicos.Identificar las diferencias de pago entre los hospitales de alto y bajo valor, en casos de colectomía sin resultados adversos, utilizando un conjunto de datos vinculados de reclamos de pago múltiple y resultados clínicos validados.Estudio de cohorte observacional retrospectivo. Asignamos a cada hospital una puntuación de valor (proporción de casos sin resultado adverso al pago medio del episodio). Estratificamos los hospitales por valor en terciles y utilizamos el análisis de pruebas de varianza para comparar los pagos entre hospitales de bajo y alto valor, primero para todos los casos y luego casos sin resultados adversos.De enero del 2012 a diciembre del 2016, utilizando datos de registro clínico de 56 hospitales que participan en el Michigan Surgical Quality Collaborative, vinculado con pagos de episodios de 30 días, del Michigan Value Collaborative.Un total de 2947 pacientes con colectomía electiva.Pagos por episodio de 30 días, ajustados al riesgo y estandarizados por precio.La tasa media de complicación ajustada fue de 31% (±10.7%) en hospitales de bajo valor y 14% (±4.6%) en hospitales de alto valor (p < 0.001). A los hospitales de bajo valor se les pagó $3807 (17%) más que a los hospitales de alto valor ($22,271 frente a $18,464, p < 0.001). Entre los casos sin resultados adversos, los pagos fueron de $2257 (11%) más altos en hospitales de bajo valor ($19,424 vs $17,167, p = 0.04).Este estudio se centró en los resultados y no se consideraron a los procesos de atención, como impulsores de valor.En la colectomía electiva, los hospitales de alto valor logran pagos de episodios más bajos, que en los hospitales de bajo valor con casos sin resultados adversos, indicando mecanismos para aumentar el valor, más allá que la reducción de complicaciones. Objetivos valiosos para optimizar el valor de la colectomía electiva, pueden incluir mejoras en los protocolos de recuperación, así como otras intervenciones que aumenten la eficiencia en todas las fases de la atención. Vea el resumen del video en http://links.lww.com/DCR/B56.


Assuntos
Colectomia/normas , Hospitais/normas , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Idoso , Colectomia/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Seguimentos , Humanos , Incidência , Masculino , Michigan/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
4.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 486-493, Oct.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1041358

RESUMO

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.


RESUMO Objetivo: Descrever a experiência de 25 anos da Iniciativa Hospital Amigo da Criança (IHAC) no Brasil, cuja primeira unidade foi implementada em 1992. Métodos: Informações e dados foram obtidos em publicações nos sites da Organização Mundial da Saúde (OMS), do Fundo Internacional de Emergência para a Infância das Nações Unidas (UNICEF) e do Ministério da Saúde e em periódicos nacionais e internacionais, abrangendo o período de 1990 a 2017. Utilizaram-se os descritores: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" e "breastfeeding". Foram avaliados o número de hospitais nos 25 anos, a trajetória da IHAC e suas repercussões sobre o aleitamento materno no Brasil. Resultados: A IHAC é uma estratégia de intervenção na assistência hospitalar ao nascimento com foco na implementação de práticas que promovem o aleitamento materno exclusivo desde as primeiras horas de vida e com o apoio, entre outras medidas de impacto positivo na amamentação, do Código Internacional de Comercialização de Substitutos do Leite Materno. Atualmente, a iniciativa foi revisada, atualizada e expandida para integrar o cuidado aos recém-nascidos nas unidades neonatais e na atenção à mulher desde o pré-natal. Pôde-se concluir que, ao longo desses 25 anos, a quantidade de hospitais variou muito, com números ainda aquém da capacidade de leitos hospitalares. Hospitais credenciados como o Hospital Amigo da Criança mostram índices de amamentação superiores ao de hospitais não credenciados, entretanto o número de hospitais credenciados no Brasil ainda é pouco se comparado com outros países. Conclusões: A IHAC contribuiu para o aleitamento materno no Brasil nessas últimas décadas. Mais apoio pelas políticas públicas é necessário para ampliar o número de instituições credenciadas no país.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Aleitamento Materno/métodos , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/normas , Hospitais/normas , Cuidado do Lactente/normas , Brasil , Melhoria de Qualidade/estatística & dados numéricos , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Cuidado do Lactente/métodos , Cuidado do Lactente/estatística & dados numéricos
5.
BMC Health Serv Res ; 19(1): 815, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703678

RESUMO

BACKGROUND: Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. METHODS: In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. RESULTS: Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. CONCLUSION: This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.


Assuntos
Administração de Serviços de Saúde/normas , Relações Profissional-Paciente , Melhoria de Qualidade/organização & administração , Serviços de Saúde Comunitária/normas , Hospitais/normas , Humanos , Estudos Longitudinais , Quebeque
6.
Health Serv Res ; 54(5): 971-980, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506956

RESUMO

OBJECTIVE: To estimate the relationship between breach remediation efforts and hospital care quality. DATA SOURCES: Department of Health and Human Services' (HHS) public database on hospital data breaches and Medicare Compare's public data on hospital quality measures for 2012-2016. MATERIALS AND METHODS: Data breach data were merged with the Medicare Compare data for years 2012-2016, yielding a panel of 3025 hospitals with 14 297 unique hospital-year observations. STUDY DESIGN: The relationship between breach remediation and hospital quality was estimated using a difference-in-differences regression. Hospital quality was measured by 30-day acute myocardial infarction mortality rate and time from door to electrocardiogram. PRINCIPAL FINDINGS: Hospital time-to-electrocardiogram increased as much as 2.7 minutes and 30-day acute myocardial infarction mortality increased as much as 0.36 percentage points during the 3-year window following a breach. CONCLUSION: Breach remediation efforts were associated with deterioration in timeliness of care and patient outcomes. Thus, breached hospitals and HHS oversight should carefully evaluate remedial security initiatives to achieve better data security without negatively affecting patient outcomes.


Assuntos
Segurança Computacional/estatística & dados numéricos , Segurança Computacional/normas , Confidencialidade/normas , Registros Eletrônicos de Saúde/normas , Hospitais/normas , Medicare/normas , Qualidade da Assistência à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
8.
BMC Health Serv Res ; 19(1): 674, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533786

RESUMO

BACKGROUND: Little research exists on patient safety climate in the prehospital context. The purpose of this article is to test and validate a safety climate measurement model for the prehospital environment, and to explore and develop a theoretical model measuring associations between safety climate factors and the outcome variable transitions and handoffs. METHODS: A web-based survey design was utilized. An adjusted short version of the instrument Hospital Survey on Patient Safety Culture (HSOPSC) was developed into a hypothetical structural model. Three samples were obtained. Two from air ambulance workers in 2012 and 2016, with respectively 83 and 55% response rate, and the third from the ground ambulance workers in 2016, with 26% response rate. Confirmatory factor analysis (CFA) was applied to test validity and psychometric properties. Internal consistency was estimated and descriptive data analysis was performed. Structural equation modelling (SEM) was applied to assess the theoretical model developed for the prehospital setting. RESULTS: A post-hoc modified instrument consisting of six dimensions and 17 items provided overall acceptable psychometric properties for all samples, i.e. acceptable Chronbach's alphas (.68-.86) and construct validity (model fit values: SRMR; .026-.056, TLI; .95-.98, RMSEA; .031-.052, CFI; .96-.98). A common structural model could also be established. CONCLUSIONS: The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture short version (PreHSOPSC-S), for measuring patient safety climate in a prehospital context. We also demonstrated a positive relation between safety climate dimensions from leadership to unit level, from unit to individual level, and from individual level on the outcome dimension related to transitions and handoffs. Safe patient transitions and handoffs are considered an important outcome of prehospital deliveries; hence, new theory and a validated model will constitute an important contribution to the prehospital safety climate research.


Assuntos
Serviços Médicos de Emergência/normas , Segurança do Paciente/normas , Gestão da Segurança/normas , Estudos Transversais , Análise Fatorial , Hospitais/normas , Humanos , Liderança , Cultura Organizacional , Estudos Prospectivos , Psicometria , Inquéritos e Questionários
9.
Int J Med Inform ; 131: 103954, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31513943

RESUMO

OBJECTIVE: To achieve universal access to medical resources-a partial goal of the second ambitious health reform since 2010-the Chinese government aimed to build a regional medical consortium and enhance the efficiency of health information exchange (HIE). We analyzed the experience of constructing a medical consortium in Chinese hospitals, which was based on regional health information technology (RHIT) promoted by HIE. METHOD: In this longitudinal study, we analyzed the results of the annual surveys that were conducted by the China Hospital Information Management Association from 2006 to 2015. The survey results mainly concerned whether hospitals should join the regional medical consortium, the methods used for sharing inter-hospital medical data, and the out-of-hospital information interaction system. The Bass diffusion model was adopted to fit and predict the proportion of Chinese hospitals joining the consortium from 2006 to 2025. RESULT: As of 2015, the survey results of 7272 hospitals were obtained. The proportion of hospitals in partnership systems increased from 3.0% in 2007 to 57.2% in 2015. There has been a rapid development in the electronic sharing of medical data between hospitals. The proportion of hospitals that relied solely on paper documents for data interaction decreased from 43.3% in 2011 to 8.0% in 2015. There was a strong positive linear correlation between hospitals joining the consortium and the accessibility of electronic medical data exchange within hospitals (r = 0.925). The proportions of hospitals that supported dual referral systems and appointments, data browsing between hospitals and regional information systems, and remote consultation services increased to 65.0%, 61.6%, and 81.9% in 2015, as compared to 18.8%, 16.8%, and 10.9% in 2011, respectively. The Bass prediction model showed that the goal of recruiting 90% of the hospitals to the consortium by 2020 will likely be achieved (adjusted R2 = 0.93). CONCLUSION: The Chinese government has applied a top-down, high-level design model to promote the rapid development of a medical consortium, in which the RHIT technologies are crucial technical enabler.


Assuntos
Reforma dos Serviços de Saúde , Hospitais/estatística & dados numéricos , Hospitais/normas , Informática Médica/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , China , Humanos , Estudos Longitudinais , Sistemas Computadorizados de Registros Médicos/normas
11.
BMC Health Serv Res ; 19(1): 613, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470853

RESUMO

BACKGROUND: The aim was to determine the feasibility of implementing a patient safety survey which measures patients' experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective. METHODS: Mixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups. RESULTS: Patients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients. CONCLUSIONS: Patients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions.


Assuntos
Segurança do Paciente/normas , Transferência de Pacientes/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Estudos de Viabilidade , Retroalimentação , Feminino , Grupos Focais , Hospitais/normas , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Participação do Paciente , Pacientes , Melhoria de Qualidade , Gestão de Riscos , Medicina Estatal/normas , Inquéritos e Questionários , Adulto Jovem
12.
BMC Health Serv Res ; 19(1): 636, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488150

RESUMO

BACKGROUND: Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS: The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS: Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS: Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/normas , Adulto , Serviço Hospitalar de Emergência/normas , Estudos de Viabilidade , Feminino , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Reprodutibilidade dos Testes , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus , Inquéritos e Questionários/normas
13.
Transfus Apher Sci ; 58(4): 423-428, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383540

RESUMO

BACKGROUND: Plasma transfusion is not without risks. Despite a limited spectrum of indications, plasma is frequently used as prophylaxis in non-bleeding patients, to correct altered coagulation tests. A high rate of inappropriate use of plasma transfusion is frequently reported, as well as underdosage. STUDY DESIGN AND METHODS: Since 2010 we started an education program that occurred in several phases to disseminate the knowledge of plasma transfusion guidelines. Since 2014 a 'zero tolerance' policy was applied: except for massive bleedings, plasma requests were prospectively evaluated, rejecting those without an appropriate indication. When indicated, at least 10 mL/Kg b.w.were issued. The previous five year period (2005-2009) served as control. RESULTS: The number of patients transfused/year decreased by 67.6% vs the control period (149 vs 460), and the liters of plasma issued/year decreased by 70.4% (233 vs 795). The deepest fall was observed in acute care wards (-70.8%). The mean volume transfused per episode raised from 731 mL ±â€¯70 to 879 mL ±â€¯154. The Prothrombin Time ratio at the moment of transfusion request increased from a mean of 1.35 (Interquartile range 1.20-2.64) in the control period to 1.62 (Interquartile range 1.43-1.98) in the last period (p < 0.001). CONCLUSION: With a proactive educational approach a remarkable reduction of plasma order and administration has been obtained, without any consequence on morbidity and mortality and with an estimated saving since 2014 of 750,000 €. A 'zero tolerance' policy can be effectively implemented only with a thorough workup with the local physicians, including repeated rounds of information and refreshing of the updated transfusion practice and knowledge of the established guidelines over the time.


Assuntos
Transfusão de Componentes Sanguíneos/normas , Hemorragia/terapia , Hospitais/normas , Política Organizacional , Plasma , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Am J Disaster Med ; 14(1): 25-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441026

RESUMO

BACKGROUND AND OBJECTIVES: Hospitals are the vital part of disaster management and their functionality should be maintained and secured. However, it can be the target of natural and man-made disasters. In Iran, Fars Province is prone to major incidents and disasters in its hospitals at any time during the course of a year. This study aimed to examine the Hospital Safety Index (HSI) in all hospitals (public and private) affiliated to Shiraz University of Medical Sciences (SUMS). MATERIALS AND METHODS: This cross-sectional study was conducted during 2015-2016, using the World Health Organization's HSI checklist. All 58 hospitals in Fars Province affiliated to SUMS were included. The hospital assessment team was formed to collect the data retrospectively and by visiting and interviewing hospital's authority based on the checklist. The collected data were analyzed using Microsoft Excel. RESULTS: The results showed that in the above-mentioned years, the structural safety of hospitals reached the highest optimal level, whereas functional safety reached the lowest level. The results of the studies conducted in 2016 showed that during this year, the overall hospital safety level improved (6 and B). CONCLUSION: Although safety in hospitals located in Fars Province has improved due to continuous disaster mitigation and preparedness activities, there is still space for more improvement to achieve and maintain higher levels of safety in hospitals. Paying attention to this, the authors recommend that proper policies, legislation, and intra and inter-institutional coordination are the requirements for a successful outcome.


Assuntos
Defesa Civil/normas , Planejamento em Desastres/organização & administração , Desastres , Hospitais/normas , Capacidade de Resposta ante Emergências/normas , Lista de Checagem , Estudos Transversais , Humanos , Irã (Geográfico) , Estudos Retrospectivos
16.
Rev Peru Med Exp Salud Publica ; 36(2): 304-311, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460645

RESUMO

The reference hospitals of the Peruvian Ministry of Health serve patients with complex pathologies. Quality care involves not only good treatment, warmth and humanism in care, but also material resources and real capacity to solve problems. Unfortunately, the reality of the hospitals of the Peruvian Ministry of Health is far from the recommended quality standards, with notable deficiencies in their problem-solving capacity due to the lack of diagnostic aid methods, lack of equipment, and flaws in the acquisition of medications and supplies. It is inadmissible for a referential level hospital not to have imaging studies such as magnetic resonance, nuclear medicine, angiography, immunohistochemistry, molecular biology and genetic studies, among others. This article presents some of the problems encountered in daily practice from the perspective of the author as a healthcare provider and reviews the findings of the quality of care evaluation conducted by the Comptroller General of the Republic in 2018 in reference hospitals. Some immediate measures of action are proposed, emphasizing the need to immediately address the lack of infrastructure and resolution capacity for diagnosis and treatment, as well as to promote public tenders for hospital managers that would allow a transparent and meritocratic exercise not subject to political vagaries.


Assuntos
Assistência à Saúde/normas , Hospitais/normas , Qualidade da Assistência à Saúde , História do Século XX , História do Século XXI , Humanos , Peru
17.
Nurs Manag (Harrow) ; 26(4): 22-28, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468826

RESUMO

NHS regulators, such as NHS Improvement and the Care Quality Commission, promote staff involvement in quality improvement (QI), while national nursing leaders and the Nursing and Midwifery Council advocate nurses' involvement in improving services. This article critically explores the evidence base for a national nursing strategy to involve nurses in QI using a literature review. A thematic analysis shows that nurse involvement in QI has several positive outcomes, which are also included in the NHS Improvement's Single Oversight Framework for NHS Providers. The article concludes that nurse involvement in QI helps improve hospital performance.


Assuntos
Hospitais/normas , Recursos Humanos de Enfermagem no Hospital/organização & administração , Melhoria de Qualidade/organização & administração , Medicina Estatal/organização & administração , Inglaterra , Humanos , Pesquisa em Avaliação de Enfermagem
19.
Rev Esc Enferm USP ; 53: e03471, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433013

RESUMO

OBJECTIVE: To identify the prevalence of nursing process documentation in hospitals and outpatient clinics administered by the São Paulo State Department of Health. METHOD: A descriptive study conducted through interviews with nurses responsible for 416 sectors of 40 institutions on the documentation of four phases of the Nursing Process (data collection, diagnosis, prescription and evaluation) and nursing annotations. RESULTS: Of the 416 sectors studied, 89.9% documented at least one phase; 56.0% documented the four phases; 4.3% only documented nursing annotations; 5.8% did not document any phase, nor did the nursing notes. The types of sectors which were less documented were: ambulatory, diagnostic support, surgical center and obstetric center; while the ones which were most documented included: intensive care units, emergency rooms and hospitalization units. The data collection and diagnosis were the least documented phases, both in 78.8% of the sectors. CONCLUSION: Most of the studied sectors document the Nursing Process and do nursing annotations, but there are sectors where documentation does not meet formal requirements. The viability of documentation of all the Nursing Process phases in certain types of sectors needs to be better studied.


Assuntos
Documentação/estatística & dados numéricos , Processo de Enfermagem/normas , Registros de Enfermagem/normas , Instituições de Assistência Ambulatorial/normas , Brasil , Estudos Transversais , Serviço Hospitalar de Emergência/normas , Hospitais/normas , Humanos , Unidades de Terapia Intensiva/normas , Entrevistas como Assunto , Saúde Pública
20.
Curr Pharm Biotechnol ; 20(8): 658-664, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31258073

RESUMO

BACKGROUND: Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. METHODS: The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. RESULTS: Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients' engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. CONCLUSION: HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.


Assuntos
Causas de Morte/tendências , Infecção Hospitalar/epidemiologia , Assistência à Saúde/normas , Medicina Legal , Hospitais/normas , Autopsia , Infecção Hospitalar/patologia , Humanos
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