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1.
JAMA Netw Open ; 4(12): e2138596, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34928358

RESUMO

Importance: In October 2015, the Centers for Medicare & Medicaid Services began requiring US hospitals to report adherence to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). Objective: To evaluate the association of SEP-1 implementation with sepsis treatment patterns and outcomes in diverse hospitals. Design, Setting, and Participants: This retrospective cohort study with interrupted time-series analysis and logistic regression models was conducted among adults admitted to 114 hospitals from October 2013 to December 2017 with suspected sepsis (blood culture orders, ≥2 systemic inflammatory response syndrome criteria, and acute organ dysfunction) within 24 hours of hospital arrival. Data analysis was conducted from September 2020 to September 2021. Exposures: SEP-1 implementation in the fourth quarter (Q4) of 2015. Main Outcomes and Measures: The primary outcome was quarterly rates of risk-adjusted short-term mortality (in-hospital death or discharge to hospice). Secondary outcomes included lactate testing and administration of anti-methicillin-resistant Staphylococcus aureus (MRSA) or antipseudomonal ß-lactam antibiotics within 24 hours of hospital arrival. Generalized estimating equations with robust sandwich variances were used to fit logistic regression models to assess for changes in level or trends in these outcomes, adjusting for baseline characteristics and severity of illness. Results: The cohort included 117 510 patients (median [IQR] age, 67 years [55-78] years; 60 530 [51.5%] men and 56 980 [48.5%] women) with suspected sepsis. Lactate testing rates increased from 55.1% (95% CI, 53.9%-56.2%) in Q4 of 2013 to 76.7% (95% CI, 75.4%-78.0%) in Q4 of 2017, with a significant level change following SEP-1 implementation (odds ratio [OR], 1.34; 95% CI, 1.04-1.74). There were increases in use of anti-MRSA antibiotics (19.8% [95% CI, 18.9%-20.7%] in Q4 of 2013 to 26.3% [95% CI, 24.9%-27.7%] in Q4 of 2017) and antipseudomonal antibiotics (27.7% [95% CI, 26.7%-28.8%] in Q4 of 2013 to 40.5% [95% CI, 38.9%-42.0%] in Q4 of 2017), but these trends preceded SEP-1 and did not change with SEP-1 implementation. Unadjusted short-term mortality rates were similar in the pre-SEP-1 period (Q4 of 2013 through Q3 of 2015) vs the post-SEP-1 period (Q1 of 2016 through Q4 of 2017) (20.3% [95% CI, 20.0%-20.6%] vs 20.4% [95% CI, 20.1%-20.7%]), and SEP-1 implementation was not associated with changes in level (OR, 0.94; 95% CI, 0.68-1.29) or trend (OR, 1.00; 95% CI, 0.97-1.04) for risk-adjusted short-term mortality rates. Conclusions and Relevance: In this cohort study, SEP-1 implementation was associated with an immediate increase in lactate testing rates, no change in already-increasing rates of broad-spectrum antibiotic use, and no change in short-term mortality rates for patients with suspected sepsis. Other approaches to decrease sepsis mortality may be warranted.


Assuntos
Pacotes de Assistência ao Paciente , Sepse/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Biomarcadores/metabolismo , Centers for Medicare and Medicaid Services, U.S. , Feminino , Mortalidade Hospitalar/tendências , Hospitais/normas , Hospitais/tendências , Humanos , Análise de Séries Temporais Interrompida , Ácido Láctico/metabolismo , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/metabolismo , Sepse/mortalidade , Resultado do Tratamento , Estados Unidos , Adulto Jovem
2.
PLoS One ; 16(12): e0261363, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932592

RESUMO

Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. Yet luck has the potential to affect performance assessment through randomness in the sorting of patients among providers or through random events during the evaluation period. To investigate the impact luck can have on the assessment of performance, we investigated its role in assigning penalties under Medicare's Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions. We performed simulations that estimated program hospitals' 2015 readmission penalties in 1,000 different hypothetical fiscal years. These hypothetical fiscal years were created by: (a) randomly varying which patients were admitted to each hospital and (b) randomly varying the readmission status of discharged patients. We found significant differences in penalty sizes and probability of penalty across hypothetical fiscal years, signifying the importance of luck in readmission performance under the HRRP. Nearly all of the impact from luck arose from events occurring after hospital discharge. Luck played a smaller role in determining penalties for hospitals with more beds, teaching hospitals, and safety-net hospitals.


Assuntos
Economia Hospitalar/normas , Hospitais/normas , Medicare/economia , Readmissão do Paciente/economia , Qualidade da Assistência à Saúde , Reembolso de Incentivo/normas , Provedores de Redes de Segurança/normas , Idoso , Humanos , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos
3.
Pan Afr Med J ; 39: 287, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34754364

RESUMO

In Tunisia, Hospital sterilization guidelines recommend the establishment of a quality assurance system. The purpose of this study is to give an overview of the situation in a sterilization unit in order to assess the adherence to good practice criteria and to identify opportunities for improvement. We conducted a prospective study in the sterilization unit of the Hospital Tahar Sfar, Mahdia in 2019. Two internal audits were conducted under the same conditions and were carried out one year apart. The first audit identified failures and malfunctions and the outlining of an action plan. The impact of the measures undertaken was tested using a second audit. Data collection was carried out by direct observation of the existing resources and practices. Compliance rate was calculated taking into account compliant criteria and applicable criteria. The results of the first audit revealed a compliance rate of around 28.1%. The analysis used to observe deviations made it possible to identify 5 axes of improvement, in particular the implementation of a system of documentation and a quality management system. In total, we prepared 14 documents related to the managerial processes, 26 to the operational processes and 41 to the support processes. The actions put in place enabled to achieve a compliance rate of 60.4%. The approach taken to upgrade sterilization processes made it possible to standardize them while ensuring traceability.


Assuntos
Hospitais/normas , Garantia da Qualidade dos Cuidados de Saúde , Esterilização/normas , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Auditoria Administrativa , Estudos Prospectivos , Melhoria de Qualidade , Tunísia
4.
Pan Afr Med J ; 40: 49, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795829

RESUMO

Introduction: despite the adoption of mental disorders act in 1972, the use of required mental health care act (MHCA) forms during admission of patients with mental illnesses remained below the legal expectation in the Maun District Hospital. This study audited Letsholathebe II Memorial Hospital (LIIMH) professionals´ usage of MHCA forms. Methods: this was a quasi-experimental study that audited files of patients admitted with mental illnesses, before, three and six months after a continuing medical education (CME). Cochran Q, McNemar symmetry Chi-square were used for comparison of performance. Results: of the 239 eligible files, we accessed 235 (98.3%). About two in ten (n=36/235, 15.3%) MHCA forms were not used in combination with required forms. The quasi-majority of MHCA forms set used, aligned with involuntary admission (n=134/137, 97.8%). Required admission MHCA forms significantly increased from nil before continuing medical education (CME-0), to 64.6% (n=51/79) at CME-3 and 77% (n=59/77) at CME-6 (p<0.001). However, there was no statistical difference between the last two periods (64.6% vs 77%, p=0.164). Voluntary admission remained below 13% (n=10/79). Only six types of MHCA forms were used during this study. Conclusion: there was no adequate use of required MHCA forms at LIIMH before CME. Thereafter, the proportion of adequate use increased from period CME-0 to the periods CME-3 and CME-6. However, there was no difference in proportion between the last two periods. We recommend an effective and regular CME twice a year for health professionals on selected MHCA forms.


Assuntos
Educação Continuada/métodos , Transtornos Mentais/terapia , Admissão do Paciente/normas , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Botsuana , Feminino , Formulários como Assunto , Pessoal de Saúde/educação , Pessoal de Saúde/normas , Hospitais/normas , Humanos , Masculino , Auditoria Médica , Admissão do Paciente/legislação & jurisprudência , Atenção Primária à Saúde/legislação & jurisprudência , Adulto Jovem
5.
PLoS One ; 16(10): e0258618, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34648582

RESUMO

BACKGROUND: Hospital performance is often monitored by surveys that assess patient experiences with hospital care. Certain patient characteristics may shape how some aspects of hospital care are viewed and reported on surveys. OBJECTIVE: The aim of the study was to examine factors considered important to patients and determine whether there were differences in answers based on age, gender, or educational level. METHODS: Cross-sectional study based on a hospital survey developed via literature review and specialist recommendations. This study included randomly selected patients 18 years or older who were recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Survey domains included age, gender, educational level, factors considered important for the health care in a hospital setting and sources of information about hospital quality used by each subject. Answers description and statistical analysis using Fisher exact test were performed. RESULTS: The survey was applied to 262 patients who were admitted under different services. The most important concern reported was the risk of getting a hospital-acquired infection (67.18%), followed by understanding explanation from the doctors' plans (64.12%) and doctors' ability to listen carefully (58.78%). Women are more concerned about their risk of falling (p = 0.03). Patients older than 65 years find important that the doctors explain everything in a way they can easily understand (p = 0.02), while lower educated patients consider most if the doctor treats them with courtesy and respect (p = 0.0027). CONCLUSION: Patient characteristics have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with patients.


Assuntos
Hospitais/normas , Satisfação do Paciente/estatística & dados numéricos , Pacientes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários , Adulto Jovem
6.
Molecules ; 26(19)2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34641421

RESUMO

Medical errors associated with IV preparation and administration procedures in a hospital workflow can even cost human lives due to the direct effect they have on patients. A large number of such incidents, which have been reported in bibliography up to date, indicate the urgent need for their prevention. This study aims at proposing an analytical methodology for identifying and quantifying IV drugs before their administration, which has the potential to be fully harmonized with clinical practices. More specifically, it reports on the analysis of a piperacillin (PIP) and tazobactam (TAZ) IV formulation, using Raman spectroscopy. The simultaneous analysis of the two APIs in the same formulation was performed in three stages: before reconstitution in the form of powder without removing the substance out of the commercial glass bottle (non-invasively), directly after reconstitution in the same way, and just before administration, either the liquid drug is placed in the infusion set (on-line analysis) or a minimal amount of it is transferred from the IV bag to a Raman optic cell (at-line analysis). Except for the successful identification of the APIs in all cases, their quantification was also achieved through calibration curves with correlation coefficients ranging from 0.953 to 0.999 for PIP and from 0.965 to 0.997 for TAZ. In any case, the whole procedure does not need more than 10 min to be completed. The current methodology, based on Raman spectroscopy, outweighs other spectroscopic (UV/Vis, FT-IR/ATR) or chromatographic (HPLC, UHPLC) protocols, already applied, which are invasive, costly, time-consuming, not environmentally friendly, and require specialized staff and more complex sample preparation procedures, thus exposing the staff to hazardous materials, especially in cases of cytotoxic drugs. Such an approach has the potential to bridge the gap between experimental setup and clinical implementation through exploitation of already developed handheld devices, along with the presence of digital spectral libraries.


Assuntos
Antibacterianos/administração & dosagem , Hospitais/normas , Piperacilina/administração & dosagem , Análise Espectral Raman/métodos , Tazobactam/administração & dosagem , Fluxo de Trabalho , Antibacterianos/análise , Humanos , Piperacilina/análise , Tazobactam/análise
7.
Bone Joint J ; 103-B(10): 1627-1632, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34587811

RESUMO

AIMS: The aim of this study was to determine the impact of hospital-level service characteristics on hip fracture outcomes and quality of care processes measures. METHODS: This was a retrospective analysis of publicly available audit data obtained from the National Hip Fracture Database (NHFD) 2018 benchmark summary and Facilities Survey. Data extraction was performed using a dedicated proforma to identify relevant hospital-level care process and outcome variables for inclusion. The primary outcome measure was adjusted 30-day mortality rate. A random forest-based multivariate imputation by chained equation (MICE) algorithm was used for missing value imputation. Univariable analysis for each hospital level factor was performed using a combination of Tobit regression, Siegal non-parametric linear regression, and Mann-Whitney U test analyses, dependent on the data type. In all analyses, a p-value < 0.05 denoted statistical significance. RESULTS: Analyses included 176 hospitals, with a median of 366 hip fracture cases per year (interquartile range (IQR) 280 to 457). Aggregated data from 66,578 patients were included. The only identified hospital-level variable associated with the primary outcome of 30-day mortality was hip fracture trial involvement (no trial involvement: median 6.3%; trial involvement: median 5.7%; p = 0.039). Significant key associations were also identified between prompt surgery and presence of dedicated hip fracture sessions; reduced acute length of stay and both a higher number of hip fracture cases per year and more dedicated hip fracture operating lists; Best Practice Tariff attainment and greater number of hip fracture cases per year, more dedicated hip fracture operating lists, presence of a dedicated hip fracture ward, and hip fracture trial involvement. CONCLUSION: Exploratory analyses have identified that improved outcomes in hip fracture may be associated with hospital-level service characteristics, such as hip fracture research trial involvement, larger hip fracture volumes, and the use of theatre lists dedicated to hip fracture surgery. Further research using patient level data is warranted to corroborate these findings. Cite this article: Bone Joint J 2021;103-B(10):1627-1632.


Assuntos
Benchmarking , Fixação de Fratura/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Hospitais/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Algoritmos , Auditoria Clínica , Bases de Dados Factuais , Fraturas do Quadril/mortalidade , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Análise Multivariada , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Reino Unido/epidemiologia
9.
J Infect Dev Ctries ; 15(8): 1074-1079, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34516413

RESUMO

INTRODUCTION: Public life in China is gradually returning to normal with strong measures in coronavirus 2019 (COVID-19) control. Because of the long-term effects of COVID-19, medical institutions had to make timely adjustments to control policies and priorities to balance between COVID-19 prevention and daily medical services. METHODOLOGY: The framework for infection prevention and control in the inpatient department was effectively organized at both hospital and department levels. A series of prevention and control strategies was implemented under this leadership: application of rigorous risk assessment and triage before admission through a query list; classifying patients into three risk levels and providing corresponding medical treatment and emergency handling; establishing new ward visiting criteria for visitors; designing procedures for PPE and stockpile management; executing specialized disinfection and medical waste policies. RESULTS: Till June 2020, the bed occupancy had recovered from 20.0% to 88.1%. In total, 13045 patients were received in our hospital, of which 54 and 127 patients were identified as high-risk and medium-risk, respectively, and 2 patients in the high-risk group were eventually laboratory-confirmed with COVID-19. No hospital-acquired infection of COVID-19 has been observed since the emergency appeared. CONCLUSIONS: The strategies ensured early detection and targeted prevention of COVID-19 following the COVID-19 pandemic, which improved the recovery of medical services after the pandemic.


Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hospitais/estatística & dados numéricos , Controle de Infecções/métodos , COVID-19/epidemiologia , China/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Hospitalização/estatística & dados numéricos , Hospitais/normas , Humanos , Controle de Infecções/instrumentação , Pacientes Internados/estatística & dados numéricos , Isolamento de Pacientes/métodos , Equipamento de Proteção Individual , Medição de Risco , Triagem
10.
Crit Care ; 25(1): 329, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507601

RESUMO

BACKGROUND: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.


Assuntos
Parada Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Hospitais/normas , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Hospitais/estatística & dados numéricos , Hospitais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Resultados em Cuidados de Saúde/métodos , Estudos Prospectivos
12.
PLoS One ; 16(8): e0255490, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34388154

RESUMO

AIMS: The aim of this study was to compare discrepancies between diagnosed and autopsied causes of death in 1,112 hospital autopsies and to determine the factors causing this discrepancies. METHODS: 1,112 hospital autopsies between 2010 and 2013 were retrospectively studied. Ante-mortem diagnoses were compared to causes of death as determined by autopsy. Clinical diagnoses were extracted from the autopsy request form, and post-mortem diagnoses were assessed from respective autopsy reports. Variables, such as sex, age, Body Mass Index, category of disease, duration of hospital stay and new-borns were studied in comparison to discrepancy. P-values were derived from the Mann-Whitney U test for the constant features and chi-2 test, p-values < 0,05 were considered significant. RESULTS: 73.9% (n = 822) patients showed no discrepancy between autopsy and clinical diagnosis. The duration of hospitalisation (6 vs. 9 days) and diseases of the cardiovascular system (61.7%) had a significant impact on discrepancies. CONCLUSION: Age, cardiovascular diseases and duration of hospital stay significantly affect discrepancies in ante- and post-mortem diagnoses.


Assuntos
Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Hospitais/normas , Idoso , Autopsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
N Engl J Med ; 385(7): 618-627, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379923

RESUMO

BACKGROUND: The Center for Medicare and Medicaid Innovation launched the Medicare Bundled Payments for Care Improvement-Advanced (BPCI-A) program for hospitals in October 2018. Information is needed about the effects of the program on health care utilization and Medicare payments. METHODS: We conducted a modified segmented regression analysis using Medicare claims and including patients with discharge dates from January 2017 through September 2019 to assess differences between BPCI-A participants and two control groups: hospitals that never joined the BPCI-A program (nonjoining hospitals) and hospitals that joined the BPCI-A program in January 2020, after the conclusion of the intervention period (late-joining hospitals). The primary outcomes were the differences in changes in quarterly trends in 90-day per-episode Medicare payments and the percentage of patients with readmission within 90 days after discharge. Secondary outcomes were mortality, volume, and case mix. RESULTS: A total of 826 BPCI-A participant hospitals were compared with 2016 nonjoining hospitals and 334 late-joining hospitals. Among BPCI-A hospitals, the mean baseline 90-day per-episode Medicare payment was $27,315; the change in the quarterly trends in the intervention period as compared with baseline was -$78 per quarter. Among nonjoining hospitals, the mean baseline 90-day per-episode Medicare payment was $25,994; the change in quarterly trends as compared with baseline was -$26 per quarter (difference between nonjoining hospitals and BPCI-A hospitals, $52 [95% confidence interval {CI}, 34 to 70] per quarter; P<0.001; 0.2% of the baseline payment). Among late-joining hospitals, the mean baseline 90-day per-episode Medicare payment was $26,807; the change in the quarterly trends as compared with baseline was $4 per quarter (difference between late-joining hospitals and BPCI-A hospitals, $82 [95% CI, 41 to 122] per quarter; P<0.001; 0.3% of the baseline payment). There were no meaningful differences in the changes with regard to readmission, mortality, volume, or case mix. CONCLUSIONS: The BPCI-A program was associated with small reductions in Medicare payments among participating hospitals as compared with control hospitals. (Funded by the National Heart, Lung, and Blood Institute.).


Assuntos
Economia Hospitalar , Medicare/economia , Pacotes de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Mecanismo de Reembolso , Idoso , Idoso de 80 Anos ou mais , Grupos Diagnósticos Relacionados , Cuidado Periódico , Feminino , Insuficiência Cardíaca/terapia , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Readmissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estados Unidos
15.
PLoS One ; 16(7): e0255329, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34320041

RESUMO

Both voluntary in-hospital reporting and mandatory national-level reporting systems for patient safety issues need to work well to develop a patient safety learning system that is effective in preventing the recurrence of adverse events. Some of the hospital systems and activities may increase voluntary in-hospital reporting and mandatory national-level reporting. This study aimed to identify the hospital systems and activities that increase voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues. An anonymous mail survey of hospitals in Japan was conducted in 2017. The hospitals were selected by stratified random sampling according to number of beds. The survey examined the annual number of reported events in the voluntary in-hospital reporting system for patient safety and experience of reporting unexpected patient deaths possibly due to medical interventions to the mandatory national-level reporting system in the last 2 years. The relationship of the answer to the questions with the patient safety management systems and activities at each hospital was analyzed. The response rate was 18.8% (603/3,215). The number of in-hospital reports per bed was positively related to identifying events by referring complaints or questions of patients or family members, using root cause analysis for analyzing reported events, and developing manuals or case studies based on reported events, and negatively related to the unification and standardization of medical devices and equipment. The experience with mandatory national-level reporting of serious adverse events was positively related to identifying problematic cases by a person in charge of patient safety management from the in-hospital reporting system of complications and accidental symptoms. Enhanced feedback for reporters may promote voluntary in-hospital reporting of minor cases with low litigation risks. Developing an in-hospital mechanism that examines all serious complications and accidental symptoms may promote mandatory national-level reporting of serious adverse events with high litigation risks.


Assuntos
Segurança do Paciente/normas , Gestão da Segurança/organização & administração , Estudos Transversais , Hospitais/normas , Humanos , Japão , Notificação de Abuso , Segurança do Paciente/legislação & jurisprudência , Gestão da Segurança/métodos
17.
Maturitas ; 149: 34-36, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34134888

RESUMO

Nosocomial COVID-19 in older patients has a high mortality rate. We describe an outbreak of COVID-19 in a geriatric acute care unit (GACU) in March/April 2020 and the lessons learnt regarding prevention. Thirty-six patients were diagnosed with COVID-19 during that 2-month period, in France's "first wave" of SARS-CoV-2 infections. Thirty (83.3%) were considered nosocomial. Attributable mortality reached 33.3% in these patients. Healthcare workers (HCW) were not spared, with an overall attack rate of 36.8%, but the rate was especially high among nurse assistants (68.2%). Repeated testing, single rooms, hand hygiene, and good use of personal protective equipment are paramount in GACUs to prevent in-hospital COVID-19 outbreaks.


Assuntos
COVID-19/transmissão , Infecção Hospitalar/virologia , Pessoal de Saúde/normas , Hospitais/normas , Controle de Infecções/organização & administração , Equipamento de Proteção Individual/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Feminino , Humanos , Controle de Infecções/normas , Masculino
18.
BMC Cancer ; 21(1): 670, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090361

RESUMO

BACKGROUND: The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. METHODS: An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. RESULTS: There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. CONCLUSION: The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.


Assuntos
Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Bangladesh , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais/normas , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Desenvolvimento Sustentável , Neoplasias do Colo do Útero/diagnóstico
19.
Cancer Invest ; 39(6-7): 482-488, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34077307

RESUMO

This study examined racial/ethnic differences in the use of high-quality hospitals among thyroid cancer patients. The study included adult patients diagnosed between 2004 and 2015 identified in the California Cancer Registry linked with hospital discharge records. Hospital quality was defined using a composite thyroid cancer-specific hospital quality score. Black (risk ratio [RR] 0.75, 95% CI 0.70-0.80), Hispanic (RR 0.73, 95% CI 0.71-0.75), and Asian/Pacific Islander patients (RR 0.86, 95% CI 0.84-0.89) were less likely to be treated in high-quality hospitals than non-Hispanic White patients. This disparity persisted after adjusting for insurance status and socioeconomic status.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hospitais/normas , Neoplasias da Glândula Tireoide/etnologia , Adulto , California/etnologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Socioeconômicos
20.
J Surg Oncol ; 124(3): 334-342, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33961716

RESUMO

BACKGROUND: The relationship between hospital Magnet status recognition and postoperative outcomes following complex cancer surgery remains ill-defined. We sought to characterize Textbook Outcome (TO) rates among patients undergoing (HP) surgery for cancer in Magnet versus non-Magnet centers. METHODS: Medicare beneficiaries undergoing HP surgery between 2015 and 2017 were identified. The association of postoperative TO (no complications/extended length-of-stay/90-day mortality/90-day readmission) with Magnet designation was examined after adjusting for competing risk factors. RESULTS: Among 10,997 patients, 21.3% (n = 2337) patients underwent surgery at Magnet hospitals (non-Magnet centers: 78.7%, n = 8660). On multivariable analysis, patients undergoing HP surgery had comparable odds of achieving a TO at Magnet versus non-Magnet hospitals (hepatectomy: odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.94-1.17; pancreatectomy-OR: 0.88, 95% CI: 0.74-1.06). Patients treated at hospitals with a high nurse-to-bed ratio had higher odds of achieving a TO irrespective of whether they received surgery at Magnet (high vs. low nurse-to-bed ratio; OR: 1.38; 95% CI: 1.01-1.89) or non-Magnet centers (OR: 1.26; 95% CI: 1.10-1.45). Similarly, hospital HP volume was strongly associated with higher odds of TO following HP surgery in both Magnet (Leapfrog compliant vs. noncompliant; OR: 1.24, 95% CI: 1.06-1.44) and non-Magnet centers (OR: 1.18; 95% CI: 1.11-1.26). CONCLUSION: Hospital Magnet designation was not an independent factor of superior outcomes after HP surgery. Rather, hospital-level factors such as nurse-to-bed ratio and HP procedural volume drove outcomes.


Assuntos
Hospitais/normas , Neoplasias Hepáticas/cirurgia , Medicare/estatística & dados numéricos , Neoplasias Pancreáticas/cirurgia , Idoso , Feminino , Hepatectomia/normas , Hepatectomia/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Análise Multivariada , Pancreatectomia/normas , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/mortalidade , Qualidade da Assistência à Saúde , Resultado do Tratamento , Estados Unidos/epidemiologia
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