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1.
Recurso na Internet em Inglês | LIS - Localizador de Informação em Saúde, LIS-ES-PROF | ID: lis-LISBR1.1-47001

RESUMO

Informe del ECDC dirigido a autoridades de Salud Pública y administradores de hospitales de países de la UE/EEE, cuyo objetivo es apoyar los planes de preparación de salud pública, relacionados con los equipos de protección personal en los centros sanitarios en los que se estén tratando a pacientes infectados por el nuevo coronavirus 2019-nCoV o en los que se sospecha la infección.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Equipamento de Proteção Individual , Planejamento em Desastres , Planos de Emergência , Planos de Contingência , Planejamento Hospitalar
2.
Am Surg ; 85(9): 1033-1039, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638520

RESUMO

Regionalization of complex surgical care has increased interhospital transfers to quaternary centers within large health-care systems. Risk-based patient selection is imperative to improve resource allocation without compromising care. This study aimed to develop predictive models for identifying low-risk patients for transfer to a fully integrated satellite hepatopancreatobiliary (HPB) service in the northeast region of the health-care system. HPB transfers to the quaternary center over 15 months from hospitals in proximity to the satellite HPB center. A predictive tool was developed based on simple pretransfer variables and outcomes for 30-day major complications (Clavien grade ≥ 3), readmission, and mortality. Thresholds for "low risk" were set at different SDs below mean for each model. Predictive models were developed from 51 eligible northeast region patient transfers for major complications (Brier score 0.1948, receiver operator characteristic (ROC) 0.7123, P = 0.0009), readmission (Brier score 0.0615, ROC 0.7368, P = 0.0020), and mortality (Brier score 0.0943, ROC 0.7989, P = 0.0023). Thresholds set from 2 SD below the mean for all models identified 2 as "low risk." Adjusting the threshold for the serious complication model to only 1 SD below the mean increased the "low-risk" cohort to five patients. These models demonstrate an easy-to-use tool to assist surgeons in identifying low-risk patients for diversion to a fully integrated satellite center. Improved interhospital transfers within a region could begin a transition from centers of excellence toward health-care systems of excellence.


Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Modelos Logísticos , Pancreatopatias/cirurgia , Transferência de Pacientes , Medição de Risco/estatística & dados numéricos , Tomada de Decisão Clínica , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Planejamento Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Readmissão do Paciente , Complicações Pós-Operatórias , Medição de Risco/métodos
3.
Washington, D.C.; PAHO; 2019-08-13.
em Inglês | PAHO-IRIS | ID: phr-51448

RESUMO

[Introduction]. The Hospital Safety Index occupies a central place in local, national and global efforts to improve the functioning of hospitals in emergencies and disasters. This is an area that the World Health Organization (WHO) has promoted and supported for more than 25 years. After the Pan American Health Organization (PAHO) and WHO released the first version of the Hospital Safety Index in 2008, ministries of health and other health entities, other government ministries and agencies, and public and private hospitals across the six regions of WHO have joined their counterparts in the Americas in applying and adapting the Hospital Safety Index. The growing interest in safe hospitals led to calls from countries and other stakeholders for the revision of Hospital Safety Index to make it a truly global assessment tool that can be used in all contexts across the world. In emergencies, disasters and other crises, a community must be able to protect the lives and well-being of the affected population, particularly in the minutes and hours immediately following impact or exposure. The ability of health services to function without interruption in these situations is a matter of life and death. The continued functioning of health services relies on a number of key factors, namely: that health services are housed in structures (such as hospitals or other facilities) that can resist exposures and forces from all types of hazards; medical equipment is in good working order and is protected from damage; community infrastructure and critical services (such as water, electricity etc.) are available to support the health services; and health personnel are able to provide medical assistance in safe and secure settings when they are most needed... This Guide for evaluators for the Hospital Safety Index provides a step-by-step explanation of how to use the Safe Hospitals Checklist, and how the evaluation can be used to obtain a rating of the structural and nonstructural safety, and the emergency and disaster management capacity, of the hospital. The results of the evaluation enable hospital’s own safety index to be calculated.


Assuntos
Emergências em Desastres , Instalações de Saúde , Gestão da Segurança , Medicina de Emergência , Planejamento em Desastres , Avaliação de Risco e Mitigação , Arquitetura Hospitalar , Planejamento Hospitalar , Instituições de Saúde, Recursos Humanos e Serviços
5.
Rev. enferm. UFPE on line ; 13(5): 1223-1230, maio 2019. ilus, tab, graf
Artigo em Português | BDENF - Enfermagem | ID: biblio-1024138

RESUMO

Objetivo: analisar o fluxo do principal recurso material utilizado em sala operatória de um hospital universitário. Método: trata-se de um estudo qualitativo, descritivo, documental e observacional realizado em um hospital universitário. Executaram-se duas etapas: análise documental dos recursos materiais utilizados em sala operatória; e construção e análise descritiva do fluxograma do material elencado. Catalogaram-se, posteriormente, esses recursos, armazenando-os em um banco de dados no Microsoft® Excel, versão 2016, para a realização da análise descritiva. Resultados: revelou-se que os materiais mais utilizados foram gaze e compressa com 3.415 e 3.325 unidades, respectivamente. Evidenciaram-se, pelo fluxograma, 44 etapas, 10 departamentos envolvidos e 15 processos documentais mapeados. Conclusão: observou-se que a falta de compressa resultou em compras emergenciais para garantir o funcionamento do setor e o fluxo institucional. A aquisição de materiais é complexa, burocrática e morosa. Pode-se minimizar a falta dos recursos materiais com uma inserção mais evidente do enfermeiro no planejamento em sala operatória.(AU)


Objective: to analyze the flow of the main material resource used in an operating room of a university hospital. Method: this is a qualitative, descriptive, documentary and observational study carried out in a university hospital. The two initial phases were: documentary analysis of the material resources used in the operating room; and construction and descriptive analysis of the flowchart with the material listed. These resources were subsequently cataloged and stored in a database using Microsoft® Excel, version 2016, in order to perform the descriptive analysis. Results: it was found that the most used materials were gauzes and compresses, with 3,415 and 3,325 units, respectively. The flowchart indicated 44 phases, 10 departments involved, and 15 mapped processes. Conclusion: it was observed that the lack of compresses resulted in emergency purchases aimed at maintaining the operation of the sector and the institutional flow. The acquisition of materials is complex, bureaucratic, and time-consuming. The lack of material resources can be minimized with a more evident insertion of nurses in operating room planning.(AU)


Objetivo: analizar el flujo del principal recurso material utilizado en el quirófano de un hospital universitario. Método: se trata de un estudio cualitativo, descriptivo, documental y observacional realizado en un hospital universitario. Se llevaron a cabo dos etapas: análisis documental de los recursos materiales utilizados en el quirófano; y la construcción y el análisis descriptivo del diagrama de flujo del material enumerado. Esos recursos fueron posteriormente catalogados y almacenados en una base de datos usando Microsoft® Excel, versión 2016, para la realización del análisis descriptivo. Resultados: se encontró que los materiales más utilizados fueron gasa y compresa con 3.415 y 3.325 unidades, respectivamente. El diagrama de flujo mostró 44 etapas, 10 departamentos involucrados y 15 procesos documentales mapeados. Conclusión: se observó que la falta de compresas resultó en compras de emergencia para asegurar el funcionamiento del sector y el flujo institucional. La adquisición de materiales es compleja, burocrática y morosa. Se puede minimizar la falta de recursos materiales con una inserción más evidente del enfermero en la planificación en el quirófano.(AU)


Assuntos
Humanos , Masculino , Feminino , Enfermagem de Centro Cirúrgico , Salas Cirúrgicas , Assistência Perioperatória , Recursos Materiais em Saúde , Fluxo de Trabalho , Administração Hospitalar , Planejamento Hospitalar , Administração de Materiais no Hospital , Epidemiologia Descritiva , Pesquisa Qualitativa
6.
Stud Health Technol Inform ; 258: 261-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30942767

RESUMO

Geomatics becomes a major field of science facing challenges to assist medical informatics and health decision makers thanks to attractive concepts, methods and easy, user-friendly-way IT technologies. PoleSat_2018 presents a web-based graphical user interface with an embedded optimized and automated algorithm. It is primarily geared for geomatics non-specialists and allows computer simulations by modelling scenarios of hospital grouping and/or closure. The consultation, reflection, prospective views, offered in a very short time to policy makers will find a successful support for health planning strategic decisions.


Assuntos
Simulação por Computador , Planejamento Hospitalar , Sistemas de Informação Geográfica , Hospitais , Informática Médica , Estudos Prospectivos
8.
J Formos Med Assoc ; 118(1 Pt 1): 186-193, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29665984

RESUMO

BACKGROUND/PURPOSE: Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED. METHODS: For QIP, the following 3 action plans were initiated: 1) Changing the choice architecture of patients' willingness to transfer from opt-in to opt-out; 2) increasing the turnover rate of beds and daily monitoring of the number of free beds for boarding ED patients; 3) reevaluation of patients with a LOS of >32 h after the morning shift. RESULTS: Transfer rates increased minimally after implementation of this project, but the sample size was too small to achieve statistical significance. No significant increase was observed in the number of free medical beds, but discharge rates after 12 pm decreased significantly (p < 0.001). The proportion of over 48 h LOSs decreased from 4.9% to 3.7% before and after QIP implementation, respectively (p < 0.001). CONCLUSION: Patients with LOS of >32 h were reevaluated first. After QIP, the proportion of LOSs of >48 h dropped significantly. Changing the choice architecture may require further systemic effort and a longer observation duration. Higher-level administrators will need to formulate a more comprehensive bed management plan to speed up the turnover rate of free inpatient beds.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Aglomeração , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Acesso aos Serviços de Saúde , Número de Leitos em Hospital , Planejamento Hospitalar , Humanos , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Taiwan , Fatores de Tempo
10.
Indian Pediatr ; 55(9): 776-779, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30345984

RESUMO

OBJECTIVE: To decrease the waiting time for preterm babies visiting the Retinopathy of prematurity clinic in a tertiary eye hospital. DESIGN: Interventional study. SETTING: Tertiary eye care hospital. PATIENTS: All preterm babies reporting for screening and follow up at Retinopathy of prematurity clinic. INTERVENTION/PROCEDURE: A quality improvement team comprising of a faculty (team leader), two senior residents, two junior residents, one nursing officer, and a registration staff was constituted. Fish bone analysis was done to understand various reasons for the high waiting time for preterm babies. Baseline data was collected followed by multiple Plan-Do-Study- Act (PDSA) cycles. MAIN OUTCOME MEASURE: Average waiting-time, maximum waiting-time, and last baby entry-time were measured. RESULTS: The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range 74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min (90 to 118 min), respectively. At the end of 3rd PDSA cycle, these reduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110 to 135 min), and 60 min (range 45 to 80 min), respectively and were sustained; the decrease from baseline being 14.3%, 31.2%, and 46%, respectively. CONCLUSION: The time spent in the waiting area at the Retinopathy of Prematurity clinic was significantly reduced by simple changes in the process flow.


Assuntos
Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Retinopatia da Prematuridade/diagnóstico , Listas de Espera , Planejamento Hospitalar/normas , Planejamento Hospitalar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos
12.
20 Century Br Hist ; 29(4): 547-575, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29939329

RESUMO

This article augments the literature on the British experience of planning by examining attempts to plan the hospital system between 1962 and 1977. The Hospital Plan for England and Wales of 1962 proposed the construction of a suite of new 'District General Hospitals'. Underpinning this proposal was a belief in the value of standardized designs and construction methods, both of which were subsequently investigated in detail by the Ministry of Health and the Department of Health and Social Security (DHSS). The history of this project reveals the challenges of putting centralized planning into practice. Yet while the standardization programme was scaled back in 1975, the article suggests that the drive to 'plan' modern Britain perhaps lasted longer than might initially be thought, into the 1980s, with implications for the way that the broader history of this period is framed.


Assuntos
Planejamento Hospitalar , Programas Nacionais de Saúde/história , Mudança Social , Inglaterra , História do Século XX , País de Gales
13.
Health Policy ; 122(7): 728-736, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29884295

RESUMO

OBJECTIVES: To compare projected and observed hospital inpatient use in Belgium and to draw lessons from that comparison. METHODS: In 2005, projections for hospital service use were generated up to 2015, based on demographic change, substitution from inpatient to day care, and, the evolution of the average length of stay (LOS). The accuracy of the forecasts was assessed by comparing projected and observed population size, admissions and inpatient days, average LOS and percentage change in case mix. RESULTS: The demographic growth was underestimated. Overall, the baseline projection for hospital admissions was remarkably close to the observed figures but the underlying case mix diverged importantly. With substitution between inpatient and day care, the number of admissions was underestimated by 15%-40%. The number of days was projected to increase in every scenario, whereas a decreasing trend was observed mainly due to the faster decline in average LOS than projected. CONCLUSION: Hospital capacity planning is an important component of evidence informed policymaking. Projection results benefit from a well-designed methodology: choice of forecast groups, estimation models, selection criteria, and a sensitivity analysis of the results. To cope with the dynamic and continuously evolving context in which hospitals operate, regular updates to incorporate new data and to reassess estimated trends should be an integral part of the projection framework.


Assuntos
Previsões , Planejamento Hospitalar , Hospitalização/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Bélgica , Humanos , Tempo de Internação/tendências
14.
J Vasc Surg Venous Lymphat Disord ; 6(4): 471-476.e6, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29602759

RESUMO

BACKGROUND: In mid-2007, endovenous ablation (EVA) of the great saphenous vein was introduced into the publicly funded health care system in Saskatchewan, Canada. We hypothesize that the introduction of EVA resulted in a decrease in use of high ligation and stripping (HL/S), decreased costs to the health care system, and increased demand of patients for great saphenous vein ablative procedures. METHODS: We retrospectively reviewed administrative data to capture cases of HL/S between 2003 and 2014 and cases of EVA of the great saphenous vein (endovenous laser treatment and radiofrequency ablation) between 2007 and 2014. Accounting for the change in practice pattern that occurred slowly between 2007 and 2009, we divided our patients into the pre-EVA era (2003-2006) and the post-EVA era (2010-2014). Procedure costs were determined with models used by our health region for this purpose. RESULTS: Utilization rates for great saphenous vein intervention remained similar in the pre-EVA (90 procedures per year) and post-EVA (92 procedures per year; P = .83) eras. Case costs of HL/S ($1965.12/case) were higher than those of EVA (endovenous laser treatment, $1295.08/case; radiofrequency ablation, $1410.54/case). The total annual costs of great saphenous vein intervention decreased from $176,861 in the pre-EVA era to $134,525 (P = .02). CONCLUSIONS: Introduction of publicly funded EVA has reduced rates of HL/S and reduced costs to our health system by approximately $42,000 per year, without increasing great saphenous vein intervention rates.


Assuntos
Ablação por Cateter/economia , Assistência à Saúde/economia , Procedimentos Endovasculares/economia , Custos de Cuidados de Saúde , Planejamento Hospitalar/economia , Terapia a Laser/economia , Saúde Pública/economia , Veia Safena/cirurgia , Varizes/economia , Varizes/cirurgia , Demandas Administrativas em Assistência à Saúde , Ablação por Cateter/efeitos adversos , Redução de Custos , Análise Custo-Benefício , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Terapia a Laser/efeitos adversos , Determinação de Necessidades de Cuidados de Saúde/economia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Saskatchewan , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
15.
Stroke ; 49(4): 1021-1023, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29491140

RESUMO

BACKGROUND AND PURPOSE: We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. METHODS: We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center. RESULTS: There were 2 326 943 emergency medical services runs during the study period, of which 15 099 had a provider diagnosis of stroke. Bypassing the closest hospital for a PSC was common before the official policy and increased steadily over time. Geographic modeling suggested that bypassing the closest hospital in favor of the closest PSC adds a median of 3.1 minutes to transport time. Bypassing to the closest comprehensive stroke center would add a median of 8.3 minutes. CONCLUSIONS: Within a large metropolitan area, the time cost of routing patients preferentially to PSCs and comprehensive stroke centers is low.


Assuntos
Serviços Médicos de Emergência , Acidente Vascular Cerebral/terapia , Transporte de Pacientes/métodos , Estudos Transversais , Mapeamento Geográfico , Política de Saúde , Planejamento Hospitalar , Hospitais Urbanos , Humanos , Philadelphia , Fatores de Tempo , Tempo para o Tratamento
16.
Rev. neurol. (Ed. impr.) ; 66(6): 182-188, 16 mar., 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-172283

RESUMO

Introducción. La esclerosis múltiple (EM) es una enfermedad desmielinizante y autoinmune con progresión variable y alto riesgo de hospitalización. En algunos estudios, estos ingresos se utilizan como marcadores sustitutivos de la progresión de la enfermedad, pero en Portugal, debido a las asimetrías organizacionales y las opciones de seguridad clínica, esta relación no es lineal. El patrón de ingresos por EM puede proporcionar datos relevantes para el diseño de estrategias de gestión de la enfermedad y asignación de recursos. Objetivo. Caracterizar los ingresos por EM en Portugal continental entre 2002 y 2013 a través de los casos constantes en la base de datos de morbilidad hospitalaria con código de diagnóstico principal CIE-9-MC 340. Pacientes y métodos. Se utilizaron técnicas de mapeo, análisis de clusters espaciotemporales y análisis de variaciones espaciales en tendencias temporales de la tasa de ingresos por EM. Resultados. Entre 2002 y 2013, la tasa de ingreso anual por EM fue de 82,2 por 100.000 ingresos, con una tendencia decreciente anual del 3,73%. Se identificaron siete clusters espaciotemporales con tasas de ingresos por esta patología desde 2,27 a 4,23 superiores a la tasa nacional. Además, se detectaron cuatro áreas con tendencia creciente en la tasa de ingreso en este período temporal (+0,17 a +11,5%): Sintra-Cascais-Amadora, Serra da Estrela, Alentejo-Algarve y Trás-os-Montes. Conclusión. Estos resultados demuestran la asimetría esperada por las diferencias organizativas, factores ambientales, genéticos y opciones de seguridad clínica. Permite la identificación de áreas y tendencias evolutivas de las tasas de ingreso por EM, y posibilita el diseño de intervenciones en salud más enfocadas (AU)


Introduction. Multiple sclerosis (MS) is a demyelinating and autoimmune disease with variable progression and high risk of hospital admission. In some studies these hospitalizations may be used as surrogate markers of disease progression, however in Portugal, due to organizational asymmetries and clinical safety choices this relationship is not linear. The admission patterns for this pathology can provide relevant data to the design of disease’s management strategies and resource allocation. Aim. To characterize hospital admissions for MS in mainland Portugal between 2002 and 2013 through the cases included in the hospital morbidity database with the code ICD-9-CM 340 as primary diagnosis. Patients and methods. In this study mapping techniques, analysis of spatio-temporal clusters and analysis of spatial variations in temporal trends of hospital admission rates for MS were used. Results. Between 2002 and 2013 the rate of annual hospital admission for MS was 82.2/100,000 hospitalizations, with a decreasing trend of 3.73%/year. Seven spatial-temporal clusters were identified with hospital admission rates for this pathology ranging from 2.27 to 4.23 higher than the national rate. In addition, in this time period four areas with increasing trend in hospital admission rate (+ 0.17 to +11.5%) were detected: Sintra-Cascais-Amadora, Serra da Estrela, Alentejo-Algarve and Trás-os-Montes. Conclusion. These data demonstrate the expected asymmetry of organizational differences, environmental, genetic and clinical safety choices. This study allowed the identification of areas and evolutionary trends of hospital admission rates for MS, enabling the design of more focused health interventions (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Planejamento Hospitalar/organização & administração , Exposição Ambiental , Interferon beta/uso terapêutico , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Portugal/epidemiologia , Conglomerados Espaço-Temporais , Planejamento Hospitalar/estatística & dados numéricos , Atividades Cotidianas , Unidades Hospitalares/economia , Unidades Hospitalares/estatística & dados numéricos
17.
BMJ Open ; 8(1): e018263, 2018 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-29382676

RESUMO

OBJECTIVES: Patient engagement (PE) improves patient, organisation and health system outcomes, but most research is based on primary care. The primary purpose of this study was to describe the characteristics of published empirical research that evaluated PE in hospital health service improvement. DESIGN: Scoping review. METHODS: Five databases were searched from 2006 to September 2016. English language studies that evaluated patient or provider beliefs, participation in PE, influencing factors or impact were eligible. Screening and data extraction were done in triplicate. PE characteristics, influencing factors and impact were extracted and summarised. RESULTS: From a total of 3939 search results, 227 studies emerged as potentially relevant; of these, 217 were not eligible, and 10 studies were included in the review. None evaluated behavioural interventions to promote or support PE. While most studies examined involvement in standing committees or projects, patient input and influence on decisions were minimal. Lack of skill and negative beliefs among providers were PE barriers. PE facilitators included careful selection and joint training of patients and providers, formalising patient roles, informal interaction to build trust, involving patients early in projects, small team size, frequent meetings, active solicitation of patient input in meetings and debriefing after meetings. Asking patients to provide insight into problems rather than solutions and deploying provider champions may enhance patient influence on hospital services. CONCLUSIONS: Given the important role of PE in improving hospital services and the paucity of research on this topic, future research should develop and evaluate behavioural interventions for PE directed at patients and providers informed by the PE barriers and facilitators identified here. Future studies should also assess the impact on various individual and organisational outcomes.


Assuntos
Planejamento Hospitalar , Participação do Paciente , Melhoria de Qualidade/organização & administração , Tomada de Decisões , Humanos
18.
Ann Surg ; 267(6): 1169-1172, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28650358

RESUMO

OBJECTIVE: The aim of this study was to investigate the volume-outcome relationship in kidney transplantation by examining graft and patient outcomes using standardized risk adjustment (observed-to-expected outcomes). A secondary objective was to examine the geographic proximity of low, medium, and high-volume kidney transplant centers in the United States. SUMMARY OF BACKGROUND DATA: The significant survival benefit of kidney transplantation in the context of a severe shortage of donor organs mandates strategies to optimize outcomes. Unlike for other solid organ transplants, the relationship between surgical volume and kidney transplant outcomes has not been clearly established. METHODS: The Scientific Registry of Transplant Recipients was used to examine national outcomes for adults undergoing deceased donor kidney transplantation from January 1, 1999 to December 31, 2013 (15-year study period). Observed-to-expected rates of graft loss and patient death were compared for low, medium, and high-volume centers. The geographic proximity of low-volume centers to higher volume centers was determined to assess the impact of regionalization on patient travel burden. RESULTS: A total of 206,179 procedures were analyzed. Compared with low-volume centers, high-volume centers had significantly lower observed-to-expected rates of 1-month graft loss (0.93 vs 1.18, P<0.001), 1-year graft loss (0.97 vs 1.12, P<0.001), 1-month patient death (0.90 vs 1.29, P=0.005), and 1-year patient death (0.95 vs 1.15, P=0.001). Low-volume centers were frequently in close proximity to higher volume centers, with a median distance of 7 miles (interquartile range: 2 to 75). CONCLUSIONS: A robust volume-outcome relationship was observed for deceased donor kidney transplantation, and low-volume centers are frequently in close proximity to higher volume centers. Increased regionalization could improve outcomes, but should be considered carefully in light of the potential negative impact on transplant volume and access to care.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Transplante de Rim/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Doadores de Tecidos , Morte , Sobrevivência de Enxerto , Acesso aos Serviços de Saúde , Planejamento Hospitalar , Humanos , Falência Renal Crônica/mortalidade , Transplante de Rim/mortalidade , Doadores de Tecidos/provisão & distribução , Estados Unidos/epidemiologia
19.
Am J Disaster Med ; 13(4): 239-252, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30821338

RESUMO

INTRODUCTION: Crises in the operating room (OR) are uncommon events that require an expeditious response from all providers to minimize morbidity and mortality to both patients and staff. Evacuation during a surgical procedure presents a unique challenge. There is a paucity of data on the ideal response, ideal times, and training needs for hospital staff. METHODS: The authors herein describe a full-scale simulation exercise of the emergent mid-procedure evacuation of seven ORs. RESULTS: Median time to evacuate from the OR and reach the Post-Anesthesia Care Unit safety point was 3:50 minutes (range, 1:22 minutes to 6:00 minutes). Multiple lessons were learned from direct observation, post-drill debrief, and post-drill survey of participants. CONCLUSIONS: Emergent mid-procedure evacuation of ORs can be expeditious if needed. Critical themes in leadership, communication, and coordination of care were discovered. Surgeons, anesthesiologists, and OR staff should consider performing an OR evacuation drill to improve their local efficacy and efficiency in emergent OR evacuation.


Assuntos
Planejamento em Desastres/métodos , Planejamento Hospitalar , Salas Cirúrgicas , Planejamento em Desastres/organização & administração , Humanos , Liderança , Transferência de Pacientes/métodos , Recursos Humanos em Hospital , Inquéritos e Questionários
20.
Washington, D.C.; OPS; 2018.
em Espanhol | PAHO-IRIS | ID: phr-51462

RESUMO

El índice de seguridad hospitalaria ocupa un lugar central en las iniciativas locales, nacionales y mundiales para mejorar el funcionamiento de los hospitales durante las emergencias y los desastres. La Organización Mundial de la Salud (OMS) ha promovido y apoyado este objetivo durante más de 25 años. A raíz de la publicación de la versión original del índice de seguridad hospitalaria por la Organización Panamericana de la Salud (OPS) y la OMS en 2008, ministerios y otras entidades de salud, otros ministerios y dependencias gubernamentales y hospitales públicos y privados de las seis regiones de la OMS en el mundo se han unido a sus homólogos de la Región de las Américas en la aplicación y adaptación de dicho instrumento. El interés suscitado por el concepto de los hospitals seguros frente a los desastres se ha traducido en llamamientos por parte de los países y otras partes interesadas para que se revise el índice de seguridad hospitalaria a fin de transformarlo en un instrumento de evaluación de carácter internacional que pueda aplicarse en cualquier circunstancia en todo el mundo. En caso de emergencias, desastres y otras crisis parecidas, una comunidad debe ser capaz de proteger la vida y el bienestar de la población afectada, particularmente en los minutos y horas que siguen al impacto o la exposición. La capacidad de los servicios de salud para funcionar sin interrupción en estas situaciones es un asunto de vida o muerte. El funcionamiento continuo de estos servicios depende de muchos factores esenciales, a saber: que los servicios de salud se presten en edificios (como los hospitals y establecimientos similares) capaces de resistir la exposición y las fuerzas de toda clase de amenazas; que el equipo médico funcione correctamente y esté protegido para que no resulte dañado; que la infraestructura y los servicios públicos esenciales (como el suministro de agua y electricidad, por ejemplo) puedan apoyar los servicios de salud; y que el personal sanitario pueda prestar asistencia médica en entornos seguros y protegidos cuando más se necesita...En la presente Guía del evaluador, para determinar el índice de seguridad hospitalaria, se explica paso a paso cómo usar la lista de verificación, así como la manera en que la evaluación puede usarse para clasificar la seguridad estructural y no estructural, y la capacidad de gestión de emergencias y desastres del hospital. Los resultados de la evaluación permiten calcular el índice de seguridad del hospital.


Assuntos
Emergências em Desastres , Hospitais , Gestão de Riscos , Medicina de Emergência , Arquitetura Hospitalar , Planejamento Hospitalar
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