Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 414
Filter
1.
Article in Portuguese | LILACS | ID: biblio-1368414

ABSTRACT

RESUMO: Introdução: Por se tratar de um setor complexo e que compreende grande parte dos custos de um hospital, o centro cirúrgico demanda uma contínua avaliação de suas atividades, com o objetivo de propiciar uma melhora da sua eficiência e da segurança dos pacientes. Uma estratégia interessante para se realizar tal avaliação é a utilização de um conjunto de indicadores de qualidade preestabelecidos, dividindo os atributos do serviço em estrutura, processos e resultados. Para que isso seja possível, é necessário que o serviço analisado possua uma fonte de dados bem estruturada, tendo o Núcleo Interno de Regulação um papel importante nesse processo. Objetivo: Este estudo teve como objetivo a análise de índices de gestão do centro cirúrgico de um hospital terciário especializado em cirurgias eletivas através da mensuração de dados referentes a indicadores de qualidade. Metodologia: Trata-se de um estudo observacional descritivo feito de forma retrospectiva em um hospital escola público do interior do estado de São Paulo. Foram mensurados 18 indicadores referentes ao período de 01/06/2019 a 31/12/2019, a partir de consultas a diferentes setores administrativos do local. Os resultados passaram por uma análise estatística descritiva ao final da coleta de dados. Resultados: Os principais resultados encontrados foram: taxa de cumprimento da agenda cirúrgica de 95,8%, taxa de cancelamento de 4,1%, taxa de ocupação de 47,9%, turnover de 23,1 minutos, tempo médio de atraso no início das cirurgias de 32,8 minutos, tempo de permanência na sala de recuperação pós-anestésica de 37,4 minutos, taxa de absenteísmo dos profissionais de 8,94% e as taxas de infecção do sítio cirúrgico, de mortalidade operatória e de acidente de trabalho foram todas 0%. Conclusões: Apesar da alta taxa de cumprimento da agenda cirúrgica, a taxa de ocupação se encontrou aquém do ideal, sugerindo que o agendamento das cirurgias pode ser melhorado. Além disso, demonstrou-se que a estratégia de "cirurgias reservas" adotada no hospital auxilia no cumprimento da meta de cirurgias programadas e no aumento da taxa de ocupação. (AU)


ABSTRACT: Introduction: As a complex sector that results in a large part of the costs in a hospital, the operating room demands a continuous evaluation of its activities, with the objective of providing an improvement in its efficiency and in patient safety. An interesting strategy to carry out such an evaluation is using a set of pre-established quality indicators, by the division of the service's attributes into structure, processes and results, which can provide a broad perspective of the activities developed and facilitate decision-making by the hospital manager. In this analysis process, it is necessary that the service has a well-structured data source, where the Internal Regulation Center plays an important role. Objective: The objective of this study was to analyze, through the measurement of data related to quality indicators, the management indexes of the operating room of a tertiary-level hospital specialized in elective surgeries. Methodology: This is a descriptive observational study that was conducted retrospectively at a public teaching hospital. In this research, 18 indicators, related to the period from 06/01/2019 to 12/31/2019, were measured based on consultations to different administrative sectors of the hospital. The results went through a descriptive statistical analysis at the end of data collection. Results:The main results found were as follows: the fulfillment rate of the surgical schedule was 95.8%, the cancellation rate was 4.1%, the occupancy rate was 47.9%, the turnover time was 23.1 minutes, the mean delay time in the start of surgeries was 32.8 minutes, length of stay in the post-anesthesia care unit was 37.4 minutes, the professionals' absenteeism rate was 8.94%, and the rates of surgical site infection, operative mortality and work accident were all 0%. Conclusions: Despite the high fulfillment rate of the surgical schedule, the occupancy rate was below the ideal, suggesting that scheduling of surgeries can be improved. In addition, it was shown that the "reserve surgeries" strategy adopted at the hospital helped to reach the goal of scheduled surgeries and to increase the occupancy rate. (AU)


Subject(s)
Surgery Department, Hospital , Quality Indicators, Health Care , Quality Management
2.
Rev. medica electron ; 43(2): 3061-3073, mar.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1251926

ABSTRACT

RESUMEN Introducción: la propia asistencia médica provoca, en determinadas situaciones, problemas de salud que pueden llegar a ser importantes para el enfermo. El análisis de la mortalidad es uno de los parámetros utilizados para investigar la seguridad en la realización de procederes de cirugía mayor. Objetivo: determinar los factores asociados a la mortalidad operatoria en cirugías mayores. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo, de los pacientes que fallecieron tras la realización de una cirugía mayor, en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, en el período comprendido de enero de 2011 a diciembre de 2019. Resultados: la tercera edad aportó 77,3 % de los fallecidos. La hipertensión arterial, diabetes mellitus y cardiopatía isquémica fueron las principales comorbilidades. El abdomen agudo fue el diagnóstico operatorio más frecuente con 98 (58,3 %). Las complicaciones aportaron el 11,9 % de los fallecidos; los eventos adversos, 29,7 %, y por el curso natural de la enfermedad, murió un 58,3 %. El síndrome de disfunción múltiple de órganos y el shock séptico resultaron las principales causas de muerte (62 %). Conclusiones: la mortalidad operatoria estuvo asociada a factores de riesgo como edad avanzada, enfermedades crónicas y cirugía de urgencia. Los eventos adversos elevan la incidencia de mortalidad en cirugía mayor. Las infecciones son la principal causa de mortalidad operatoria (AU).


ABSTRACT Introduction: medical care itself causes, in certain situations, health problems that could be very important for the patient. The mortality analysis is one of the parameters used to study safety performing procedures of major surgery. Objective: to determine the factors associated to operatory mortality in major surgeries. Materials and methods: a retrospective, descriptive and observational study was carried out of the patients who passed away after undergoing a major surgery in the Military Hospital Dr. Mario Munoz Monroy in the period between January 2011 and December 2019. Results: 77.3 % of the deceased were elder people. The main co-morbidities were arterial hypertension, diabetes mellitus and ischemic heart disease. The most frequent surgery diagnosis was acute abdomen with 98 patients (58.3 %). Complications yielded 11.9 % of the deceases, adverse events 29.7 % and 58.3 % died due to the natural course of the disease. The organs multiple dysfunction syndrome and septic shock were the main causes of dead (62 %). Conclusions: operatory mortality was associated to risk factors like advanced age, chronic diseases and emergency surgery. The adverse events increase mortality incidence in major surgery. Infections are the main causes of operatory mortality (AU).


Subject(s)
Humans , Male , Female , Surgical Procedures, Operative/mortality , Hospital Mortality/trends , Operating Rooms/methods , General Surgery/methods , Surgery Department, Hospital/standards , Surgery Department, Hospital/trends , Inpatients , Intraoperative Complications/surgery
3.
Rev. chil. ortop. traumatol ; 62(1): 57-65, mar. 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1342675

ABSTRACT

Se ha declarado una pandemia ante la propagación de un nuevo virus con alta contagiosidad, llamado síndrome respiratorio agudo severo coronavirus 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV2). El mundo ha quedado detenido ante la rápida expansión del virus, con una letalidad que en algunos países llega a 15%. En Chile, el gobierno ha tomado medidas rápidas y agresivas que han permitido mantener la curva de contagios a un nivel que permita atender de manera adecuada a la población. Dentro de estas medidas, se contempla la suspensión de cirugías y consultas ambulatorias. Como cirujanos ortopédicos, nos hemos visto afectados por estas medidas, y existe confusión respecto a cuál es la conducta más adecuada. Quisimos hacer esta guía para resumir parte de las evidencias disponibles y orientar a los cirujanos ortopédicos respecto a esta patología. El comportamiento de esta guía es dinámico, dadas las múltiples opiniones, experiencias y evidencias, que surgen diariamente, por lo que recomendamos mantenerlo como referencia, no como certeza.


A pandemic has been declared due to a new highly contagious virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The world has come to a halt due to the rapid expansion of a virus whose lethality has reached 15% in some countries. In Chile, the government has taken decisive, aggressive measures in an attempt to control disease spread and provide healthcare to those who need it. These decisions include the suspension of elective surgeries and other ambulatory procedures. As Orthopedic surgeons we have been affected by these measures and there is doubt regarding the best course of action. We prepared this guide to summarize available evidence and orient our colleagues regarding this pathology. This guide is meant to be dynamic, as new opinions, evidence and experiences arise every day. Therefore, we advise the reader to keep it as a reference, not an undisputable truth.


Subject(s)
Humans , Orthopedics/organization & administration , Orthopedic Procedures , COVID-19/prevention & control , Surgery Department, Hospital/organization & administration , Emergencies , Pandemics/prevention & control
4.
In. Machado Rodríguez, Fernando; Cluzet, Óscar; Liñares Divenuto, Norberto Jorge; Gorrasi Delgado, José Antonio. La pandemia por COVID-19: una mirada integral desde la emergencia del hospital universitario. Montevideo, Cuadrado, 2021. p.161-171, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344077
5.
Rev. medica electron ; 42(6): 2633-2643, nov.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1150043

ABSTRACT

RESUMEN Introducción: la cirugía como ciencia médica tuvo grandes retos para llegar a tener una forma de tratamiento quirúrgico seguro y viable, entre estos uno de los mayores era como evitar los resultados adversos. Se realizó un análisis de los pacientes que reingresaron en el servicio de cirugía general por post operatorio complicado. Objetivo: determinar las causas de reingresos por postoperatorio complicado en el servicio de cirugía general. Material y métodos: se realizó un estudio prospectivo - descriptivo- observacional sobre el universo, que fueron todos los pacientes reingresados por postoperatorio complicados, por el servicio de Cirugía General. Se analizaron múltiples variables que pudieran estar en relación con los reingresos las cuales fueron obtenidas a través de una planilla de recolección de datos y procesadas por el programa computadorizado Microsoft Office 2009. Resultados: los pacientes que reingresaron, el mayor porcentaje son del sexo masculino, de la raza blanca y los mayores de 60 años. Los reingresos por complicaciones postquirúrgicas representan un bajo por ciento respecto al volumen de casos que son intervenidos y la principal causa de reingreso fue la infección del sitio quirúrgico, las variables analizadas las que más se relacionaron con los reingresos fueron las operaciones realizadas por vía convencional, atendidos en salas abiertas, con operaciones limpias contaminadas. Conclusiones: de los pacientes que reingresaron 6 de cada 10 son del sexo masculino de la raza blanca y su edad mayor de 60 años (AU).


SUMMARY Introduction: Surgery, as a medical science, faced big challenges to become a form of a safe, feasible surgical treatment; among them, one of the biggest was avoiding adverse outcomes. The authors carried out an analysis of the patients readmitted in the service of General Surgery of the University Hospital "Faustino Perez Hernandez" of Matanzas due to complicated post-surgery evolution in the period from January 2016 to December 2018. Objective: to determine the causes of readmissions due to complicated post-surgery evolution in the service of General Surgery of the University "Hospital Faustino Perez Hernandez". Materials and methods: a prospective, descriptive, observational study was carried out on a universe of all patients readmitted in the service of General Surgery due to complicated post-surgery evolution. The authors analyzed several variables that could be related to readmissions and were obtained from a data collection form and processed with the computer program Microsoft Office 2009. Results: the main results were that among readmitted patients, the highest percent were male, white and elder than 60 years old. Readmissions due to post-surgery complications represent a low percent with respect to the quantity of patients who underwent surgery, and the main cause of readmission was infection at the surgery site. From the analyzed variables the once related the most with readmissions were conventional surgeries, patients looked after in open wards, with contaminated clean operations. Conclusions: six from each ten patients were male, white, and aged more than 60 years (AU).


Subject(s)
Humans , Male , Female , Patient Readmission , Postoperative Complications/classification , Postoperative Period , Surgery Department, Hospital , Causality , Multivariate Analysis
6.
Rev. argent. cir ; 112(4): 469-479, dic. 2020. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1288159

ABSTRACT

RESUMEN Antecedentes: como Cirugía Mayor Ambulatoria (CMA) se designan procedimientos quirúrgicos te rapéuticos o diagnósticos, realizados con anestesia general, locorregional o local, con sedación o sin ella, que requieren cuidados posoperatorios de corta duración, por lo que no necesitan ingreso hos pitalario. Objetivo: analizar la experiencia de la Unidad de Cirugía Mayor Ambulatoria integrada al Servicio de Cirugía del Hospital Avellaneda, de San Miguel de Tucumán, en el período enero 2014- diciembre 2018. Material y métodos: estudio descriptivo, retrospectivo, de corte transversal, de asociación cruzada. Pacientes entre 14 y 75 años. Los datos fueron recolectados de una base prospectiva implementada desde el inicio de una experiencia piloto. Resultados: se realizaron 3827 intervenciones quirúrgicas, de las cuales 2327 fueron procedimientos quirúrgicos bajo la modalidad de CMA; 1514 correspondieron al sexo femenino; prevaleció el rango de 45 a 54 años de edad. Los procedimientos quirúrgicos realizados fueron: colecistectomía laparoscópi ca, patología de la pared abdominal, patologías orificiales, procedimientos combinados. Indicadores de calidad: la tasa de cancelación, valor atribuible a la ausencia del paciente el día de la cirugía, y de suspensión, debido a la modalidad selección del paciente y de infraestructura, ambas tasas mostraron una disminución estadísticamente significativas entre los años 2014 y 2018. La tasa de reintervención fue en el último año de 0,35%; los ingresos y reingresos disminuyeron a 1,6% y 1,07%, respectivamen te al año 2018. Se presentaron 52 complicaciones, 13 mayores y 39 menores. El grado de satisfacción fue elevado: un 99,5%. Conclusión: la CMA es un proceso seguro, con tasas de complicaciones bajas.


ABSTRACT Background: Major ambulatory surgery is defined as therapeutic or diagnostic surgical procedures, performed under general, regional or local anesthesia, with or without sedation, which require short-term postoperative care, and therefore do not require hospital admission Objective: The aim of this study is to analyze the experience of the same day unit integrated to the Department of General Surgery and Gastrointestinal Surgery at Hospital de Clínicas Pte. Avellaneda in San Miguel de Tucumán between January 2014 and December 2018. Material and methods: We conducted a descriptive and retrospective cross-sectional study. Patients between 14 and 75 years were included. Data were collected from a prospective database implemented for the beginning of a pilot experience. Results: A total of 3827 surgeries were performed; 2327 corresponded to MAS procedures; 1514 patients were women, and aged ranged between 45 and 54 years. The surgical procedures corresponded to laparoscopic cholecystectomy, abdominal wall defects, perianal diseases and combined procedures. Quality indicators: the cancellation rate, which indicates the percentage of patients who did not attend the day surgery unit, and the rate of procedures suspended due to issues associated with patient selection and infrastructure, showed a statistically significant reduction between 2014 and 2018. Unplanned repeated surgery rate was 0.35% in 2018, and unplanned admissions and readmissions decreased to 1.6% and 1.07%, respectively, in 2018. Major complications occurred in 13 patients and 39 patients presented minor complications. Patient's satisfaction was 99.5%.. Conclusion: MAS is a safe process, with low rate of complications.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Argentina , Postoperative Complications , Surgery Department, Hospital/statistics & numerical data , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies , Patient Satisfaction , Cholecystectomy, Laparoscopic , Quality Indicators, Health Care/statistics & numerical data , Ambulatory Surgical Procedures/adverse effects
7.
Rev. argent. cir ; 112(3): 266-273, jun. 2020. graf, tab.
Article in Spanish | LILACS | ID: biblio-1279740

ABSTRACT

RESUMEN Antecedentes: la pandemia de COVID-19 ha introducido cambios drásticos en el sistema de salud. Las cirugías electivas son una de las actividades quirúrgicas que más han descendido durante la pandemia. Objetivo: analizar el impacto de la pandemia de COVID-19 en la cirugía pancreática en una institución pública y otra privada. Se comparó, en cada institución, con el número de cirugías en el mismo período del año pasado. Material y métodos: se revisaron en una base prospectiva los pacientes que recibieron una cirugía pancreática en las dos instituciones entre el 10/3/20 y el 24/6/20. Se determinaron los datos epide miológicos, el tipo de resección pancreática, el diagnóstico anatomopatológico, la morbilidad y la mor talidad. Se compararon con los pacientes en ambas instituciones que recibieron cirugía pancreática durante el período 10/3/19 al 24/6/19. Resultados: durante la pandemia se realizaron 23 resecciones pancreáticas (13 duodenopancreatec tomías cefálicas, 9 pancreatectomías izquierdas y 1 pancreatectomía total). El 70% (16/23) fueron adenocarcinomas. La morbilidad alcanzó el 34,7% y no se registró mortalidad. Ningún paciente ni miembro del equipo quirúrgico se infectó con coronavirus. La pandemia no tuvo impacto en el núme ro de cirugías en el centro privado (22 vs. 20, p = 0,88), mientras que en el centro público hubo una reducción significativa en el número de cirugías (14 vs. 3, p = 0,009). Conclusión: la cirugía pancreática se puede hacer con seguridad durante la pandemia. En el centro privado se mantuvo el número de cirugías pancreáticas. En el centro público, con máxima prioridad para pacientes con COVID-19, hubo un descenso significativo.


ABSTRACT Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective surgeries are the surgical activities with greater decline during the pandemic. Objective: The aim of this paper is to analyze the impact of the COVID-19 pandemic in pancreatic sur gery in a public and a private institution. The number of surgeries performed in each institution was compared with those performed in same period of the previous year. Material and methods: Data from a prospective database of all the patients who underwent pancrea tic surgery between March 10, 2020, and June 3, 2020, were analyzed. The epidemiological data, type of pancreatic resection, pathology diagnosis, morbidity and mortality were determined in each insti tution and compared with patients who underwent pancreatic surgery in both institutions between March 3, 2019, and June 24, 2019. Results: 23 pancreatic resections were performed during the pandemic (13 cephalic pancreaticoduo denectomies, 9 left pancreatectomies and 1 total pancreatectomy); 70% (16/23) were adenocarcino mas. There were 34.7% complications and no deaths were reported. None of the patients was infected with coronavirus. The pandemic had no impact on the number of pancreatic resections in the private institution (22 vs. 20, p = 0.88), while the number of pancreatic surgeries was significantly lower in the public center (14 vs. 3, p = 0.009). Conclusion: Pancreatic surgery can be safely performed during the pandemic. The number of pancrea tic surgeries did not decline during the pandemic. The priority for treating patients with COVID-19 at the public center resulted in a significant decrease in pancreatic surgeries.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pancreatectomy/statistics & numerical data , Morbidity , COVID-19 , Pancreas , Pancreatectomy/mortality , Surgery Department, Hospital , Hospitals, Private , Hospitals, Public
8.
Rev. argent. cir ; 112(1): 30-42, mar. 2020. graf, tab
Article in English, Spanish | LILACS | ID: biblio-1125779

ABSTRACT

Antecedentes: las cirujanas en la Argentina experimentan barreras en el ámbito laboral y personal tratando de lograr sus objetivos profesionales. El objetivo de esta investigación fue explorar las barreras que enfrentan las cirujanas en su carrera laboral en las tres principales ciudades de la República Argentina. Material y métodos: estudio exploratorio transversal. Se utilizaron encuestas anónimas a cirujanas durante un período de 6 meses. Resultados: un 59% de las cirujanas son solteras y no viven en pareja. Aquellas con hijos son las principales encargadas de la crianza. Los esposos o convivientes aparecen en tercer lugar, con un muy bajo porcentaje de responsabilidad en la tarea. En la mayoría de los espacios laborales no existe un sistema que facilite el cuidado de hijos en su trabajo. El 65% afirma haber dejado de presentar trabajos científicos luego de la maternidad. Solo un 26% de los pacientes ha rechazado sus servicios en favor de ser intervenido por un cirujano hombre. Por el contrario, un 42% de los jefes ha rechazado ser acompañado en cirugías por cirujanas. Casi un 85% de las cirujanas ha recibido comentarios alusivos a su sexualidad durante su trabajo. Conclusión: las estructuras organizacionales quirúrgicas operan como un marco normativo estructurador de prácticas y discursos que han construido, en el nivel simbólico, subjetivo e institucional, las desigualdades entre mujeres y varones en el ámbito de la actuación médica. La feminización del sector en los últimos tiempos y la salida de la mujer al ámbito laboral no implican necesariamente la equidad de género.


Background: Women surgeons in Argentina face barriers in the workplace and in their personal life when trying to achieve their professional goals. The aim of this investigation was to explore the career barriers women surgeons face in the three main cities of Argentina. Material and methods: We conducted an exploratory cross-sectional study. Anonymous surveys were administrated to women surgeons during a six-month period. Results: Among survey respondents, 59% were single and did not live with a partner. Those with children are the primary carers. Spouses or partners appear in third place, with a very low percentage of responsibility as carers. Most workplaces where female surgeons work do not have childcare facilities. Sixty-five percent of the survey respondents had not presented scientific papers after having children. Only 26 percent of patients had rejected their services in favor of a male surgeon and 42% of head surgeons had refused to be assisted by female surgeons. Almost 85% of women surgeons have received comments about their sexuality during their work. Conclusions: The organizational structures of surgery departments work as a structured regulatory framework of practices and speeches that have constructed the inequalities between women and men in the field of medical action at the symbolic, subjective and institutional level. The recent feminization of the surgical field and the entrance of women in the workplace do not necessarily imply gender equality.


Subject(s)
Humans , Female , Adult , Middle Aged , Young Adult , Surgery Department, Hospital/statistics & numerical data , Women, Working/psychology , Gender Inequality , Gender Role , Surgery Department, Hospital/trends , Women, Working/statistics & numerical data , Breast Feeding , Pregnancy , Cross-Sectional Studies , Sexual Harassment/statistics & numerical data , Harassment, Non-Sexual/statistics & numerical data , Internship and Residency/statistics & numerical data
9.
Rev. colomb. anestesiol ; 47(1): 5-13, Jan.-Mar. 2019. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-990916

ABSTRACT

Abstract Introduction: Patient safety includes monitoring, analysis, and proposed actions for the prevention of reportable events with unwanted effects (REUE). Objective: To estimate the incidence, preventability, severity, and contributing factors of REUEs in patients admitted to the surgery service. Materials and methods: Prospective cohort study in patients with at least 12hours of hospitalization in the surgical services of a university hospital in Bogotá, Colombia. Random sampling was used and the sample size was 200 subjects. Sociodemographic and baseline clinical variables were evaluated. We estimated the presence of REUE detection events, their preventability and severity. The analysis of the contributing factors was done using the London protocol. Results: A total of 106 women (52.47%) and 96 men (47.53%) were included; the median age was 51.93 years (range 18-93); 60% had at least 1 comorbidity measured by the Charlson index and 25.74% had 3 or more. Of the participants, 28.21% presented at least 1 detection event, the incidence of REUEs was 11.8%, and 75% of them were classified as preventable while 75% were serious events. The main contributing factors were: patient-related 58.33%, related to scheduled tasks and clinical context 50.00%, and work team-related factors 37.50%. Conclusion: The incidence, preventability, and severity of REUE are similar to those reported in the literature. The analysis of the contributing factors shows areas that are susceptible to intervention and can be considered as opportunities for improvement.


Resumen Introducción: La seguridad del paciente incluye la vigilancia, análisis y la propuesta de acciones para la prevención de eventos reportables con efectos no deseados (EREND). Objetivo: Estimar la incidencia, preventibilidad, severidad y factores contribuyentes de los EREND en pacientes hospitalizados en el servicio de cirugía. Materiales y métodos: Estudio de cohorte prospectiva en pacientes con al menos 12 horas de hospitalización en los servicios quirúrgicos de un hospital universitario en Bogotá, Colombia. Muestreo aleatorio. Tamaño muestral: 200 sujetos. Se evaluaron las variables sociodemográficas y clínicas basales. Se estimó la presencia de eventos de detección, de EREND, si eran prevenibles y su severidad. El análisis de los factores contribuyentes se hizo mediante el protocolo de Londres. Resultados: Se incluyeron 106 mujeres (52.47%) y 96 hombres (47.53%); la edad mediana fue 51.93 años (rango 18-93). El 60% tuvo al menos una comorbilidad medida por el índice de Charlson y el 25.74% tuvo 3 o más. El 28.21% de los participantes presentaron al menos un evento de detección, la incidencia de EREND fue 11.8% y el 75% de estos fueron calificados como prevenibles y 75% fueron eventos serios. Los principales factores contribuyentes fueron: del paciente 58.33%, relacionados con tareas programadas y contexto clínico 50.00% y factores del equipo de trabajo 37.50%. Conclusiones: La incidencia, evitabilidad y severidad de los EREND del estudio se encuentran dentro de las reportadas en la literatura, el análisis los factores contribuyentes presenta elementos que son susceptibles de intervención y pueden ser considerados como oportunidades de mejora.


Subject(s)
Humans , Male , Female , Middle Aged , Surgery Department, Hospital , Drug-Related Side Effects and Adverse Reactions , Patient Safety , Hospitals , Universities , Comorbidity , Cohort Studies , Equipment and Supplies , Hospitalization
10.
Article in Chinese | WPRIM | ID: wpr-774431

ABSTRACT

Construction of research-based surgery department includes standardizing surgical practices, collecting and analyzing clinical data, discovering problems in clinical practices, designing and conducting reliable and high-level clinical research, improving and innovating surgical technologies according to research conclusions, working out technical specifications and promoting them through clinical education, and creating new clinical research needs arised by innovative and cutting-edge technologies and theories. By integrating technology, research, standardization, promotion and evaluation, and making close connections between different parts of clinical practices, scientific research and clinical teaching, it helps achieve coordinated development of surgical practices and translational research, and will finally promote the cultivation of medical talents and the progress of medical technologies. Since 2010, the General Surgery Department of Nanfang Hospital has established the basic idea of subject construction of "research-oriented surgery with data as the core, minimally invasive surgery with laparoscopic as the characteristic, and specialized surgery with high-efficiency service as the guidance", and has taken a series of measures to build it into a well-known research-based gastrointestinal surgery in China. The achievements of this speciaty have emerged from nothing, research platforms from few to many, the talent echelon from following to leading, and the influence from regional to international. The discipline construction has achieved a leap from quantitative to qualitative changes.


Subject(s)
Biomedical Research , Reference Standards , China , Digestive System Surgical Procedures , Reference Standards , Gastrointestinal Diseases , General Surgery , Hospitals , Reference Standards , Humans , Minimally Invasive Surgical Procedures , Reference Standards , Program Development , Surgery Department, Hospital , Reference Standards
11.
San Salvador; s.n; abr. 2019. 63 p. ilus, tab, graf, mapas.
Thesis in Spanish | LILACS | ID: biblio-1007177

ABSTRACT

OBJETIVO. Valorar los conocimientos, actitudes y prácticas en la aplicación de la lista de verificación de cirugía segura en el Hospital Nacional de Jiquilisco (HNJ), departamento de Usulután, El Salvador, en el período de Julio - Diciembre 2018. DISEÑO: El estudio es de tipo CAP (descriptivo), se realizó en el HNJ, ubicado en el departamento de Usulután, municipio de Jiquilisco. Es un Hospital de Segundo Nivel de Atención, el universo y muestra fue de 23 recursos entre ellos; 8 médicos, 9 enfermeras y 6 anestesistas que laboran en sala de operaciones, a quienes se les aplico la encuesta. La información obtenida se procesó a través del programa estadístico SPSS y los hallazgos se presentaron en tablas y gráficos. RESULTADOS: En cuanto al conocimiento, actitud y práctica referida, se encontró que el 56% del personal que labora en quirófano conoce los momentos de la lista de verificación de cirugía segura (LVCS), 59% están dispuestos a realizar el llenado de la LVCS en sus 3 momentos y el 83% manifestó realizar la práctica que conlleva la LVCS en sus 3 momentos. CONCLUSIONES: De los 23 recursos, que laboran en el quirófano de sala de operaciones del HNJ, la mayoría conocen la LVCS y tienen actitud positiva para su aplicación; pero hay un menor número, el cual es significativo y preocupante que no conoce y no está dispuesto a realizar su aplicación, esto afecta la seguridad de la intervención quirúrgica y pone en riesgo la vida del paciente


Subject(s)
Humans , Operating Rooms , General Surgery , Surgery Department, Hospital , Health Knowledge, Attitudes, Practice , Public Health , Epidemiology, Descriptive
12.
Barbarói ; (53): 251-260, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1025393

ABSTRACT

Este artigo tem por objetivo identificar os domínios da qualidade de vida dos profissionais de enfermagem que atuam nos centros cirúrgicos de quatro hospitais do Rio Grande do Sul. Tratase de um estudo transversal realizado a partir de dois questionários: um sócio demográfico e o SF-36 (Medical Outcomes Study 36 ­ Item Short ­ Form Health Survey). Para o tratamento estatístico foram aplicadas frequência, média e desvio padrão em variáveis nominais e o teste t para amostras independentes. A amostra do estudo (125 participantes: 81,6% sexo feminino) correspondeu a 57,33% da população total, destes 48,8% eram do bloco cirúrgico, 30,4% da central de materiais e 20,8% da sala de recuperação anestésica. A média de idade foi de 35,8 anos e a média de atuação na instituição foi de 4,6 anos. Os oito domínios avaliados evidenciaram um escore médio superior a 50, porém, "Estado Geral de Saúde", "Dor" e "Vitalidade" apresentaram os menores escores. O estudo revela aspectos importantes sobre a qualidade de vida dos profissionais da enfermagem, apontando fatores com possibilidades de melhorias nos domínios avaliados.(AU)


This article aims to identify the domains of the nursing professional's quality of life domains that work in the surgical centers of four hospitals in Rio Grande do Sul. It is a cross-sectional study which has been realized as of two questionnaires, one was a socioeconomic and the other one was the SF-36 (Medical Outcomes Study 36 - Item Short - Form Health Survey). For statistics processing, frequency, mean and standard deviation have been applied to nominal variables and T Test for independent samples. The sample of the study (125 participants: 81,6% female gender) have corresponded to 57,33% of the total population, from that total 48,8% are from the surgical center, 30,4% are from the material center, and 20,8% are from the anesthesia recovery room. The average age is of 35,8 years old and the mean of working years in the institution is of 4,6 years. The eight domains which have been evaluated, have obtained average score superior to 50,0, although, "General State of Health", "Pain" and "Vitality" have presented the minor scores. The study discloses important aspects regarding the interference in the professionals' quality of life, pointing out factors with potential for improvement among the evaluated domains.(AU)


Subject(s)
Humans , Male , Female , Adult , Quality of Life , Surgery Department, Hospital , Perioperative Nursing , Licensed Practical Nurses , Nurses , Work Hours , Pain Measurement , Cross-Sectional Studies , Sex Distribution
13.
Rev. colomb. psiquiatr ; 47(3): 148-154, jul.-set. 2018. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-978315

ABSTRACT

resumen Introducción: El delirium es un síndrome neuropsiquiátrico frecuente y con graves consecuencias, especialmente para los pacientes ancianos y con deterioro cognitivo preexistente. Métodos: Estudio descriptivo de una única cohorte retrospectiva. El objetivo es comparar los factores de riesgo y la mortalidad según el tipo de tratamiento (quirúrgico y no quirúrgico) en un grupo de pacientes con delirium hospitalizados. Resultados: Se analizó a 184 pacientes con delirium hospitalizados, por causas quirúrgicas el 29,3% y no quirúrgicas el 70,7%. El 50,5% eran mujeres; el 50% de los pacientes tenían 74 anos o menos (intervalo intercuartílico, 27 arios), con diferencias estadísticas, siendo mayores los no quirúrgicos (p = 0,002). El 42,9% de los pacientes presentaban deterioro cognitivo previo, con mayor proporción entre los no quirúrgicos (el 50,8 frente al 24,1%) y diferencias significativas (p = 0,001). El 89,7% recibía medicamentos anticolinérgicos y el 99,5%, más de 3 medicamentos, sin diferencias significativas. La mitad de los pacientes permanecieron en hospitalización 16,3 días o menos (intervalo intercuartílico, 23 días), y fue significativamente más larga la estancia en el grupo quirúrgico (p < 0,001); el 14,7% de los pacientes murieron en el hospital, sin diferencias estadísticas entre los grupos (p = 0,073). Discusión: No hubo diferencias significativas en la mortalidad entre los grupos, si bien fue mayor en el no quirúrgico (el 17,7 frente al 7,4%). En cuanto a la edad, se encontró que el grupo de mayor mortalidad (el no quirúrgico) tenía una edad y un deterioro cognitivo significativamente mayores, lo cual coincide con la literatura científica.


ABSTRACT Introduction: Delirium is a common neuropsychiatric syndrome with severe consequences, especially for elderly patients with pre-existing cognitive impairment. Methodology: Descriptive study of one retrospective cohort, with the aim of comparing risk factors and mortality between surgical treatment and non-surgical treatment in a group of hospitalised patients with delirium. Results: Of the 184 hospitalised patients with delirium analysed, 29.3% were for surgical causes and 70.7% for non-surgical causes. Just over half (50.5%) were women, and 50% of the patients were 74 years or less (interquartile range, 27 years), with statistical differences (P=.002). Prior cognitive impairment was observed in 42.9% of patients, with a greater proportion of non-surgical (50.8% vs 24.1%) with significant differences (P=.001). Anticholinergic medications were received by 89.7% of patients, and almost all of them (99.5%) received three or more medicines, with no significant differences. Half (50%) of the patients remained in hospital for 16.3 days or less (interquartile range, 23 days). Hospitalisation was significantly longer in the surgical group (P<.001). The hospital mortality was 14.7%, with no statistical differences between groups (P=.073). Discussion: Although there were no significant differences in mortality between the groups, it was higher in the non-surgical (17.7% vs. 7.4%). Increased mortality was found in the older group (non-surgical) that also had significantly greater cognitive impairment, which coincides with that in the scientific literature.


Subject(s)
Humans , Male , Female , Aged , Risk Factors , Mortality , Delirium , Surgery Department, Hospital , Syndrome , Hospitalization
14.
Rev. chil. cir ; 70(2): 117-126, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959359

ABSTRACT

Resumen Objetivo: Evaluar el grado de Síndrome de Burnout en el quehacer de los médicos del Servicio de Cirugía Hospital Hernán Henríquez Aravena y Departamento de Cirugía de la Universidad de La Frontera, Temuco, Chile, valorando los niveles de agotamiento emocional, realización personal y despersonalización. Material y Método: Estudio de corte transversal. Se incluyeron 19 internos de medicina, 11 residentes de cirugía y 15 cirujanos pertenecientes al Servicio de Cirugía del Hospital Hernán Henríquez Aravena y Departamento de Cirugía de la Universidad de La Frontera. Instrumento aplicado: cuestionario MBI. Se realizó cálculo de medidas de tendencia central y porcentaje, así como comparación de variables a través de t de Student y valores de coeficientes de alfa de Cronbach. Resultados: Respecto a la escala de MBI, la prevalencia global del síndrome fue del 64,4%, mientras que, por dimensiones, el cansancio emocional mostró una prevalencia del 76%; la baja realización personal en el trabajo, el 55%, y la despersonalización el 62%. Se obtuvo diferencias estadísticamente significativas en cansancio emocional y despersonalización según variables sociodemográficas: hombres y mujeres, solteros y casados, sujetos sin hijos y con hijos, si hace o no turnos de urgencia, obteniendo niveles más altos en las mujeres, en solteros, en sujetos sin hijos y los que hacen turnos de urgencia. Conclusión: Se acepta que el factor central desencadenante es el excesivo agotamiento emocional que gradualmente lleva a un estado de distanciamiento emocional y cognitivo en sus actividades diarias, con la consecuente incapacidad de responder a las demandas del servicio. En este distanciamiento ocurre una despersonalización, indiferencia, y actitudes vinculadas al sarcasmo y la ironía hacia las responsabilidades o hacia las personas, una tendencia de no creer en la sinceridad del ser humano. Por tanto se deben tomar medidas para intentar reducir la prevalencia de este síndrome, principalmente en nuestros internos y residentes.


Aim: To assess the degree of emotional exhaustion, personal accomplishment and depersonalization in the work of physicians of the Hospital Hernán Henríquez Aravena surgery service and department of surgery of the Universidad de La Frontera, Temuco, Chile. Material and Method: Cross-sectional study. 19 medical interns, 11 surgical residents and 15 surgeons of Hernán Henríquez Aravena Hospital and surgery department of Universidad de La Frontera were included. Applied instrument: MBI questionnaire in its adaptation of the Spanish population. Calculation of measures of central tendency and percentage, as well as comparison of variables through t Student and values of Cronbach's alpha coefficients were performed. Results: Regarding the MBI scale, the overall prevalence of the syndrome was 64.4%, whereas, by dimensions, emotional exhaustion showed a prevalence of 76%; Low personal accomplishment at work, 55%, and depersonalization 62%. Statistically significant differences were found in emotional exhaustion and depersonalization according to socio-demographic variables: men and women, single and married, subjects without children and with children, whether or not they take emergency room shifts, obtaining higher levels in women, unmarried, subjects without children and those who take emergency shifts. Conclusions: It is accepted that the central triggering factor is the high emotional exhaustion that gradually leads to a state of emotional and cognitive distancing in their daily activities, with the consequent inability to respond to demands of the service. In this distancing occurs depersonalization, indifference and cynical attitudes toward responsibilities or towards people. Therefore, measures should be taken to try to reduce the prevalence of this syndrome in our medical interns and residents, mainly.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Physicians/psychology , Surgery Department, Hospital , Burnout, Professional/epidemiology , Stress, Psychological/epidemiology , Chile , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Shift Work Schedule , Hospitals, Teaching , Internship and Residency , Medical Staff, Hospital/psychology
15.
Postgrad. Med. J. Ghana ; 7(1): 1-5, 2018. ilus
Article in English | AIM, AIM | ID: biblio-1268717

ABSTRACT

Background: Surgeons carry out procedures on patients daily, many of which are invasive and may be associated with some risks and complications. The concept of informed consent in surgical practice was introduced after certain legal issues arose. Today patients are entitled to know and be accorded the right to determine what happens to their bodies. This study set out to determine if there had been any improvement in the informed consent process over the years, taking a closer look at the various aspects of the information given :This was a cross-sectional study carried out at the Department of Surgery, Korle Bu Teaching Hospital. One hundred consecutive post-operative patients were recruited and interviewed on information discussed at various stages during the preoperative period and on the administration of the consent form. Results: Thirty seven (66.0%) out of 56 elective cases felt they had been given enough information to their understanding to enable them give informed consent. Thirty (68.1%) out of 44 emergencies also felt they had been given enough information. Forty (71.4%) of elective cases were able tell what their diagnosis was but only 23 (41.0%) knew what procedure had been done. Similarly 32 (72.2%) emergency cases were able to tell what their diagnosis was but only 16 (36.3%) knew what procedure had been done. Conclusion: Informed consent in the Department of Surgery of the Korle Bu Teaching Hospital is unsatisfactory and needs to be improved


Subject(s)
Consent Forms , Ghana , Hospitals, Teaching , Informed Consent , Medical Audit , Patient Satisfaction , Surgery Department, Hospital , Surgical Procedures, Operative
16.
Revista Digital de Postgrado ; 6(1): 28-37, jun. 2017. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1096847

ABSTRACT

La cancelación de procedimientos quirúrgicos en una sala de cirugía, afecta la productividad de la misma y ocasiona un impacto emocional en el paciente. Objetivo: determinar las principales causas de cancelación del turno quirúrgico, en el Servicio de Cirugía General del Hospital Dr. Francisco Antonio Rísquez, en el periodo 2006-2015. Métodos: se revisaron las planillas del plan quirúrgico diario de cirugía, en el área de quirófano y los libros de cancelación de acto quirúrgico del departamento de Cirugía del hospital. Resultados: en el Hospital "Dr. Francisco Antonio Risquez", se planificaron para acto quirúrgico del Servicio de Cirugía desde el 2006 al 2015; 2.872 pacientes, de los cuales se suspendieron 1.082 (37,67 %). Las causas específicas de las cancelaciones del turno quirúrgico fueron: ausencia de anestesiólogos: 613 pacientes (56,65%), prolongación del turno quirúrgico: 132 (12,20%), crisis hipertensiva: 81 (7,49%), aire acondicionado dañado: 47 (4,34%), ascensor averiado: 38 (3,51%), "otros": 36 (3,33%), falta de material quirúrgico: 33 (3,05%), ausencia delespecialista en cirugía: 31 (2,87%), maquina anestésica dañada: 27 ( 2,50%), enfermedad aguda del paciente: 20 (1,85%), área quirúrgica contaminada: 14 (1,29%) y exámenes preoperatorios incompletos: 10 (0,92%). Por causas atribuidas al personal médico 666 (61,55 %) casos, seguidas por las inherentes a la institución 306 (28,28 %) personas y 110 (10,17 %) suspensiones atribuibles al paciente. Conclusiones: el índice de suspensión de cirugías en el período evaluado en nuestro centro fue muy alto. Las principales causas de cancelación del turno quirúrgico fueron atribuibles al personal médico(AU)


the cancellation of surgical procedures in a surgery room affects the productivity of the same and causes an emotional impact on the patient. Objective: to determine the main causes of cancellation of surgical interventions in the department of General Surgery of "Dr. Francisco Antonio Rísquez" Hospital, during the period comprised between 2006 and 2015. Methods: the daily surgical schedule formats were revised, located on the fourth floor in the operating room area, as well as the books detailing the cancellation of interventions by the department of Surgery, located in the hospital's office of medical records. Results: in "Dr. Francisco Antonio Rísquez" Hospital, 2.872 patients were scheduled for intervention by the department of surgery between the years 2006 and 2015, of which 1.082 (37, 67%) The specific causes behind the cancellation of the interventions were: absence of anesthesiologist: 613 (56,65%), prolonged surgery times: 132 (12,20%), hypertensive crisis: 81 (7,49%), malfunctioning air conditioning: 47 (4,34%), elevator out of order: 38 (3,51%), others: 36 (3,33%), lack of surgical equipment: 33 (3,05%), absence of attending surgeon: 31 (2,87%), patient with acute illness: 27 (2,50%), non-operative anesthesia machinery: 20 (1,85%), contaminated operating room: 14 (1,29%) and incomplete preoperatory exams: 10 (0,92%). Causes attributed to medical staff predominated by 666 (61, 55%) cases, followed by causes attributed to the hospital in 306 (28, 28%) people, and 110 (10, 17%) suspensions attributed to the patient. Conclusions: the rate of suspension of surgeries in our center was very high and therefore worrisome for all health personnel. The main causes of cancellation of the surgical shift were attributable to medical personnel(AU)


Subject(s)
Humans , Surgery Department, Hospital , Surgical Procedures, Operative/psychology , Perioperative Period , Patient Care , Hospitalization , Internal Medicine
17.
Rev. SOBECC ; 22(1): 42-51, jan.-mar. 2017.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-833448

ABSTRACT

Objetivo: Analisar as produções nacional e internacional dos indicadores de qualidade em Enfermagem no Centro Cirúrgico. Método: Revisão integrativa da literatura de 2009 a 2016 de artigos indexados nas bases de dados: Literatura Latino­Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online e US National Library of Medicine. A amostra final foi composta por 17 artigos. Resultados: Houve predominância das publicações nacionais, em 2013, realizadas por enfermeiros mestres, com abordagem quantitativa. Os temas dessas foram: importância, confiabilidade e benefícios dos indicadores de qualidade para o gerenciamento da assistência de Enfermagem; principais dificuldades quanto ao uso dos indicadores; sistema informatizado para coleta de dados dos indicadores e visão dos enfermeiros a respeito do uso dessa ferramenta de qualidade. Conclusão: Foram observados os benefícios e as principais dificuldades referentes à utilização dos indicadores de qualidade para o Centro Cirúrgico. No entanto, a avaliação de desempenho do Centro Cirúrgico por meio de indicadores ainda é pouco utilizada.


Objective: To analyze the national and international scientific work concerning quality indicators in nursing in the surgical center. Method: This is an integrative review of the literature from 2009 to 2016 of articles indexed in the databases Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, and US National Library of Medicine. The final sample included 17 articles. Results: In 2013, scientific studies carried out by master nurses with a quantitative approach were predominant. The themes of these studies were importance, reliability, and benefits of the quality indicators for the management of nursing care; difficulties in using the indicators; computerized system for data collection of indicators; and nurses' perspective on the use of this tool for the quality assessment. Conclusion: Benefits and main difficulties on the use of quality indicators for the surgical centers were observed. However, the surgical center performance assessment by means of indicators is still poorly used.


Objetivo: Analizar las producciones nacionales e internacionales de los indicadores de calidad en Enfermería en el Quirófano. Método: Revisión integrativa de la literatura de 2009 a 2016 de artículos indexados en las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Scientific Electronic Library Online y US National Library of Medicine. La muestra final fue compuesta por 17 artículos. Resultados: Hubo predominancia de las publicaciones nacionales, en 2013, realizadas por enfermeros maestros, con abordaje cuantitativo. Los temas de esas publicaciones fueron: importancia, confiabilidad y beneficios de los indicadores de calidad para la gestión de la asistencia de Enfermería; principales dificultades con relación al uso de los indicadores; sistema informatizado para colecta de datos de los indicadores y visión de los enfermeros al respecto del uso de esa herramienta de calidad. Conclusión: Fueron observados los beneficios y las principales dificultades referentes a la utilización de los indicadores de calidad para el Quirófano. Sin embargo, la evaluación de desempeño del Quirófano por medio de indicadores aún es poco utilizada.


Subject(s)
Humans , Surgery Department, Hospital , Evaluation Studies as Topic , Nursing Care , Organization and Administration , Quality of Health Care , Quality Indicators, Health Care
18.
Medwave ; 17(2): e6881, 2017.
Article in English, Spanish | LILACS | ID: biblio-995542

ABSTRACT

INTRODUCCIÓN En el contexto de la evaluación de servicios hospitalarios, la incorporación de índices de gravedad permite tener una variable de control esencial para la comparación del desempeño en el tiempo y el espacio a través del llamado ajuste por riesgo. El índice de gravedad para servicios quirúrgicos, se construyó en 1999 y se validó como un índice general para estos servicios. Dieciséis años después el contexto hospitalario ha cambiado y se consideró necesaria una revalidación de este índice de gravedad que avale su utilidad actual. OBJETIVO Evaluar la validez y confiabilidad del índice de gravedad para servicios quirúrgicos, que avale su uso razonable en las condiciones actuales. MÉTODOS Se realizó una investigación descriptiva retrospectiva en el servicio de cirugía general del Hospital Clínico Quirúrgico Hermanos Ameijeiras en el segundo semestre del año 2010. Se revisaron las historias clínicas de 511 pacientes egresados de este servicio. Las variables utilizadas fueron las mismas del índice original con sus ponderaciones. Se evaluaron validez conceptual o de constructo, validez de criterio y confiabilidad interevaluadores así como consistencia interna del índice propuesto. RESULTADOS La validez de constructo se expresó en una asociación significativa entre el valor del índice de gravedad para servicios quirúrgicos y el estado al egreso. Se comprobó también correlación significativa, aunque débil, con la estadía hospitalaria. En cuanto a validez de criterio, la correlación entre el índice de gravedad propuesto y el índice de Horn fue de 0,722 (intervalo de confianza de 95%: 0,677-0,761); mientras que con el índice Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) la correlación fue de 0,454 (intervalo de confianza de 95%: 0,388-0,514) con el riesgo de muerte y 0,539 (intervalo de confianza de 95%: 0,462-0,607) con el riesgo de morbilidad. La consistencia interna mostró α de Cronbach estandarizado de 0,8; la confiabilidad interevaluadores resultó en un coeficiente de confiabilidad de 0,98 para el índice de gravedad para servicios quirúrgicos cuantitativo y un coeficiente de κ ponderado global de 0,87 para el índice de gravedad para servicios quirúrgicos ordinal. CONCLUSIONES La validez y confiabilidad del índice propuesto fue adecuada en todos los aspectos evaluados. El índice de gravedad para servicios quirúrgicos puede utilizarse en el contexto original y es fácilmente adaptable a otros contextos.


INTRODUCTION In the context of the evaluation of hospital services, the incorporation of severity indices allows an essential control variable for performance comparisons in time and space through risk adjustment. The severity index for surgical services was developed in 1999 and validated as a general index for surgical services. Sixteen years later the hospital context is different in many ways and a revalidation was considered necessary to guarantee its current usefulness. OBJECTIVE To evaluate the validity and reliability of the surgical services severity index to warrant its reasonable use under current conditions. METHODS A descriptive study was carried out in the General Surgery service of the "Hermanos Ameijeiras" Clinical Surgical Hospital of Havana, Cuba during the second half of 2010. We reviewed the medical records of 511 patients discharged from this service. Items were the same as the original index as were their weighted values. Conceptual or construct validity, criterion validity and inter-rater reliability as well as internal consistency of the proposed index were evaluated. RESULTS Construct validity was expressed as a significant association between the value of the severity index for surgical services and discharge status. A significant association was also found, although weak, with length of hospital stay. Criterion validity was demonstrated through the correlations between the severity index for surgical services and other similar indices. Regarding criterion validity, the Horn index showed a correlation of 0.722 (95% CI: 0.677-0.761) with our index. With the POSSUM score, correlation was 0.454 (95% CI: 0.388-0.514) with mortality risk and 0.539 (95% CI: 0.462-0.607) with morbidity risk. Internal consistency yielded a standardized Cronbach's alpha of 0.8; inter-rater reliability resulted in a reliability coefficient of 0.98 for the quantitative index and a weighted global Kappa coefficient of 0.87 for the ordinal surgical index of severity for surgical services (IGQ). CONCLUSIONS The validity and reliability of the proposed index was satisfactory in all aspects evaluated. The surgical services severity index may be used in the original context and is easily adaptable to other contexts as well.


Subject(s)
Humans , Surgery Department, Hospital , Surgical Procedures, Operative , Severity of Illness Index , Observer Variation , Reproducibility of Results , Cuba , Length of Stay
19.
REME rev. min. enferm ; 21: [1-8], 2017. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-907977

ABSTRACT

Objetivou-se identificar a taxa de cancelamento cirúrgico em um hospital universitário público, bem como caracterizar as cirurgias e os motivos à sua suspensão. Trata-se de pesquisa descritiva, transversal, retrospectiva e documental. Foi realizada com base nos agendamentos cirúrgicos e prontuários de pacientes a serem atendidos na Unidade de Centro Cirúrgico de um hospital de ensino público do interior do Paraná, Brasil. A população foi oriunda do total (n=2828) de procedimentos cirúrgicos agendados entre abril e novembro de 2013 e a amostra analisada foram todas aquelas intervenções que foram canceladas (n=522), independentemente do motivo. Com os dados tabulados, procedeu-se à análise estatística descritiva, em percentual. A taxa geral de cancelamento cirúrgico foi obtida a partir da fórmula de um programa de qualidade/produtividade hospitalar, determinada em 18,45%. Ainda, constatou-se prevalência de cancelamentos oriundos das especialidades de Cirurgia Geral (25,48%); Ortopedia (23,57%); e Neurocirurgia (20,11%). Os motivos mais frequentes para suspensão operatória foram vinculados àqueles inerentes aos recursos humanos (61,38%) e à ineficiência do planejamento cirúrgico (21,45%). Concluiu-se que a taxa identificada foi discretamente alta. Ressalta-se a necessidade de monitoramento do capital humano responsável pelo planejamento e execução de cirurgias.


The objective of the study was to identify the surgical cancellation rate in a public university hospital, as well as characterize the surgeries and the reasons for suspension. This is a descriptive, cross-sectional, retrospective and documentary research. The study was based on surgical schedules and medical records of patients assisted at the Surgical Center Unit of a public teaching hospital in the countryside of Paraná, Brazil. The population came from the total number (n = 2828) of surgical procedures scheduled between April and November 2013 and the sample analyzed corresponded to all interventions that were canceled (n = 522), regardless of the reason. Data were tabulated and analyzed through descriptive statistics, using percentage values. An overall rate of surgical cancellation of 18.45% was obtained through an equation of a hospital quality/productivity program. Prevalence of cancellations General Surgery (25.48%); Orthopedics (23.57%); and Neurosurgery (20.11%) were observed. The most frequent reasonsfor suspension were related to those inherent to human resources (61.38%) and in efficient surgical planning (21.45%). We conclude that the identifiedrate was discreetly high. It is necessary to monitor the human capital responsible for the planning and realization of surgeries.


El objetivo de esta investigación fue identificar la tasa de cancelaciones quirúrgicas en un hospital universitario público y caracterizar las cirugíasy los motivos de la suspensión. Se trata de un estudio descriptivo, transversal, retrospectivo y documental basado en la programación quirúrgica yen los expedientes clínicos de los pacientes atendidos en la unidad del centro quirúrgico de un hospital público de enseñanza del Estado de Paraná,Brasil. La población deriva del total (n=2828) de los procedimientos quirúrgicos programados entre abril y noviembre de 2013 y la muestra analizada consistió en todas aquellas intervenciones que habían sido canceladas (n=522), independientemente del motivo. Con los datos tabulados se realizóel análisis estadístico descriptivo, en porcentaje. La tasa global de cancelaciones quirúrgicas se obtuvo mediante la fórmula de un programa decalidad y productividad hospitalaria, determinada en 18,45%. Se constató la prevalencia de cancelaciones de las siguientes áreas: cirugía general(25,48%); ortopedia (23,57%); y neurocirugía (20,11%). Las motivos más comunes estaban vinculados con recursos humanos (61,38%) e ineficienciaen la planificación quirúrgica (21,45%). Se llegó a la conclusión que la tasa global identificada fue ligeramente más alta. Se apunta a la necesidad deun seguimiento de los recursos humanos responsables de la planificación y ejecución de cirugías.


Subject(s)
Humans , Perioperative Nursing , Quality Indicators, Health Care , Quality Management , Surgery Department, Hospital , Surgical Procedures, Operative
20.
Rev. Eugenio Espejo ; 10(2): 33-39, dic.-2016.
Article in Spanish | LILACS | ID: biblio-980765

ABSTRACT

Se realizó un estudio con enfoque cuantitativo, de tipo observacional descriptivo, de corte transversal, con el propósito de caracterizar los costos de la realización de colecistectomía laparoscópica en el Hospital Provincial General Docente Riobamba (HPGDR), durante el año 2014. La población de estudio estuvo constituida por los documentos contables relacio-nados con esa prestación de salud en particular, los cuales estaban archivados en el Departa-mento Financiero, Centro Quirúrgico y Servicio de Cirugía. Los datos fueron recolectados mediante la técnica de la revisión de documentos, para lo cual se diseñó la respectiva guía. El importe del equipamiento resultó el más elevado dentro del rubro activos fijos tangibles con un valor de $210 923.26 USD. El análisis del valor colecistectomías laparoscópicas atendien-do al uso de trocar reutilizable y descartable mostró una diferencia de $ 434,00 USD a favor del primero de estos.


A quantitative, descriptive observational, cross-sectional study was carried out in order to characterize the costs of performing laparoscopic cholecystectomy at the General Hospital of Riobamba (HPGDR) during 2014. The study population was constituted by the accounting documents related to that particular health benefit, which were filed in the Financial Depart-ment, Surgical Center and Surgery Service. The data was collected using the document review technique by the means of the respective guide. The amount of the equipment was the highest within the tangible fixed assets with a value of $ 210 923.26. The analysis of the value of laparoscopic cholecystectomies based on the use of reusable and disposable trocar showed a difference of $ 434.00 USD in favor of the first of these ones.


Subject(s)
Humans , Surgery Department, Hospital , Cholecystectomy, Laparoscopic , Delivery of Health Care , Health Care Costs , Laparoscopy
SELECTION OF CITATIONS
SEARCH DETAIL