[ comparative study on results of hospitals in Tehran based on the organizational excellence model]

During recent years, due to the importance of health services quality, the health service managers have been paying enormous attention to improvement of health care quality and therefore, the Organizational Excellence Model is increasingly in use as a competition framework for recognition of achievement towards the organizational quality, performance excellence, and also the growth of organizational knowledge regarding the quality and performance excellence. To assess the results of two hospitals affiliated to Social Security Organization in Tehran based on the Organizational Excellence Model. The present work was a cross-sectional study carried out at two hospitals named as Alborz and Panzdah-e-Khordad in 2005. Both hospitals were granted an ISO 9001 certification. The data gathering tool consisted of an EFQM questionnaire filled in during group working sessions, interview with hospital managers, and also the available documents kept at different wards. Data were collected according to the "four criteria of results" in the hospitals. The highest scores were gained in Panzdah-e-Khordad hospital in key performance results [56.5%] followed by customer results [46.1%], society results [40.6%], and people results [39%]. Totally, our findings showed that Panzdah-e-Khordad hospital achieved a higher score [236.1out of a total of 500 points] compared to Alborz hospital with 212.2 points. It is believed that the health care area is one of the best fields for application of the model towards the performance excellence and gaining better organizational results and hence, it seem that the model has a high potential in responding to problems commonly seen in health sector

[Evaluation of sub-fascial lidocaine infusion in post-operative pain management following laparotomy]

One of the important problems of major abdominal surgery is post-operative pain control. There are different modalities to control the pain after surgery, such as oral, local or intravenous analgesic drugs, regional nerve block, epidural catheters and pain killer pumps with their own benefits and complications. The aim of this study was to evaluate the effect of continuous peritoneal infusion of lidocaine by a pain killer pump for post-operative pain management following laparotomy. This double blind randomized clinical trial was performed on 76 patients [38 cases and 38 controls] who underwent laparotomy with midline incision, in Imam Hospital, Sari, Iran, in 2008. Two groups were matched in age and sex. After surgery a catheter infusion pump was prepared for all patients. In case group, 2% lidocaine [20mg/kg/day] and for control, normal saline infused for 24 hours. Pain score [Visual Analog Scale], blood pressure, heart rate, respiratory rate, temperature and analgesic requirement was evaluated in 4, 10, 16 and 24 hours after surgery. Results analyzed by means of SPSS [15] software and chi-square, t test and repeated measurement. The p value less than 0.05 was considered to be significant statistically. 76 patients, 39 [51.3%] females and 37 [48.7%] males, with mean age of 47.03 +/- 15.2 years were studied. There was no significant difference in age, sex and weight between two groups. The mean of admission days was 5.03 +/- 0.6 in case and 5.29 +/- 1.3 in control, with no significant difference between them. Mean of opiod consumption was 16.05 +/- 13.05 mg and 25.39 +/- 11.4 mg in case and control respectively [P= 0.002]. Mean of VAS score, blood pressure, heart rate, respiratory rate and temperature in case group was less than control group and the difference was significant statistically. Pain severity changes during 4, 10, 16 and 24 hours following surgery were significantly different in two groups, with linear correlation between time and pain reduction. Our study demonstrates that continuous infusion of 2% lidocaine by a pain killer pump can reduce pain and opioid requirements after abdominal surgeries