Improving Theatre Productivity by Digitising Surgical Equipment Repairs.

Introduction A few cancelled surgeries are due to surgical equipment issues representing a significant burden to both patients and National Health Service (NHS) hospitals on waiting lists. Despite this, there remain very few strategies designed to tackle these avoidable cancellations, especially in combination with digitisation. Our aim was to demonstrate improved efficiency through a pilot study in collaboration with Broomfield Hospital (Broomfield, United Kingdom), MediShout Ltd (London, United Kingdom), and B. Braun Medical Ltd (Sheffield, United Kingdom) with the digitalisation of the equipment repair pathway. Methods MediShout digitised two distinct repair pathways: ad-hoc repairs and maintenance equipment services (MES). Pre- and post-digitisation outcome measures were collected including the number of process steps, staff contribution time, non-staff continuation time, turnaround time, cancelled surgeries, planned preventative maintenance compliance, and staff satisfaction. The number of steps, staff contribution time, and non-staff contribution time were calculated using cognitive task analyses and time-motion studies, respectively. Turnaround time and cancellation data were taken from existing hospital data sets and staff satisfaction was measured through two staff surveys. Results Digitising the ad-hoc repair pathway reduced the number of steps by 18 (118 to 100) and saved 74 minutes of total staff time (Broomfield Hospital and B. Braun) per repair, resulting in annual efficiency savings of £21,721.48. Digitising the MES repair pathway reduced the number of steps by 13 (74 to 61) and saved 56 minutes of total staff time per repair, resulting in annual efficiency savings of £3469.44. Turnaround time for the repaired kit decreased by 14 days and 29 days for the digital ad-hoc and digital MES pathways, respectively. Elective operations cancelled due to equipment issues decreased by 44%, from 1.5 operations/month pre-pilot to 0.83 operations/month post-pilot. Planned preventative maintenance compliance across the MES pathway increased by 67% (33% to 100%). Staff satisfaction with the repair pathway improved from 12% to 96%. Conclusion This pilot study showcases the numerous benefits that can be achieved through digitisation and offers an innovative case study to approach avoidable cancellations due to equipment failure.

Effect of Digital Early Warning Scores on Hospital Vital Sign Observation Protocol Adherence: Stepped-Wedge Evaluation.

BACKGROUND: Early warning scores (EWS) are routinely used in hospitals to assess a patient's risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed. OBJECTIVE: This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention. METHODS: We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient's first elevated EWS (EWS ≥3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey. RESULTS: We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73). CONCLUSIONS: We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes.

Interprofessional collaboration mediates the relationship between perceived organizational learning and safety climate in hospitals: A cross-sectional study.

BACKGROUND: Organizational learning (OL) and interprofessional collaboration (IPC) are said to enhance medical safety in hospitals, but the relationship between these variables has not been quantitatively tested. OBJECTIVE: This study examines the mediating effects of IPC on the relationship between OL and safety climate (improvement, compliance, and patient/family involvement). METHODS: An anonymous self-reporting questionnaire was administered to 1,495 healthcare workers from November 2021 to January 2022. The questions regarded the hospital's safety climate, OL, and IPC. A mediation analysis using structural equation modeling was conducted to examine the mediating role of IPC on the relationship between OL and the three safety climates. The indirect effect was estimated using 2,000 bootstrap samples. RESULTS: Responses from 643 healthcare workers were analyzed. The direct effects of OL were 𝛽 = .74, 75 (p < .001) on improvement and involvement and 𝛽 = 0.1 (p > .05) on compliance. The indirect effects of IPC on improvement and involvement were 𝛽 = .14 (95%CI: .00 ∼ .06) and 𝛽 = .37 (95%CI: .04 ∼ .09), respectively. CONCLUSION: This study determined the mechanisms that enhance a hospital's safety climate, demonstrating that IPC mediates the relationship between OL and improvement and patient/family involvement. However, OL and IPC are not related to compliance.

Age and sex-related differences in outcomes of OHCA patients after adjustment for sex-based in-hospital management disparities.

OBJECTIVES: Out-of-hospital cardiac arrest (OHCA) survival differences due to sex remain controversial. Previous studies adjusted for prehospital variables, but not sex-based in-hospital management disparities. We aimed to investigate age and sex-related differences in survival outcomes in OHCA patients after adjustment for sex-based in-hospital management disparities. METHODS: This retrospective observational study used a prospective multicenter OHCA registry to review data of patients from October 2015 to December 2020. The primary outcome was good neurological outcome defined as cerebral performance category score 1 or 2. We performed multivariable logistic regression and restricted cubic spline analysis according to age. RESULTS: Totally, 8988 patients were analyzed. Women showed poorer prehospital characteristics and received fewer coronary angiography, percutaneous coronary interventions, targeted temperature management, and extracorporeal membrane oxygenation than men. Good neurological outcomes were lower in women than in men (5.8% vs. 12.2%, p < 0.001). After adjustment for age, prehospital variables, and in-hospital management, women were more likely to have good neurological outcomes than men (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 1.07-1.74, p = 0.012). The restricted cubic spline curve showed a reverse sigmoid pattern of adjusted predicted probability of outcomes and dynamic associations of sex and age-based outcomes. CONCLUSIONS: Women with OHCA were more likely to have good neurological outcome after adjusting for age, prehospital variables, and sex-based in-hospital management disparities. There were non-linear associations between sex and survival outcomes according to age and age-related sex-based differences.

Inpatient management of epidermolysis bullosa: Consensus-based hands-on instructions for neonates and postneonates.

BACKGROUND: Epidermolysis bullosa (EB), characterized by skin fragility and blistering, often requires hospitalization. Training for inpatient management of EB is limited, with no unified recommendations available in North America. OBJECTIVE: To develop consensus-derived best practices for hands-on inpatient management of EB in both the neonatal and postneonatal period. METHODS: A modified Delphi method (expert-based input via 2 surveys and a final review) was implemented. Available guidelines from EB Clinical Research Consortium centers were analyzed to determine areas of focus and formulate statements to be voted on by EB Clinical Research Consortium members, experienced EB nurses, and select family members. Study participants evaluated statements using a Likert scale: statements with at least 70% agreement were accepted; statements with 30% or more disagreement were rejected. RESULTS: Ten areas of focus were identified. Delphi participants included 15 dermatologists, 8 nurses, and 6 nonhealth care caregivers. Consensus was established on 103/119 neonatal statements and 105/122 postneonatal statements; no statements were rejected. Most recommendations applied to both age groups. LIMITATIONS: Recommendations may require adjustment based on individual patient's clinical context. CONCLUSION: Using the Delphi method, a consensus-derived resource for hospital-based health care professionals who manage patients with EB has been developed to improve the quality of inpatient care.

A discrete-event simulation model for assessing operating room efficiency of thoracic, gastrointestinal, and orthopedic surgeries.

BACKGROUND: In hospital management, pinpointing steps that most enhance operating room (OR) throughput is challenging. While prior literature has utilized discrete event simulation (DES) to study specific strategies such as scheduling and resource allocation, our study examines an earlier planning phase, assessing all workflow stages to determine the most impactful steps for subsequent strategy development. METHODS: DES models real-world systems by simulating sequential events. We constructed a DES model for thoracic, gastrointestinal, and orthopedic surgeries summarized from a tertiary Chinese hospital. The model covers preoperative preparations, OR occupation, and OR preparation. Parameters were sourced from patient data and staff experience. Model outcome is OR throughput. Post-validation, scenario analyses were conducted for each department, including: (1) improving preoperative patient preparation time; (2) increasing PACU beds; (3) improving OR preparation time; (4) use of new equipment to reduce the operative time of a selected surgery type; three levels of improvement (slight, moderate, large) were investigated. RESULTS: The first three improvement scenarios resulted in a 1%-5% increase in OR throughput across the three departments. Large reductions in operative time of the selected surgery types led to approximately 12%, 33%, and 38% increases in gastrointestinal, thoracic, and orthopedic surgery throughput, respectively. Moderate reductions resulted in 6%-17% increases in throughput and slight reductions of 1%-7%. CONCLUSIONS: The model could reliably reflect OR workflows of the three departments. Among the options investigated, model simulations suggest that improving OR preparation time and operative time are the most effective.

Association of medical care capacity and the patient mortality of septic shock: a cross-sectional study.

BACKGROUND: Hospitals with higher septic shock case volume demonstrated lower hospital mortality. We conducted this study to investigate whether this phenomenon was only caused by the increase in the number of admissions or the need to improve the medical care capacity in septic shock at the same time. METHODS: Seven-hundred and eighty-seven hospitals from China collected in a survey from January 1, 2021 to December 31, 2021. Medical care capacity for septic shock was explored by patients with septic shock in intensive care units (ICU) divided into beds, intensivists, and nurses respectively. MAIN RESULTS: The proportion of ICU patients with septic shock was negatively associated with the patient mortality of septic shock (Estimate [95%CI], -0.2532 [-0.5038, -0.0026]) (p-value 0.048). The ratios of patients with septic shock to beds, intensivists, and nurses were negatively associated with mortality of septic shock (Estimate [95%CI], -0.370 [-0.591, -0.150], -0.136 [-0.241, -0.031], and -0.774 [-1.158, -0.389]) (p-value 0.001, 0.011 and < 0.001). Severe pneumonia, the most common infection that caused a septic shock, correlated positively with its mortality (Estimate [95%CI], 0.1002 [0.0617, 0.1387]) (p-value < 0.001). CONCLUSIONS: Hospitals with higher medical care capacity for septic shock were associated with lower hospital mortality.

The Diagnostic Association of Radiological and Clinicopathological Parameters in Community-Acquired Pneumonia in Children: A Cross-Sectional Study.

Background Globally, pneumonia is one of the significant causes of death in children under the age of five years. Assessment of disease severity is essential for clinical decision-making. Clinicians in resource-limited settings use the WHO Integrated Management of Childhood Illness (IMNCI) guidelines to diagnose and treat pneumonia. Chest X-rays and blood biomarkers are frequently performed in children presenting with pneumonia, but their role in clinical decision-making is limited. Objective To evaluate the association of chest X-ray results, clinical parameters, and blood inflammatory biomarkers with the severity of community-acquired pneumonia (CAP) in children to decide which tests are helpful in accurately classifying the severity of pneumonia. Methods This cross-sectional, analytical study was conducted at the Combined Military Hospital, Lahore, among 421 children aged two months to five years who were admitted with complaints of cough and difficulty breathing and were COVID-19 negative. Data was collected through a structured questionnaire, including demographic information and clinical categorization of pneumonia severity using WHO criteria, SpO2 levels, chest X-rays, complete blood count (CBC), and C-reactive protein (CRP) levels obtained within 24 hours of admission. Statistical evaluation of 323 children was done using SPSS version 26, and analysis of variance (ANOVA), chi-square test, and Fisher's exact test were applied to determine statistical significance. p-Value <0.05 was considered significant. Results The median age of the study population was eight months (IQR: 3-20 months); 113 (33.1%) were girls and 127 (37.2%) were underweight children. Eighteen (5.3%) patients had no pneumonia, 245 (71.8%) patients had non-severe pneumonia, and 78 (22.9%) patients had severe pneumonia. The clinical features of severe pneumonia were more common in children with radiologic findings of alveolar CAP than non-alveolar CAP (36.2% and 20%, respectively, p: 0.05). A higher percentage of patients with alveolar CAP had CRP >6 mg/dL than non-alveolar CAP (69.9% and 35%, respectively, p < 0.001). Patients with undernutrition (WAZ <-2 SD), hypoxemia (SpO2 <95%), and having CRP >6 mg/dL were associated with clinical features of severe pneumonia (46.1% vs. 33.8%, 100% vs 47.3%, and 67.9% vs 48.5%, respectively, p < 0.05). A significantly greater frequency of a bilateral multifocal distribution (p = 0.020), and the involvement of the right paracardiac region (p = 0.043) and the left lower lobe (p = 0.007) in those with severe pneumonia was observed. Conclusion Clinical diagnosis of pneumonia, along with the assessment of risk factors, including undernutrition and hypoxemia, should be adequate to diagnose pneumonia in children. Chest X-rays and CRP levels can be helpful in hospitalized children for whom physicians have difficulty deciding about antibiotic prescriptions, but their role in routinely classifying the severity of pneumonia in children is limited.

Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study.

BACKGROUND: Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24 h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). METHODS: This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90 days, and we evaluate the possible association between different types of management. RESULTS: TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). CONCLUSIONS: Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.

Navigating the Future: The Transformative Impact of Artificial Intelligence on Hospital Management- A Comprehensive Review.

This comprehensive review explores the transformative impact of artificial intelligence (AI) on hospital management, delving into its applications, challenges, and future trends. Integrating AI in administrative functions, clinical operations, and patient engagement holds significant promise for enhancing efficiency, optimizing resource allocation, and revolutionizing patient care. However, this evolution is accompanied by ethical, legal, and operational considerations that necessitate careful navigation. The review underscores key findings, emphasizing the implications for the future of hospital management. It calls for a proactive approach, urging stakeholders to invest in education, prioritize ethical guidelines, foster collaboration, advocate for thoughtful regulation, and embrace a culture of innovation. The healthcare industry can successfully navigate this transformative era through collective action, ensuring that AI contributes to more effective, accessible, and patient-centered healthcare delivery.

Economic Impact of Lean Healthcare Implementation on the Surgical Process.

OBJECTIVES: The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact. METHODS: Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow. Projects based on these methods now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed. RESULTS: Process improvements have led to annual operational savings of over EUR 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits. CONCLUSIONS: The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC), and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from stage zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.

Utility and Utilization of Patient-Reported Experience Measures for the Supplementary COVID-19 Protective Actions at the Ovidius Clinical Hospital in Romania.

Patient-reported experience measures (PREMs) provide assessments of patients' subjective experiences and perceptions regarding their interactions with the healthcare system and its services. We present a cross-sectional study of the patient perception and evolution of COVID-19 cases performed at Ovidius Clinical Hospital in Romania during the COVID-19 pandemic. The study objective is to explore the utility and the utilization of PREMs in monitoring patient perceptions of the supplementary protective actions. During the pandemic, the hospital implemented early supplementary protective actions, like PCR and lung CT, to all surgically admitted patients in the hospital alongside government-recommended actions. At the same time, functional PREMs were used to evaluate patient perceptions regarding these supplementary actions. The research was carried out for 19 months between June 2020 and December 2021. The findings revealed that opinions about the severity of the COVID-19 pandemic, the personal risk of infection, and the perception of protective actions in the hospital were not correlated. Conclusions: The patients' appreciation of the COVID-19 protective actions taken by the hospital is related more to the general perceptions induced by the number of cases presented in the mass media and less by perceptions of the gravity of the problem or the risk of infection. In a hospital, the primary mission of patient safety is essential, and it must be fulfilled even if the patients are not sure or fully convinced that this is for their benefit. For management decisions and monitoring, using PREMs can be essential in a situation when general evidence is not conclusive.

Driving the implementation of hospital examination reservation system through hospital management.

BACKGROUND: Hospital Examination Reservation System (HERS) was designed for reducing appointment examination waiting time and enhancing patients' medical satisfaction in China, but implementing HERS would encounter many difficulties. This study would investigate the factors that influence patients' utilization of HERS through UTAUT2, and provide valuable insights for hospital managements to drive the effective implementation of HERS. It is helpful for improving patients' medical satisfaction. METHODS: We conducted a survey through the Sojump platform, targeting patients were who have already used HERS. We collected questionnaire information related to factors behavior intention, performance expectancy, and effort expectancy. Subsequently, we employed a structural equation model to analyze the factors influencing patients' utilization of HERS. RESULTS: A total of 394 valid questionnaires were collected. Habit was the main direct positive factor influencing the behavioral intention of HERS (ß = 0.593; 95%CI: 0.072, 1.944; P = 0.002), followed by patient innovation (ß = 0.269; 95%CI: 0.002, 0.443; P < 0.001), effort expectancy (ß = 0.239; 95%CI: -0.022, 0.478; P = 0.048). Patient innovation and facilitating conditions also have an indirect effect on behavioral intention. Perceived privacy exposure has a significantly negative effect on behavioral intention (ß=-0.138; 95%CI: -0.225, -0.047; P < 0.001). The above variables explained 56.7% of the variation in behavioral intention. CONCLUSIONS: When HERS is implemented in hospitals, managements should arrange volunteers to guide patients to bring up the habit and solve the using difficulties, and managements could invite patients with high innovation to recommend HERS to others, what's more, it is a valid way to retain the old form of appointment to pass the transition period to the new system. HERS utilization and patients' medical satisfaction will be enhanced through the guidance of hospital management means.

Exploring effective implementation pathways to become an excellent chief financial officer in public hospital: a qualitative comparative analysis (QCA) from China.

BACKGROUND: Hospital chief financial officer (CFO) contributes to improving health system performance. However, how to become an excellent hospital CFO has rarely been considered from a holistic perspective. This paper aims to identify competencies required by hospital CFO to fulfil the position's responsibilities and explore effective implementation pathways to generate high performance and improve healthcare service. METHODS: We conducted 61 semi-structured interviews with individuals in key leadership positions in China's hospitals and researchers focusing on healthcare system management to identify core competencies necessary for hospital CFO. Interviews were analysed through a multi-stage review process and modified via expert vetting using a national panel of 23 professors. Subsequently, interviews were conducted with 32 hospital CFOs from 14 provinces throughout September 2021 to May 2022. We scored the performance of 32 hospital CFOs in various aspects of competency and used the fuzzy-set qualitative comparative analysis to explore the competency configurations of excellent CFOs. RESULTS: We identify seven core competencies necessary for a hospital CFO to fulfil management practices, including personal morality, resource management, strategy management, learning ability, negotiating skill, leadership skill, and financial management. The findings indicate that a single competency factor is not a necessary condition to become an excellent hospital CFO. The results of qualitative comparative analysis then make it possible to propose four configurational paths, namely, supportive, interpersonal, all-around development, and technical, to become an excellent hospital CFO and achieve effective managerial performance. CONCLUSIONS: The responsibilities of hospital CFOs are complex and varied, hence, a better understanding of competencies required by CFO is essential to implement their responsibilities effectively. The identification in this study of the four effective implementation pathways to becoming an excellent hospital CFO enriches the literature on hospital management and provides implications for China's hospitals and their CFOs.

Perceived implications of COVID-19 on physical, mental and social aspects of resident doctors in a tertiary care hospital.

BACKGROUND: The COVID-19 pandemic has put health care systems of many countries under major stress. Due to its high transmission capacity, it has spread across the globe at a rampant pace. India is one of the countries which has been severely affected by COVID-19. It has posed onerous tasks in front of doctors. Along with it, it has left physical, social and mental implications on well-being of doctors. OBJECTIVES: The purpose of this study is to get an in-depth understanding about the implications of COVID-19 on physical, social and mental aspects of resident doctors in tertiary care hospital. METHOD: We performed a qualitative study which involved in-depth interviews of resident doctors who have worked during the COVID-19 pandemic from general medicine department of tertiary care hospital. Interviews were then manually transcribed and analyzed. RESULT: Data analysis by preparing transcript unveiled that doctors were constantly facing burnout and mental distress along with less social support. Our study also found that there was a shortage of resources and demonstrated poor doctor patient ratio which led to a decrease in efficiency of doctors. Our findings are not only confined to doctors facing burden but has also explored sanguine perceptions of resident doctors. CONCLUSION: While treating COVID-19 patients, resident doctors suffered a great setback. Providing them with mental aid, social support, ample resources and decreasing their work burden is recommended to effectively manage future pandemic.

Introduction of hospital-based health technology assessment in China: experiences from seven pilot hospitals.

OBJECTIVES: This study aimed to introduce a pilot program for hospital-based health technology assessment (HB-HTA) in China and present the participants' experiences based on seven case studies from seven tertiary hospitals. METHODS: One-year pilot projects were initiated at the beginning of 2018. Seven pilot hospitals were closely followed from the beginning until the completion of their pilot HTA project. Regular interviews were conducted with the hospital managers leading the HB-HTA projects and key members of the special HTA teams. Observations were made based on field trips and written HTA reports. RESULTS: Three pilot projects evaluated the use of medical consumables, three evaluated the use of surgical or medical interventions, and one evaluated an innovative management model for ventilators. Real-world data were collected from all the pilot projects to assist with the assessments. Most HB-HTA pilot projects achieved remarkable results such as improvements in economic efficiency; however, there were also obvious deficiencies such as the lack of a necessary cost-effectiveness analysis. CONCLUSIONS: The results varied among the seven HB-HTA pilot projects. The HB-HTA pilot program was implemented to promote the use of HB-HTA in hospital decision making in China. At the same time, HB-HTA in China faces challenges. We have made some policy recommendations based on the findings of the pilot projects.

Research on Satisfaction Degree of Doctor-patient Communication Quality based on Patient Perception / 中国医学伦理学

Objective sampling method was used to conduct a questionnaire survey on outpatients in two hospitals in Guangdong province in order to evaluate patients’ satisfaction with the quality of medical service. This paper explored the factors that affect patients’ evaluation of medical service quality, and found that patients’ age was negatively correlated with the evaluation of medical service quality. It is suggested that the establishment of friendly medical institutions should be carried out according to the national policy. At the same time, the management mechanism of hospital should be improved, the number of medical service centers for "efficient" should be increased, and the medical service personnel should be regularly trained; carry out medical knowledge education in community, improve the popularization of personal medical knowledge and close the cognitive gap between doctors and patients.

Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers.

Participation of main users in identifying key performance indicators (KPIs) for management dashboards contributes to their success. The aim of this study was to identify and prioritize the KPIs of hospital management dashboards from the viewpoint of hospital managers. This study was conducted on managers of public hospitals at a national level in Iran in 2020. Data were collected using a self-administrated questionnaire. The KPIs were classified into five categories, namely financial, operational, human resources, safety and quality of care, services provided to patients. A total of 234 hospital managers participated in this study. Totally, 25 KPIs were determined for the hospital management dashboard, including the patient falls rate, waiting time for patients in the emergency department, patient satisfaction, total hospital revenue, financial balance, bed occupancy rate, patients' discharge with own agreement, average length of stay, and personnel satisfaction. For designing hospital management dashboards, the domains of services provided to patients, safety and quality of care, financial resources, human resources, and operational are important from the hospital managers' viewpoint, respectively. The results of this study can be helpful for developers of business intelligence tools, such as hospital management dashboards, to visualize the most important indicators for managers.

Sistema de Gestión Hospitalaria para la atención de la pareja infértil. Centro Territorial de Holguín, 2021

Introducción: La infertilidad es una enfermedad del sistema reproductivo que altera el equilibrio biológico, psicológico y social de las parejas. En Cuba existe un programa para el tratamiento de la pareja infértil y el Ministerio de Salud Pública incluye en sus directrices implementar las bases organizativas, sistema de trabajo, indicadores, funciones y control que garanticen el perfeccionamiento del Programa para la óptima atención de parejas infértiles, y dentro de esto se incluye confeccionar bases de datos donde se registren las parejas tratadas por este motivo. Objetivos: Implementar un Sistema de Gestión Hospitalaria para la atención de la pareja infértil, en el Centro Territorial de Holguín. Métodos: Se realizó un estudio de desarrollo tecnológico, se confeccionó sobre el sistema de base de datos relacional postgreSQL, se empleó la herramienta Odoo con el objetivo de englobar en un único software todas las prestaciones que necesita la consulta. Se utilizó el lenguaje de programación Python. Resultados: SCAPI, permite gestionar la información de los pacientes y sus historias clínicas, está compuesto por módulos relacionados: configuración general, permite crear los perfiles de usuarios y los permisos para interactuar con el sistema; SCAPI muestra y gestiona toda la información relacionada con la historia clínica digital, la agenda de turnos, medios diagnósticos (estudios de reserva ovárica, espermogramas, ecografías ováricas, estudios hormonales, técnicas de baja y alta tecnología entre otros). Conclusiones: El Sistema de Gestión Hospitalaria para la atención de la pareja infértil, contribuye al objetivo de una mayor calidad de la atención al paciente pues gestiona la información de estos y sus historias clínicas de manera rápida, oportuna y fiable.

Introduction: Biological infertility is a disease of the reproductive system that alters the psychological and social balance of couples. In Cuba there is a program for the treatment of infertile women and the Ministry of Public Health includes in its guidelines to implement the organizational bases, work system, indicators, functions and control that guarantee the improvement of the Program, including databases where couples treated for this reason are registered. Objective: To implement a Hospital Management System for the infertile couple care in the Holguín Territorial Center. Methods: A study of technological development was carried out using postgre SQL relational database system, Odoo tool, and Python programming language. Results: SCAPI allows to manage the information of patients and their medical records; it is made up of modules that are related to each other: the general configuration module which allows you to create user profiles and permissions to interact with the system; the SCAPI module which shows and manages all the information related to the digital medical history, appointment schedules, and diagnostic means (ovarian reserve studies, spermograms, ovarian ultrasound, hormonal studies, low and high technology techniques, among others). Conclusions: Hospital Management System for the care of infertile couples allows managing fast, timely and reliable information on patients and their medical records during care consultations for infertile couples with the aim of achieving a higher quality of patient care.

Los determinantes de la estancia hospitalaria en un hospital universitario de alta complejidad

Objetivo: Establecer y cuantificar los determinantes de la estancia hospitalaria en un hospital universitario de Medellín de alta complejidad de Medellín, entre 2013 y 2018, valorar su importancia y modelar la estancia esperada. Metodología: Estudio observacional analítico retrospectivo de datos agregados. Siguiendo el método paso a paso, se corrieron siete modelos con estancia hospitalaria media como variable dependiente y las respectivas variables independientes: complejidad, oportunidad de apoyos diagnósticos, disponibilidad de insumos, casos de estancia prolongada y capacidad financiera. Se seleccionó el mejor modelo usando los criterios de ajuste Akaike e información Bayesiana, junto con las medidas de significancia global y significancia individual de los coeficientes. Se realizaron pruebas estadísticas de validez del modelo y se calcularon los coeficientes estandarizados. Resultados: Los valores medios de las variables más relevantes y su desviación estándar (de) fueron: estancia hospitalaria media, 8,09 días (de = 0,40); complejidad por consumo de recursos, 1,28 unidades (de = 0,07); apoyos diagnósticos, 90,74 mil estudios (de = 10,05); casos de estancia extrema, 4,36 % (de = 0,70), y complejidad por casuística, 1 (de = 0,03). Significancia global F = 55,2, p< 0,001. Significancia de los coeficientes: complejidad por consumo de recursos, p< 0,01; apoyos diagnósticos y casos de estancia extrema, p< 0,001; complejidad por casuística, p< 0,05. Coeficientes estandarizados: complejidad por consumo de recursos, 0,35; apoyos diagnósticos, 0,35; casos de estancia extrema, 0,26, y complejidad por casuística, 0,24. R2 ajustado 0,82. Conclusión: Los determinantes de la estancia hospitalaria en orden de importancia son: complejidad por consumo de recursos, apoyos diagnósticos, casos de estancia extrema, complejidad por casuística, inventario disponible y ganancias brutas.

Objective: To establish and quantify the determinants of hospital stay in a high complexity university hospital in Medellin between 2013 and 2018, assess their importance, and model the expected length of stay. Methodology: Retrospective analytical observational study of aggregate data. While following the method step by step, seven models were used, where mean hospital stay was the dependent variable and the respective independent variables were complexity, timeliness of diagnostic procedures, availability of supplies, cases of prolonged stay and financial capacity. The best model was selected using the Akaike and Bayesian information criterion, along with measures of both overall significance and individual significance of the coefficients. Statistical tests of model validity were performed and standardized coefficients were calculated. Results: The mean values of the most relevant variables and their standard deviation (SD) were: mean hospital stay, 8.09 days (SD = 0.40); complexity by resource consumption, 1.28 units (SD = 0.07); diagnostic procedures, 90.74 thousand studies (SD = 10.05); cases of extremely prolonged stay, 4.36% (SD = 0.70), and complexity by casuistry, 1 (SD = 0.03). Overall significance: F = 55.2, p < 0.001. Significance of coefficients: complexity by resource consumption, p < 0.01; diagnostic procedures and cases of extremely prolonged stay, p < 0.001; complexity by casuistry, p < 0.05. Standardized coefficients: complexity by resource consumption, 0.35; diagnostic procedures, 0.35; cases of extremely prolonged stay, 0.26; and complexity by casuistry, 0.24. Adjusted R2 0.82. Conclusion: In order of importance, the determinants of hospital stay are complexity by resource consumption, diagnostic procedures, extremely prolonged stay, complexity by casuistry, available inventory and gross profit.

Objetivo: Estabelecer e quantificar os determinantes da permanência hospitalar em um hospital universitário de alta complexidade de Medellín, entre 2013 e 2018, valorar sua importância e fazer a modelação da permanência esperada. Metodologia: Estudo observacional analítico retrospectivo de dados agregados. Seguindo o método passo a passo, foram aplicados sete modelos com permanência hospitalar média como variável dependente e as respectivas variáveis independentes: complexidade, oportunidade de apoios diagnósticos, disponibilidade de insumos, casos de permanência prolongada e capacidade financeira. Selecionou-se o melhor modelo usando os critérios de ajuste Akaike e informação Bayesiana, junto com as medidas de significância individual dos coeficientes. Realizaram-se provas estatísticas de validade do modelo e calcularam-se os coeficientes padronizados. Resultados: Os valores médios das variáveis mais relevantes e seu desvio-padrão (DP) foram: permanência hospitalar média, 8.09 dias (DP = 0,40); complexidade por consumo de recursos, 1,28 unidades (DP = 0,07); apoios diagnósticos, 90,74 mil estudos (DP = 10,05); casos de permanência extrema, 4,36 % (DP = 0,70), e complexidade por casuística, 1 (DP = 0,03). Significância global F = 55,2, p < 0,001. Significância dos coeficientes: complexidade por consumo de recursos, p < 0,01; apoios diagnósticos e casos de permanência extrema p < 0,001; complexidade por casuística, p < 0,05. Coeficientes padronizados: complexidade por consumo de recursos, 0,35; apoios diagnósticos, 0,35; casos de permanência extrema, 0,26 e complexidade por casuística, 0,24. R2 ajustado 0,82. Conclusão: Os determinantes da permanência hospitalar em ordem de importância são: complexidade por consumo de recursos, apoios diagnósticos, casos de permanência extrema, complexidade por casuística, inventário disponível e lucros brutos.