Search

Background: The way the healthcare delivery system is reflected by patient satisfaction. Establishing a health system with better results depends on it. It has been assumed that higher patient satisfaction levels correlate with quality healthcare outcomes. There is little national data to support patient satisfaction with inpatient health services in Ethiopia. In order to estimate the pooled proportion of patient satisfaction and determine the associated factors with inpatient health services at public hospitals, a systematic review and meta-analysis were conducted. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed in the extraction of the data. To get the included studies, the following electronic databases were searched: Pub-Med, Google Scholar, Med-Line, Web of Science, Scopus and Repositories. Software called STATA version 17 was used to analyze statistical data using the random effects model. Forest plots were used to display the pooled results. Results: Of the 1583 records resulted in electronic databases searching, 11 studies with 3,958 participants were included in this systematic review and meta-analysis. The estimated pooled proportion of patient satisfaction with inpatient health services was found to be 57.4% (95% CI: 50.88–64.59, I2 = 95.25%). Assuring privacy for patients (OR = 7.44, 95% CI: 3.63–15.25, I2 = 0.0%), availability of direction signs (2.96, 95% CI: 1.91–4.57, I2 = 0.0%), providing adequate information (OR = 3.27, 95% CI: 1.63–6,58, I2 = 65.60%), history of previous admission (OR = 0.29, 0.18–0.46, I2 = 86.36%) and providing on time treatment (OR = 1.63, 95% CI: 1.21–2.20, I2 = 86.36%) were statistically significant factors associated with patient satisfaction with inpatient health services. Conclusion: The estimated pooled level of patient satisfaction with inpatient health services is low in Ethiopia. A higher level of patient satisfaction with inpatient health treatments was predicted by factors such as privacy assurance, fast services, availability of direction signs, provision of services with adequate information transfer, and no history of previous admission. To improve patient satisfaction, the Ministry of Health and hospital administration must place a strong emphasis on ensuring the provision of high-quality, standard-based inpatient healthcare. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality and standard of hand-written operative notes in a teaching institute. Methods: This prospective study was carried out in the department of surgery, Fatima Hospital, Baqai Medical University, from January 2023 till May 2023. One hundred fifty operative notes from general surgery domain were considered. These notes were evaluated according to the guidelines of Royal College of Surgeons, with added-on a few variables by the author. Results: All 150 notes were handwritten. Resident surgeon wrote the operative notes under the supervision of primary surgeon. There was a deficiency in mentioning medical record number, procedure starting time and duration of surgery. An important statement about the hemostasis is that it is secured-per-operatively was not documented. The residents were reluctant to explain the surgical procedures diagrammatically. The operative room number was missing in all notes. Post operative instructions lacked the information for nothing per oral, blood pressure, temperature, pulse rate, and input and output charting. Conclusion: It is observed that the operative surgical notes were however explainable about the procedure, but quality and standard was not matchable with that of Royal College of Surgeons notes. Hence, a lack of formal training for the resident surgeons in operative notes writing was observed. This study is a thought provoker to the surgeons and a guide to resident trainees, and hospital management to provide a handful operative notes writing theme in the form of performa provided in the department. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of new-onset diabetes mellitus (NODM) in patients with COVID-19 in a tertiary care hospital. Method: It was a retrospective descriptive study carried out in Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa province of Pakistan from November 2021 to April 2022. All patients having new onset Diabetes Mellitus (NODM) were identified among a total of 300 patients admitted to the hospital with COVID-19 infection. Patients’ data including relevant investigations were accessed through the hospital management information system (HMIS). SPSS version-23 was used for data entry and statistical analysis. Results: Out of 300 COVID-19 patients included in the study, 163 (54.3%) were female and 137(45.7%) were male. The mean age of the patients was 56.80±13.72 (IQR 15) years. Frequency of the new onset diabetes was 44(14.7%); 19 (6.33%) male and 25(8.33%) female. Among the 44 NODM patients, the majority (57%) were female (p=0.720). Most (64%) of the patients with new-onset DM were in the middle age (p=0.018). Conclusion: A significant number of patients with COVID-19 infection are prone to develop new-onset diabetes during their admission to the hospital. [ABSTRACT FROM AUTHOR]

Staffing planning, recruitment, and retention is a primary function of hospital management teams to ensure sufficient health care professionals and ensure the delivery of quality health care to patients. The purpose of the study is to reveal the leading problems related to attracting and retaining nursing staff in hospital structures. Material and methods: A survey was conducted of students from the Master's Program in "Healthcare Management" from the Faculty of Public Health "prof. Dr. Ts. Vodenicharov, MD" of Medical University - Sofia during the academic year 2023/2024. There were 64 participants in the study. The obtained data were processed with a statistical program. The results show that the leading negative factor on the retention of nursing staff in hospital structures is the low salary, as well as the lack of a policy for the development of health care professionals. In order to ensure sufficient nursing staff in medical institutions, it is necessary for hospital managements to implement a policy for the selection and retention of staff. It is necessary to introduce an objective methodology for determining the workload of nursing care and adequate remuneration of nurses, based on their professional qualification and development. [ABSTRACT FROM AUTHOR]

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40–60 were the most common demographic group in the cohort (48% of all patients), and men made up a higher proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion that is somewhat smaller than what has been reported at non-VHA facilities, despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits. • From 2010 to 2019, there were 251,300 Veterans Health Administration emergency department visits for alcohol intoxication. • The annual rate of visits increased during the study period. • The majority of visits (68%) resulted in medical or psychiatric admission. • Visits for intoxication accounted for 1.3% of patients volume in the system, which is lower than other US health systems. [ABSTRACT FROM AUTHOR]

Within the scope of this research, the fuzzy‐analytical hierarchy process (F‐AHP) method is applied to assess the waste management approaches adopted by various hospitals in the city of Gwalior, India. Fuzzy‐AHP, as an alternative to traditional AHP, accommodates uncertainty and imprecision, offering a decision‐making method that is more adaptable and realistic. The F‐AHP methodology, delineated in a seven‐step process, incorporates pairwise comparisons, fuzzy mathematics, and linguistic variables to compute fuzzy weights for waste management criteria, encompassing physical, biological, social, and economic aspects. Hospital 1, with a weight value of 0.406 and strict adherence to the Bio‐medical Waste Management (Amendment), 2018 rules and regulations of the Government of India, emerges as the most promising sustainability hospital based on the F‐AHP analysis findings. Conversely, Hospital 5 exhibits the poorest waste management practices among the surveyed hospitals, earning the lowest possible ranking. While the proposed F‐AHP method provides valuable insights, the study is limited to a specific geographic area (Gwalior) and potential variations based on environmental factors. Additionally, the practical implications extend beyond the general emphasis on continuous monitoring to include specific actions for hospitals to enhance their waste management systems. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medical abortion after 12 gestational weeks often requires a stay in hospital. We hypothesised that administering the first misoprostol dose at home could increase day-care procedures as compared with overnight care procedures, shorten inpatient stays, and improve patient satisfaction. This multicentre, open-label, randomised controlled trial was done at six hospitals in Sweden. Participants were pregnant people aged 18 years and older who were undergoing medical abortion at 85–153 days of pregnancy. Randomisation was done in blocks 1:1 to mifepristone administered in-clinic followed by home administration or hospital administration of the first dose of misoprostol. Allocation was done by opening of opaque allocation envelopes. Due to the nature of the intervention, masking was not feasible. Between 24–48 h after mifepristone 200 mg, the participants administered 800 μg of misoprostol either at home 2 h before admission to hospital or in hospital. The primary outcome was the proportion of day-care procedures (defined as abortion completed in <9 h). The intention-to-treat analysis included all participants randomly assigned to receive the study drug and who had known results for the primary outcome. Individuals who received any treatment were included in the safety analyses. This trial is registered at ClinicalTrials.gov, NTC03600857, and EudraCT, 2018-000964-27. Between Jan 8, 2019, and Dec 21, 2022, 457 participants were randomly assigned to treatment groups. In the intention-to-treat-population, 220 participants were assigned to the home group and 215 to the hospital group. In the home group, 156 (71%) of 220 participants completed the abortion as day-care patients, compared with 99 (46%) of 215 in the hospital group (difference 24·9%, 95% CI 15·4–34·3; p<0·0001). In total, 97 (22%) of 444 participants in the safety analysis had an adverse event. Seven (2%) of 444 participants aborted after mifepristone only. Two (1%) of 220 in the home group aborted after the first dose of misoprostol, before hospital admission. Home administration of misoprostol significantly increases the proportion of day-care procedures in medical abortion after 12 gestational weeks, offering a safe and effective alternative to in-clinic protocols. Region Västra Götaland, Hjalmar Svensson's Fund, the Gothenburg Society of Medicine, Karolinska Institutet–Region Stockholm, and The Swedish Research Council. [ABSTRACT FROM AUTHOR]

Background: Orthopedic injuries are serious and continue to be a concern for healthcare systems worldwide. Approximately 90% of the estimated traumatic injuries occur in low- and middle-income countries. In Kenya, there is a dearth of information on orthopedic injury patterns that could be used to prioritize injury prevention measures and to help hospital management teams allocate resources appropriately. The purpose of this study was to determine the epidemiology of orthopedic injuries admitted to Kenyatta National Hospital. Methods: This was a retrospective cross-sectional study. Overall, 720 charts were reviewed. Data were analyzed using frequency distribution, pearson chi-square test and logistic regression. Results: Overall, 85% were aged 15–64 years. Approximately 80% were male, married or single. Patients with primary or secondary education composed 72%. Road traffic accidents (59.4%) and falls (24.7%) were the most common mechanisms of injury. A total of 99.9% of the inpatients were Kenyans. Open injuries were 40.1%. Lower limb (67.4%) and upper limb (26.9%) injuries were the most common. Inpatients aged 15–24 years were 74% less likely to have upper limb injuries than those aged 0–14 years (p = 0.023). However, those aged 15–24 years were 19.250 times more likely to have spine injuries than those aged 0–14 years (p = 0.008). Males were 68.6% and 51.2% less likely to have pelvic injury and comorbidities, respectively, than females (p < 0.001). Patients with secondary and tertiary education were 2.016 (p = 0.003) and 2.3 (p < 0.001) times more likely to have upper limb injuries, respectively, than those with no or preschool education. Similarly, those with tertiary education were 2.079 times more likely to have comorbidities than those with no or preschool education (p = 0.017). Conclusion: Most of the inpatients with orthopedic injuries were young, male involved in Road traffic accidents and therefore Kenya National Transport and Safety Authority needs to enforce road safety measures to reduce road carnage. Those with higher education and children were more likely to have upper limb injuries. Females were more likely to have pelvic injuries and co-morbidities. Lower and upper limb injuries were the most common injuries and this should guide resource allocation in management of orthopedic injuries. [ABSTRACT FROM AUTHOR]

Background: Hospitals rely on their electronic health record (EHR) systems to assist with the provision of safe, high quality, and efficient health care. However, EHR systems have been found to disrupt clinical workflows and may lead to unintended consequences associated with patient safety and health care professionals' perceptions of and burden with EHR usability and interoperability. This study sought to explore the differences in staff perceptions of the usability and safety of their hospital EHR system by staff position and tenure. Methods: We used data from the AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey Version 1.0 Database and the SOPS Health Information Technology Patient Safety Supplemental Items ("Health IT item set") collected from 44 hospitals and 8,880 staff in 2017. We used regression modeling to examine perceptions of EHR system training, EHR support & communication, EHR-related workflow, satisfaction with the EHR system, and the frequency of EHR-related patient safety and quality issues by staff position and tenure, while controlling for hospital ownership type and bed-size. Results: In comparison to RNs, pharmacists had significantly lower (unfavorable) scores for EHR system training (regression coefficient = -0.07; p = 0.047), and physicians, hospital management, and the IT staff were significantly more likely to report high frequency of inaccurate EHR information (ORs = 2.03, 1.34, 1.72, respectively). Compared to staff with 11 or more years of hospital tenure, new staff (less than 1 year at the hospital) had significantly lower scores for EHR system training, but higher scores for EHR support & communication (p < 0.0001). Dissatisfaction of the EHR system was highest among physicians and among staff with 11 or more years tenure at the hospital. Conclusions: There were significant differences in the Health IT item set's results across staff positions and hospital tenure. Hospitals can implement the SOPS Health IT Patient Safety Supplemental Items as a valuable tool for identifying incongruity in the perceptions of EHR usability and satisfaction across staff groups to inform targeted investment in EHR system training and support. [ABSTRACT FROM AUTHOR]

Ensuring workplace safety for healthcare workers is vital considering the important role they play in various societies which is to save life. Healthcare workers face different risks when performing tasks in various departments within hospitals, hence there is a need to assess work safety analysis procedures among healthcare workers. As a result, this study aims to assess the effectiveness of work safety analysis procedures among healthcare workers at Muvonde and Driefontein Sanatorium rural hospitals in Chirumanzu district. The research applied the descriptive cross-sectional design, combining quantitative and qualitative data collection methods. A questionnaire with both closed and open ended questionnaire was used for data collection among 109 healthcare workers at Muvonde hospital and 68 healthcare workers at Driefontein Sanatorium hospital. Secondary data sources, observations and interviews were also included as data collection methods. Quantitative data collected during the study was analysed using SPSS version 25. Braun and Clarke (2006)'s six phase framework was applied for qualitative data analysis. Ethical approval form was obtained from the District Medical Officer and Midlands State University. Findings of the study indicated that risks identified at Muvonde and Driefontein Sanatorium rural hospitals are classified as ergonomic, physical, chemical, psychosocial and biological risks. Respondents specified that these risks occur as a result of inadequate equipment, poor training, negative safety behaviour, poor management and pressure due to high workload. Safety inspection, safety workshops and monitoring of worker's safety behaviour were mentioned as measures to manage risks. However, the strengths and weaknesses of the current safety procedures need to be assessed to highlight areas for improvement to reduce occurrence of risks within the hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Sri Lanka implemented the National Programme for Elimination of Lymphatic Filariasis (NPELF) in its endemic regions in 2002. Five annual rounds of mass drug administration using the two-drug combination diethylcarbamazine (DEC) and albendazole led to sustained reductions in infection rates below threshold levels. In 2016, WHO validated that Sri Lanka eliminated lymphatic filariasis as a public health problem. Objective: To explore the impact of the NPELF on lymphatic filariasis morbidity in Sri Lanka. Methods: Passive Case Detection (PCD) data maintained in filaria clinic registries from 2006–2022 for lymphoedema and hospital admission data for managing hydroceles/spermatoceles from 2007–2022 were analyzed. The morbidity status in 2022 and trends in overall and district-wise PCD rates were assessed. Poisson log-linear models were used to assess the trends in PCD for endemic regions, including district-wise trends and hospital admissions for the management of hydroceles/spermatoceles. Results: In 2022, there were 566 new lymphoedema case visits. The mean (SD) age was 53.9 (16.0) years. The staging was done for 94% of cases, of which 79% were in the early stages (57.3% and 21.4% in stages two and one, respectively). Western Province had the highest caseload (52%), followed by the Southern (32%) and Northwestern (16%) Provinces, respectively. The reported lymphoedema PCD rate in 2022 was 0.61 per 10,000 endemic population. The overall PCD rate showed a decline of 7.6% (95%CI: 4.9% - 10.3%) per year (P < 0.0001) from 2007 to 2022. A steady decline was observed in Colombo, Gampaha and Kurunegala districts, while Kalutara remained static and other districts showed a decline in recent years. Further, admissions for inpatient management of hydroceles/spermatoceles showed a declining trend after 2015. Conclusions: The PCD rates of lymphoedema and hydroceles/spermatoceles showed a declining trend in Sri Lanka after the implementation of the NPELF. Author summary: In the year 2000, the World Health Organization initiated the mass drug administration program to eliminate lymphatic filariasis. Sri Lanka implemented the program for five years (2002–2006), offering yearly single doses of anti-filarial treatment to the eligible population of all eight endemic districts. In 2016, Sri Lanka was acknowledged as having eliminated lymphatic filariasis as a public health problem. This study explored the impact of the mass drug administration program on lymphoedema and hydrocele/spermatoceles passive case detection rates using filaria clinic and hospital admission data. A reduction in new lymphoedema case visits to filaria clinics and hospital admissions for hydrocele/spermatoceles management was noted two decades after implementing mass anti-filarial treatment in Sri Lanka. [ABSTRACT FROM AUTHOR]

Neonatal medical data holds critical information within the healthcare industry, and it is important to analyze this data effectively. Machine learning algorithms offer powerful tools for extracting meaningful insights from the medical data of neonates and improving treatment processes. Knowing the length of hospital stay in advance is very important for managing hospital resources, healthcare personnel, and costs. Thus, this study aims to estimate the length of stay for infants treated in the Neonatal Intensive Care Unit (NICU) using machine learning algorithms. Our study conducted a two-class prediction for long and short-term lengths of stay utilizing a unique dataset. Adopting a hybrid approach called Classifier Fusion-LoS, the study involved two stages. In the initial stage, various classifiers were employed including classical models such as Logistic Regression, ExtraTrees, Random Forest, KNN, Support Vector Classifier, as well as ensemble models like AdaBoost, GradientBoosting, XGBoost, and CatBoost. Random Forest yielded the highest validation accuracy at 0.94. In the subsequent stage, the Voting Classifier—an ensemble method—was applied, resulting in accuracy increasing to 0.96. Our method outperformed existing studies in terms of accuracy, including both neonatal-specific length of stay prediction studies and other general length of stay prediction research. While the length of stay estimation offers insights into the potential suitability of the incubators in the NICUs, which are not universally available in every city, for patient admission, it plays a pivotal role in delineating the treatment protocols of patients. Additionally, the research provides crucial information to the hospital management for planning such as beds, equipment, personnel, and costs. [ABSTRACT FROM AUTHOR]

Background: In the medical field, effective time management by clinical nurses is crucial for enhancing the quality of patient care. However, in recent years, with increasing work pressure for clinical nurses, procrastination has become a prevalent issue. Many nurses use smartphones as a way to alleviate stress and manage emotions, but excessive smartphone use could exacerbate procrastination, thereby jeopardizing patient safety and healthcare quality. Therefore, understanding the current state of work procrastination among clinical nurses, its heterogeneity, and exploring the impact of smartphone addiction and demographic factors on different aspects of nurse procrastination hold significant importance for improving patient care quality. Objective: This study aims to explore the current state of work procrastination among clinical nurses and identify potential profile categories. It further analyzes the impact of mobile phone addiction and demographic factors on work procrastination among clinical nurses. Methods: Convenience sampling was employed to recruit participants from three tertiary hospitals in central China from October to November 2023. Surveys measuring nurses' work procrastination and smartphone addiction were distributed and collected through online platforms. A total of 1,536 nurses participated in this study. Mplus 8.3 statistical software was used for latent profile analysis of clinical nurses' work procrastination, and SPSS 26.0 software was utilized for chi-square tests, rank-sum tests, and multi-classification logistic regression analyses. Results: The median total score for clinical nurses' work procrastination was 21.00 (17.00, 28.00), and three subgroups were identified: low procrastination (66.93%), medium-low procrastination (20.66%), and medium-high procrastination (12.41%). Additionally, logistic regression analysis revealed that smartphone addiction and department atmosphere were common influencing factors for medium-low and medium-high work procrastination. Hospitals with stricter management and nurses holding the position of head nurse were more likely to belong to the low work procrastination group. Nurses with higher incomes or those holding intermediate titles were more prone to medium-low work procrastination, while those experiencing career advancement difficulties were more likely to exhibit medium-high work procrastination (p < 0.05). Conclusion: Clinical nurses' work procrastination is generally at a medium-to-low level, with three subgroups identified: low procrastination, medium-low procrastination, and medium-high procrastination. Additionally, clinical nurses in surgical departments or those with intermediate titles exhibit higher levels of procrastination. Factors such as smartphone addiction, higher monthly income, tense departmental atmosphere, and unsuccessful career advancement are more likely to lead to work procrastination. Conversely, nurses in hospitals with strict management or those holding the position of head nurse exhibit lower levels of work procrastination. Therefore, nursing managers should pay close attention to the work procrastination behaviors of clinical nurses, actively monitor predictive factors among different groups, and provide psychological counseling and relevant training based on individual nurse circumstances. Additionally, it is also essential to focus on and improve departmental atmosphere and nurse smartphone addiction to enhance clinical nurses' work efficiency and reduce work procrastination. [ABSTRACT FROM AUTHOR]

Background: Comprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care. Methods: A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model. Results: The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%. Conclusions: These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts. [ABSTRACT FROM AUTHOR]

This study investigates the implementation of clinical pathways (CPs) for pediatric Dengue Hemorrhagic Fever (DHF) inpatients at Hospital X, a Type C hospital in Indonesia, focusing on the role of management in CP development and compliance. Clinical pathways aim to enhance hospital efficiency, quality of care, and patient satisfaction. However, the study identified several issues in CP implementation, including incomplete documentation, lack of socialization and training among staff, and inadequate managerial involvement in CP development and oversight. Data were collected through in-depth interviews with attending physicians, nurses, pharmacy staff, and medical management, along with analysis of 53 pediatric DHF CPs. Results showed that CP compliance rates were below 80%, and the hospital's organizational role in CP development, as assessed by the ICPAT dimension 6 instrument, was insufficient. Key areas of non-compliance included lack of evidence of clinical governance, integration with other hospital initiatives, and adequate support for CP documentation and variation reporting. Recommendations include increasing management involvement, providing comprehensive training for staff, and implementing regular CP evaluations. The findings highlight the need for stronger multidisciplinary collaboration and hospital management support to optimize CPs, ensure compliance, and improve service quality.. [ABSTRACT FROM AUTHOR]

This study is aimed at determining whether there is an influence of public service motivation on the performance of health workers' duties, the influence of work pleasure on the work pleasure of health employees, and the influence on work pleasure through the mediation of work satisfaction. The study is in the form of an observational causative study with a cross sectional design, which aims to determine the influence between variables based on measurement results without intervention. The data were collected through an online questionnaire in April 2024 and analyzed using the PLS-SEM technique to estimate the degree of relationship between variables in the structural model. The results of the analysis of the measurement component (outer model) shows good measurability of all indicators marked by outer loading which is high, as well as the validity of discrimination is quite good. The model has a good degree of accuracy because it is able to account for about two-thirds of all variables. For the management of the hospital, it is recommended to add the criteria of high publicly service motivation as a requirement in employee recruitment. Further research is suggested to complement the model by including factors such as work environment, organizational culture, workload, and superior leadership style as covariates. This could help in identifying unique challenges or opportunities for improving task performance and job satisfaction in different healthcare environments, ultimately leading to more tailored and effective management strategies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify the double mediating effect of effect of diversity sensitivity orientation and positive nursing organizational culture between diversity management and organizational commitment. Methods: Participants were 245 nurses working in six tertiary hospitals located in 3 different regions. Data collection was conducted from February 13, 2023 to March 6, 2023 through online self-reported questionnaire. The data were analyzed by IBM SPSS Statistics 27 and SPSS PROCESS Macro 4.2 program. Results: The direct effect of diversity management on organizational commitment was significant (β = .21, p < .001). The indirect effect of diversity management on organization commitment was .34 (95% confidence interval [CI] = .23~.47). The double mediating effect of diversity sensitivity orientation and positive nursing organizational culture in the relationship between diversity management and organizational commitment was .02 (95% CI = .00~.05). Conclusion: Diversity sensitivity orientation and positive nursing organizational culture show double mediating effect on the relationship between diversity management and organizational commitment. Education program and human resource management strategy for enhancing diversity management, diversity sensitivity orientation and positive nursing organizational culture should be provided to improve organizational commitment, and which are needed active support of the association and nursing organization. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian’s triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses’ experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience. [ABSTRACT FROM AUTHOR]

Very minimal risk assessment studies focus specifically on wastewater treatment plant (WWTP) operations and none on hospitals WWTP. Hospital waste contains complex chemicals and pathogenic organisms. Thus, any disruption of hospital WWTP operation is potentially very harmful to environmental health and safety. Risk management can prevent any undue effect and minimize operational mishaps, thus becoming even more critical when the amount of hospital waste increases due to the rise in bed occupancy. Hence, this study aims to assess the risk of hospital WWTP operation, with a class B hospital in Indonesia chosen as a case study. A risk register was created using a combination of safety audits, historical data, and semi-structured interviews. Failure mode and effects analysis (FMEA) were used to examine the impacts of each risk, the frequency of occurrence, and the existing detection for each failure. Based on the consequences, the risks were categorized into impacting humans, finance, the environment, or a combination of those three. After considering occurrence, severity, and detection, each risk was assigned a Risk Priority Number (RPN). The evaluation revealed 1 unacceptable risk, 14 undesirable risks, and 19 acceptable risks. Risk management methods were proposed for unacceptable and tolerated risks. The case study provides materials for the hospital management to aid in decision-making regarding the WWTP. It also contributes knowledge for WWTP benchmarking. [ABSTRACT FROM AUTHOR]

Global healthcare fires cause major casualties. Despite fewer incidents in Thailand, fire prevention is crucial. This study develops a prototype of fire risk assessment model for hospital buildings in urban areas aligned with NFPA 551 and OHSAS 18001, The model comprised four steps: 1) Hazard identification and fire opportunity assessments (Sources of fire, people at risk, fire and life safety and fire protection management); 2) Fire severity assessment; 3) Fire risk level assessment and 4) Fire risk management of hospital buildings in urban areas. Data was collected through interviews with eight specialists and by testing the model with simulated scenarios by eighteen specialists. Results indicated that fire opportunities in Category 4 had the highest risk score at 64.14%, followed by Category 1 at 62.58%, Category 3 at 58%, and Category 2 at 52.53%. Calculating opportunities using an equation yielded a value of 59.85, categorizing it as "Moderate". Fire severity was assessed as "High", implying a severe impact on building occupants, potentially leading to disability or death, and significant structural damaged. A "High" fire risk level mandates proactive safety management to mitigate risks before operations commence. [ABSTRACT FROM AUTHOR]

Over investigations contribute to escalating health costs driven by multiple factors including physician decisions, patient requests, information overload, technological advances, marketing, hospital management policies, insurance requirements and defensive practices. The reconciliation between knowledge and clinical wisdom while dealing with uncertainties in medicine is the primary way forward through this ethical maze. A case scenario illustrates what pediatricians need to reflect upon while facing decisions on rational investigations to maximize beneficence while being aware of economics of healthcare delivery. [ABSTRACT FROM AUTHOR]

When it comes to hospital administration, patient care, and medical data analysis, the Healthcare Internet of Things (HIoT) is nothing short of a paradigm revolution. We dive into this new paradigm to examine its farreaching effects and revolutionary possibilities in the healthcare system. The foundation is set by presenting HIoT as a groundbreaking innovation in healthcare. By leveraging IoT to connect various devices, this model enables real-time patient monitoring, efficient inventory management, and seamless telemedicine integration. HIoT is poised to revolutionize the healthcare industry by enhancing resource allocation, streamlining operations, and facilitating proactive patient care. Our investigation includes a thorough appraisal of how HIoT will affect many facets of medical treatment. We use many research approaches and quality indicators for this evaluation. We may evaluate the viability and scalability of HIoT solutions by testing them in experimental settings that mimic real-world healthcare settings. To provide a precise depiction of the healthcare system, dataset environments use well maintained medical data sources. The performance and efficacy of HIoT technologies may be evaluated using measurable criteria such as sensitivity (0.94), specificity (0.89), F1-Score (0.91), ROC-AUC (0.95), and cost savings ($150,000). To determine the relative importance of each part of the HIoT ecosystem, researchers undertake "ablation studies. Our findings provide a clear picture of the disruptive potential of HIoT. Better patient outcomes may be ensured via early interventions thanks to the improved accuracy (0.92), efficiency (9.2), and satisfaction (9.2) provided by the suggested HIoT technique for patient monitoring. When healthcare and telemedicine are combined, the success rate of remote consultations increases to 95%, response times decrease to 15 minutes, and more people have access to medical treatment. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is an increasingly rich literature on the decarbonisation of heat and the evolution of heat networks. This paper investigates whether a novel fifth Generation District Heating and Cooling Network (5GDHC) could be retrofitted to an existing National Health Service (NHS) hospital campus for the purpose of heating and cooling. The building load was simulated and input into a custom-written script to carry out a series of parametric studies and optimise design options. The model was calibrated against site data available from hospital facilities management. The research found that it is feasible to use a 5GDHC consisting of a large single mass of water to utilise inter-seasonal thermal storage. A natural water resource such as an aquifer was not required. The model tested sizing options and found that larger thermal storage, heat pumps and chillers reduce operating costs and improve flexibility. The paper closes with a discussion of the practical factors in retrofitting 5GDHC networks to a densely occupied and highly constrained campus environment. The findings are novel in further describing the circumstances for which 5GDHC networks are suitable. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the effect of oral anticoagulant (OA) use during coronavirus disease-2019 (COVID-19) on early admission laboratory parameters and/or length of hospital stay in patients receiving chronic OA medication. Materials and Methods: This retrospective study included two groups; group 1 (n=62) consisted of OA users, and group 2 (n=75) of age and sexmatched OA non-users at the time of COVID-19 diagnosis. Early admission laboratory measures, numbers of comorbidities, length of hospital stay, and outcomes of patients were recorded and analyzed. Results: Despite higher comorbidities in group 1, serum C-reactive protein (CRP) and D-dimer levels were significantly lower than group 2 (p<0.05, all). The mortality rate was higher in group 2 but did not reach statistical significance (p>0.05). Regression analysis showed that OA users (compared to OA non-users) had 0.980 and 0.520 times lower serum CRP and D-dimer levels, respectively. Conclusion: This study showed a beneficial effect of OA use on early admission serum CRP, and D-dimer levels, which are important prognostic predictors of COVID-19. Additionally, OA use is associated with fewer hospital stays for COVID-19 patients. These beneficial effects of OA use might help improve the management of this infection after further studies in this field. [ABSTRACT FROM AUTHOR]

Objectives: To employ a drug supply chain information system to optimize drug management practices, reducing costs and improving efficiency in financial and asset management. Methods: A digital artificial intelligence + vendor managed inventory (AI+VMI)-based systemfor drug supply chain information management in hospitals has been established. The system enables digitalization and intelligentization of purchasing plans, reconciliations, and consumption settlements while generating purchase, sales, inventory reports as well as various query reports. The indicators for evaluating the effectiveness before and after project implementation encompass drug loss reporting, inventory discrepancies, inter-hospital medication retrieval frequency, drug expenditure, and cloud pharmacy service utilization. Results: The successful implementation of this system has reduced the hospital inventory rate to approximately 20% and decreased the average annual inventory error rate from 0.425? to 0.025?, significantly boosting drug supply chain efficiency by 42.4%. It has also minimized errors in drug application, allocation, and distribution while increasing adverse reaction reports. Drug management across multiple hospital districts has been standardized, leading to improved access to medicines and enhanced patient satisfaction. Conclusion: The AI+VMI system improves drug supply chain management by ensuring security, reducing costs, enhancing efficiency and safety of drug management, and elevating the professional competence and service level of pharmaceutical personnel. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Intraoperative hypotension is a risk factor for kidney, heart and cognitive postoperative complications. Literature suggests that the use of low‐dose peripheral norepinephrine (NOR) reduces organ dysfunction, yet its administration remains unstandardized. In this work we develop a pharmacokinetic (PK)/pharmacodynamic (PD) model of NOR and its effect on mean arterial pressure (MAP).From June 2018 to December 2021, we included patients scheduled for elective neurosurgery and requiring vasopressors for intraoperative hypotension management at Lariboisière Hospital, Paris. Low doses of NOR were administered peripherally, and successive arterial blood samples were collected to track its plasmatic concentration. We used a compartmental modelling approach for NOR PK. We developed and compared 2 models for NOR PD on MAP. Model comparison was done using Bayes information criteria. The resulting PK/PD model parameters were fitted over the entire population and linked to age, weight, height and sex.We included 29 patients (age 52 [46–64] years, 69% female). NOR median time to peak effect on MAP was 74 [53–94] s. After bolus administration, MAP increased by 24% (15–31%). A 2‐comparment model with depot best captured NOR PK. NOR PD effect on MAP was well represented by both Emax and Windkessel models, with better results for the former. We found that age, height and weight as well as history of smoking and hypertension were correlated with model parameters.We have developed a PK/PD model to accurately track norepinephrine plasma concentration and its effect on MAP over time, which could serve for target‐controlled infusion. [ABSTRACT FROM AUTHOR]

McCulloch v Forth Valley Health Board concerned an allegation of negligence, in failing to consider treating pericarditis with non‐steroidal anti‐inflammatory drugs as a reasonable alternative treatment and not discussing this option with the patient. Montgomery v Lanarkshire Health Board held that a medical professional must disclose to a patient material risks and any reasonable alternative treatments. The materiality of a risk is to be decided by reference to a reasonable person in the patient's position, or where the medical professional should be reasonably aware that the particular patient is likely to attach significance to that risk. However, Montgomery did not define the legal standard relating to the assessment of whether an alternative treatment is reasonable. McCulloch held the correct legal test to be applied as to whether an alternative treatment is reasonable is the professional‐practice test in Bolam v Friern Hospital Management Committee. There are practical, doctrinal and normative reasons to question whether Bolam is the correct legal test in respect of the assessment of reasonable alternative treatments. Additionally, the conceptualisation of Bolam in McCulloch is overly deferential. McCulloch fails to fully consider Montgomery’s emphasis that autonomy‐respecting principles are the values that risk disclosure practices are sensitive to. [ABSTRACT FROM AUTHOR]

Background: TK Hospital management information system. IV DR Sumantri Parepare is not yet fully integrated and SIMRS must be developed to meet the criteria. Objective: This research aims to analyze the use of the Hospital Management Information System (SIMRS) at TK Hospital. IV DR. Sumantri Parepare, Parepare City. Method: The type of research used in this research is qualitative research and data collection using interviews, observation, documentation. With key informants and supporting informants using purposive sampling techniques. Results: The research results show that in terms of HR input the number of officers is sufficient and training has been given to officers regarding SIMRS, there are funds available, the availability of computers is not sufficient, SIMRS is not yet integrated, the infrastructure inadequate, inadequate implementation of SOPs and socialization Not yet done. The ability of medical records staff to use SIMRS is not optimal, there is incompleteness in filling out medical resumes and informed consent in SIMRS and reporting is carried out every month, quarterly and annually, but experiences delays. Conclusion: Improvement efforts that can be made include disseminating information about the importance or benefits of SIMRS in backing up and searching for data that is entered routinely. [ABSTRACT FROM AUTHOR]

Background: The provision of comprehensive individual health care services in outpatient units is intricately linked to drug management practices and the quality of available pharmacy services, ensuring optimal medication supply and use. Objective: This study aimed to assess the practices of drug management and the quality of outpatient pharmacy services at Haji Padjonga Daeng Ngalle (HPDN) Regional General Public Hospital in Takalar Regency, Indonesia. Method: The evaluation of drug management involves conducting in-depth interviews in the outpatient unit, focusing on planning, budgeting, procurement, storage, and distribution, compared with government regulatory standards. The quality of pharmacy services was assessed using the Solvin technique with 100 respondents, evaluating five dimensions: physical evidence, reliability, responsiveness, assurance, and empathy, using the servqual questionnaire with a Likert scale (ranging from very dissatisfied = 1, dissatisfied = 2, somewhat satisfied = 3, satisfied = 4, to very satisfied = 5). Results: Research findings indicated the level of compliance of drug management with regulations as follows: planning (66.67%), budgeting (60%), procurement (100%), storage (100%), and distribution (100%). The quality of pharmacy services demonstrated high questionnaire validity (r = 0.714), and the average dimension was a score of 4, indicating satisfactory satisfaction levels. Conclusion: This study reflects HPDN hospital's compliance with regulations while identifying specific areas for improvement to enhance the quality of pharmacy services. [ABSTRACT FROM AUTHOR]

Objectives: In Iran's accreditation program, the patient safety dimension is one of the main dimensions, holding the highest weight among the accreditation criteria. The purpose of this study was to identify the patient safety culture (PSC) in a tertiary referral hospital. Methods: The current study was conducted between March and April 2021 in a tertiary hospital in Iran. The sample size was 628 participants, selected through simple random sampling. The hospital survey on patient safety culture (HSOPSC) was used to assess provider and staff perceptions about patient safety issues, medical errors, and event reporting. The survey included 32 items that measure 10 dimensions of PSC. Normality tests, along with non-parametric Mann-Whitney and Kruskal-Wallis tests, were used to examine the relationship between PSC and demographic variables using SPSS 22 software. Results: Based on current findings, among the 10 dimensions of PSC, teamwork and organizational learning-continuous improvement received the highest scores (83% positive response), which were higher than these variables in the Agency for Healthcare Research and Quality (AHRQ) data. Conversely, staffing and work pace, as well as hospital management support for patient safety, received the lowest positive scores (43% and 55% positive response, respectively), which were lower than these variables in the AHRQ data. There was a significant positive relationship between dimensions of PSC and older age, female gender, staff with longer working experience, and longer work hours per week (P < 0.05). Conclusions: The majority of our participants felt that patient safety needs to be enhanced. Based on the findings of this study, it is recommended to emphasize the dimensions of "staffing and work pace" and "hospital management support for patient safety" more in the accreditation criteria to strengthen these dimensions in hospitals. Additionally, we have introduced a comprehensive guide for using an international tool to measure PSC, which hospitals can use to succeed in annual accreditation. [ABSTRACT FROM AUTHOR]

Diazoxide is a commonly used first-line medication for the treatment of hyperinsulinism. Hyperglycemia may occur with diazoxide use. However, hyperglycemic hyperosmolar state (HHS) secondary to diazoxide is an exceedingly rare but potentially life-threatening adverse effect. We present a case of a 2-year-old with Kabuki syndrome and hyperinsulinism on diazoxide. She presented with 4 days of fever, respiratory symptoms, and lethargy. She was influenza B positive. Initial workup indicated HHS, with an elevated serum glucose (47.1 mmol/L [847.8 mg/dL]; reference range 3.9-6.0 mmol/L; 70-108 mg/dL), serum osmolality (357 mmol/kg H2O; reference 282-300 mmol/kg H2O) but absent urine ketones and no metabolic acidosis (venous pH 7.34). Her course was complicated by an acute kidney injury. Management in the hospital included discontinuation of diazoxide and intravenous fluid resuscitation, following which hyperglycemia and hyperosmolarity resolved. No insulin therapy was required. She remained normoglycemic without diazoxide for 2 weeks but subsequently required restarting of diazoxide for hypoglycemia. This case highlights the need for early recognition and prompt management of diazoxide-related HHS to reduce negative outcomes. We present the first case report of a child with Kabuki syndrome and hyperinsulinism with diazoxide-induced HHS. [ABSTRACT FROM AUTHOR]

Hospitalisations for heart failure (HF) are associated with high rates of readmission and death, the most vulnerable period being within the first few weeks post-hospital discharge. Effective transition of care from hospital to community settings for patients with HF can help reduce readmission and mortality over the vulnerable period, and improve long-term outcomes for patients, their family or carers, and the healthcare system. Planning and communication underpin a seamless transition of care, by ensuring that the changes to patients' management initiated in hospital continue to be implemented following discharge and in the long term. This evidence-based guide, developed by a multidisciplinary group of Australian experts in HF, discusses best practice for achieving appropriate and effective transition of patients hospitalised with HF to community care in the Australian setting. It provides guidance on key factors to address before and after hospital discharge, as well as practical tools that can be used to facilitate a smooth transition of care. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Jejunalileal atresia is a cause of intestinal obstruction in the newborn, hence a surgical emergency. Prenatal diagnosis can be made by simple obstetric ultrasound and postnatal by plain abdominal x‐ray to plan a multidisciplinary approach to reduce morbidity and neonatal mortality. Atresia can occur anywhere along the intestines and is a common cause of intestinal obstruction in neonates. Jejunoileal atresia (JIA) is a rare disease occurring in 2.1 per 10,000 live births. Type 3b jejunoileal atresia occurs in 11% of all small bowel atresia. We present three cases of type 3b jejunoileal atresia. They were all missed by prenatal ultrasonography, and presented with features of intestinal obstruction. The diagnosis was confirmed by plain abdominal x‐rays and ultrasound, followed by laparotomy. Postoperative care was given in the neonatal unit according to local protocols. One recovered, however, two succumbed from neonatal infection. Jejunoileal atresia requires surgery and long postoperative care, with outcomes associated with numerous prognostic factors including multidisciplinary care and neonatal intensive care. Jejunoileal atresia is less commonly associated with other congenital anomalies, unlike duodenal atresia. Efforts are needed to scale up prenatal diagnosis of jejunoileal atresia, and therefore to plan for appropriate care after delivery. Also, further studies are needed to understand neonatal sepsis in the postoperative period and ways to improve outcomes. [ABSTRACT FROM AUTHOR]

Background & Objective: The role of Nurse Managers (NMs) is at the core of the successful implementation of performance management practices in hospitals. Although effective performance planning practices are crucial to the success of every organization, the implementation of the plans is equally important. This study aims to assess the performance execution practices of NMs from the perspective of nurses in a teaching hospital. Material & Methods: A cross-sectional study was conducted to examine the performance execution practices of NMs in a teaching hospital between 2017 and 2018. Quantitative data was collected using a modified structured questionnaire based on the Aguinis model of performance management. The study sampled 341 nurses using a proportionately stratified sampling technique from the 12 sub-Budget Management Committees (sub-BMCs). Data was analyzed using descriptive (mean, standard deviation, frequencies, and percentages) and inferential statistics (standard multiple regression). Results: The results of the study show that the overall performance execution practices were above average, with a total mean score of 3.23 and a standard deviation of 1.93. Again, 54.5% of the nurses were satisfied with the performance execution practices of their nurse manager. Results from the multiple regression indicate that NM's training (β = 0.206, p < 0.001) and interpersonal relations (β = 0.314, p < 0.001) between NM and nurses had a significant positive effect on execution practices, whereas nurses' years of work (β = -0.204, p < 0.001) with their manager had a significant negative effect. However, performance execution practices are challenged by poor supervision, inadequate human and material resources, and a lack of performance management training, as indicated by respondents. Conclusion: The findings showed that the performance execution practices were above average from the nurses point of view. Therefore, NMs should be equipped with the necessary skills through periodic in-service training and adequate resources. This will foster a positive environment for nurse education and the implementation of performance execution practices. [ABSTRACT FROM AUTHOR]

Background and Objectives: Ensuring quality in transfusion services has become an essential part of the hospital quality management system (QMS) to provide safe blood supply to the patients. The present retrospective study was conducted to assess quality performance of the blood center put forward by the National Accreditation Board for Hospitals and Healthcare Providers (NABH). Methods: The seven quality indicators (QI) defined by NABH were observed and monitored yearly for a period of four years from January 2019 to December 2022, information was gathered in a structured manner, root causes for any deviation were analyzed, and specific corrective and preventive actions were taken. Results: The overall performance was found to be satisfactory with mean transfusion-transmitted infection (TTI) rate being 1.6% and adverse transfusion reaction rate 0.35%, The wastage rate was 1.025% for whole blood & PRBC, 11.7% for platelets and 4.92% for fresh frozen plasma. The Quality control (QC) failure rates were meeting the quality requirement. The overall donor deferral rate and adverse donor reaction rate were 14% and 0.78% respectively. The component issued in study period was 99.8%. Conclusion: Quality improvement enables an organization to attain higher level of performance by creating better standards and removing deficiencies in product, processes or services. [ABSTRACT FROM AUTHOR]

The study aims to investigate the influence of organizational climate (OC) on individual innovative behavior (IIB) and examine the role of individual creativity (IC) as mediation in the construction of proposed relationships. This study involved 88 healthcare workers at Klungkung General Hospital. Data were collected using a 5-point Likert scale. The sampling method employed was non-probability based predefined criteria. Data analysis was done through a structural equation moeel (SEM) using SmartPLS. The result indicate that OC and IC positively and significantly impact IIB. Additionally, OC has a positive and significant impact on IC. Meanwhiie, IC acted as a partial mediation in the relationship between OC on IIB. Research on the impact of organizational climate on individual creativity and individual innovative behavior has primarily centered around the private sector. However, the organizational climate within public service entities, especially in healthcare, remains relatively unexplored. This presents a significant knowledge gap that merits further investigation. This research serves as a reference for formulating policy recommendations by hospital management regarding policies aimed at promoting an organizational climate that supports individual creativity and individual innovative behavior. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to understand health-care facilities' practice of deferring maintenance and to identify the relationship between deferred maintenance and hospital profitability. Design/methodology/approach: Financial statements from hospitals in Washington State were analyzed. Differences in building and equipment values were compared to the capital renewal investment benchmark. Then, linear regression analysis was conducted to identify correlations between deferring or sustaining maintenance and a hospital's profitability. Findings: The majority of hospitals in Washington State practice deferred maintenance, investing less in annual facility capital renewal than benchmark amounts. Hospitals in deferred and sustained maintenance states do not significantly differ in terms of facility size and plant operating expenses but there is a statistically significant difference in profit margins. Furthermore, a linear relationship exists between the level of investment in facility renewal and overall hospital expenses, revenue and profit. Practical implications: The findings of this research can be used to support fiscal policies related to maintaining aging health-care facility infrastructure. The findings can also be used to overcome barriers to securing capital budgets that are sufficient to optimize the safety and performance of the built environment. Originality/value: Hospitals in a state of deferred maintenance return higher profits than do hospitals in a state of sustained maintenance. Nevertheless, hospital spending on deferred maintenance backlog reduction generates a positive return on investment. While hospitals may achieve higher returns, in the short term, by spending less on facility capital renewal and focusing instead on higher-revenue-generating opportunities, additional research in necessary to understand the long-term costs of deferring facility infrastructure repairs and replacement. [ABSTRACT FROM AUTHOR]

Background: Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. Methods: A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Results: Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P< 0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. Conclusion: The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety. [ABSTRACT FROM AUTHOR]

The primary aim of this article is to propose a novel orchestration framework based on Revocable Dynamic Hash Table (RDHT) for dynamic and secure access of Electronic Health Records (EHRs) in multi-cloud environments. The proposed orchestration framework includes four processes namely, Function-Level Rewriting (FLR), Optional Function Generator (OFG), Entry Recognition (ER), and Optional File Elimination (OFE) for effectively managing the storage of EHRs. This proposed orchestration framework's performance is analysed using a web application related to hospital management systems. Once the orchestration layer authenticates the health professionals, the RDHT effectively routes the request and distributes EHRs across different cloud providers. The orchestration layer enforces access control after identifying the designated cloud providers. This process confirms that the health professionals have appropriate permission for the specifically requested operation. In comparison to the conventional methods like Quick-Functions as a Service (FaaS), Fast Healthcare Interoperability Resources (FHIR), ElGamal encryption, and Deletable Consortium Blockchain (DS-Chain), the RDHT method consumes minimal memory and running time. More precisely, the RDHT method demands a minimum response time of 1070.52 milliseconds with a memory usage of 89.68 megabyte, access time of 1187.12 milliseconds, and computation overhead of 124.56 megabyte on the Medical Information Mart for Intensive Care (MIMIC-III) dataset, especially for 300 patient records. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of bed utilization indices in a tertiary care hospital in India. Methods: This cross-sectional study was conducted in a 730-bed tertiary care hospital. Average length of stay (ALOS), bed occupancy rate (BOR), bed turnover interval (BTI), bed turnover rate (BTR), gross death rate (GDR), and net death rate (NDR) were assessed over 12 months. Data included both primary and secondary data. Results: During the study period, there were 355722 outpatients, of which 28296 were admitted and there were 32742 emergency room (ER) outpatients, of which 18361 were admitted. ALOS, BOR, BTI, BTR, GDR & NDR were 3.55, 63.55, 2.07, 5.43, 1.94 & 1.31 respectively. In the international ward, ICU, general ward, private room, and RAS ward the BOR was 37.04, 52.81, 77.66, 64.93, and 38.35 respectively and the value of ALOS was 4.01, 3.21, 3.47, 2.69, and 4.37 respectively. Conclusion: Despite being better than many hospitals in India, there is still a need for improvement in the hospital management strategy of the hospital to reach its optimum level. Monitoring of bed utilization ratios is recommended in hospital settings. [ABSTRACT FROM AUTHOR]

This study highlights the development and application of a predictive analytics system in a Midwestern hospital to assess and manage the risk of patient readmissions within 30 days of discharge. By integrating advanced analytical modeling with electronic health records, the system enables the creation of personalized care plans by accurately predicting patients' readmission risks and the optimal timing for interventions. The results suggest that such models can significantly improve resource allocation and the personalization of care plans, thereby reducing unnecessary readmissions and aligning with value-based, patient-centered healthcare goals. Hospitals are responsible for ensuring not only that the patients heal when in the hospital but also that the patients are not readmitted within 30 days of discharge. Additionally, the penalization of hospitals from the Hospital Readmissions Reduction Program in the Affordable Care Act of 2010 and the emergence of value-based, patient-centered reimbursement models continue to pressure health organizations to minimize hospital readmissions. In the face of limited staffing resources, readmission strategies are driven by three foundational components: which patients to focus on, what type of intervention should occur, and when an intervention should occur. Previous modeling work has crudely grouped patients into a few segments. With the combination of advanced analytical modeling and widely used electronic health records (EHRs), patients' risk levels and the timings of the readmission issues can be finely predicted. This provides an opportunity for creating personalized care plans (when and what intervention should occur) for patients. This study describes developing and implementing a predictive analytics-based system in a Midwestern hospital system for profiling readmission risk. Results indicate that models, such as the ones detailed in this article, that combine patient stratification and readmission risk timing can effectively extend a personalized care plan to determine when intervention timing should occur and optimize resource allocation of the care team. This comprehensive suite of predictive models would allow care teams across the continuum to offer personalized care transition plans and dynamically pivot strategies to address emerging events throughout a patient's trajectory. History: This paper was refereed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sociology & Technoscience / Sociología y Tecnociencia is the property of Universidad de Valladolid, Escuela Universitaria de Educacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This work aims to integrate the concepts generated by a systematic literature review on patient flows in emergency departments (ED) to serve as a basis for developing a generic process model for ED. Design/methodology/approach: A systematic literature review was conducted using PRISMA guidelines, considering Lean Healthcare interventions describing ED patients' flows. The initial search found 141 articles and 18 were included in the systematic analysis. The literature analysis served as the basis for developing a generic process model for ED. Findings: ED processes have been represented using different notations, such as value stream mapping and workflows. The main alternatives for starting events are arrival by ambulance or walk-in. The Manchester Triage Scale (MTS) was the most common protocol referred to in the literature. The most common end events are admission to a hospital, transfer to other facilities or admission to an ambulatory care system. The literature analysis allowed the development of a generic process model for emergency departments. Nevertheless, considering that several factors influence the process of an emergency department, such as pathologies, infrastructure, available teams and local regulations, modelling alternatives and challenges in each step of the process should be analysed according to the local context. Originality/value: A generic business process model was developed using BPMN that can be used by practitioners and researchers to reduce the effort in the initial stages of design or improvement projects. Moreover, it's a first step toward the development of generalizable and replicable solutions for emergency departments. [ABSTRACT FROM AUTHOR]