مجله بیمارستان
سال هجدهم شماره 4 (زمستان 1398)

Background & Aims of study

Hospital care and paramedical services has become one of the most important and problematic issues in the field of health and critical concern of health planners and policymakers. In current study, contribution of various paramedical services costs were extracted from the total household health expenditure.

The current study is a descriptive study that was conducted in a 5-year study period from 2011 to 2015. The annual income-based survey data of the household provided by Statistics Center during 2011-2015 was used to achieve the study aims. Excel_2013 software was used. Contribution of household and paramedical services cost were calculated from household health expenditures per year in urban and rural areas.

Regarding the results of the current study, on average, 20 % of total household health expenditure is allocated to paramedical services in urban and rural areas. The cost of radiology, sonography, radiotherapy, scan, echo cardiac stress test, endoscopy, electrocardiogram (ECG) etc, accounts for the largest contribution of hospital and non-hospital paramedical services costs, which include an averagely about 50 %t of paramedical services costs.

Understanding paramedical services costs can guide policymakers and decision-makers in the field of paramedical services to decide better. Moreover it helps them to reduce direct payments from the pocket of household health expenditures. Therefore, considering the laboratory sector and radiology, sonography, radiotherapy sectors and so on are very important to reduce paramedical services costs.

Information technology application in health care is increasing. The aim of  this study, is to introduce a scientific model for designing an electronic system for managing patient transfer.

This study is an exploratory qualitative study. At first a review of literature was carried out for identifying clinical, managerial and process indicators necessary for patient transfer. Then 30 experts, who had vast experiences on patient transfer, were selected using purposive sampling approach and their informational needs were extracted using focus group discussion and semi-structured interviews. Then clinical indicators extracted from literature review and informational needs collected from interviews were distributed among 51 experts in the form of Delphi questionnaires. Process indicators were also distributed among 35 experts to summarize all necessary indicators for designing patient transfer system. At the final step an expert panel approved the model.

Thirty eight process indicators and 249 clinical and managerial components were finalized for designing the system. The process indicators were used for designing “monitoring and reports sections” of the system. The clinical indicators were used for designing “main sections” of the system including request for patient transfer, automatic algorithm for selecting destination hospital, information flow cycle, communicating clinical data and documentation. Final model also includes user interfaces relevant to responsibility of the user.

The proposed model, which contains necessary indicators for patient transfer, can communicate clinical information among hospitals and by providing proper infrastructure, will be able to improve patient transfer process.

Medical errors represent a serious problem for intensive care and increase the length of stay and mortality. Tracking of medical errors in hospital have focused on voluntary reporting of errors, but 10 to 20 % of errors are ever reported and, of those, 90-95 percent cause no harm to patients. This study was conducted to recognition and analysis medical errors in Intensive Care Unit by GTT in 2019.   

This study was a retrospective descriptive-experimental and was conducted in the Intensive Care Unit of a public hospital in Tehran. In 2019 for 13 weeks,127 records were separately reviewed by two nurses by using the IHI checklist and final confirmation was performed by the physician. The data were analyzed by SPSS 22 software.

Results:

 622 triggers, 277 adverse events related to triggers, 121 adverse events without trigger and totally 398 adverse events were identified in ICU. 93 records from 127 records had adverse events. The incidence rate of adverse events was 73/2%, 3/13 adverse events per pa tient and the incidence rate was 24/8 adverse events per 100 patients-day. The most frequency of events and harms were respectively related to care, intensive care, surgery and medication modules.

Conclusion:

 According to the result of patient records reviewing and the high rate of AEs that required intervention and also the result of similar study, we can state this tool is more reliable than other methods to detect AEs, such as voluntary reporting of error.

Regarding the chronic course of obstructive pulmonary disease and multiple problems which it brings to individuals and the community in terms of physical, mental, and economic aspects; this study aimed to investigate the role of life-style factors in disease exacerbation and hospitalization among COPD patients.

Methods & Materials:

 This is a descriptive, prospective study of outpatients with COPD in a tertiary care clinic. To collect data, a demographic questionnaire (including age, gender, marital status, occupation, and educational level), an international physical activity questionnaire (IPAQ), and a mini-nutritional assessment (MNA) tool were used. Disease severity was also determined by Initiative for Chronic Obstructive Lung Disease (GOLD) index.

A total of 128 patients (78.1% male) were recruited with a mean age of 65.3+11.9 years. Findings revealed significant correlations among physical activity level of patients and their nutrition, smoking behavior, BMI, and disease exacerbation. In fact patients with older age, lower BMI, smoking habit for a long time, and limited physical activity were more probable to face with disease exacerbation and hospitalization.

Evidence suggests that adoption of health promotion strategies and emphasis on health based approaches can be helpful in reducing hospitalization among COPD patients. Due to their effectiveness and low cost, such policies are regarded as cost effective strategies in dealing with chronic diseases.

The purpose of this study was to investigate the quality of life of employees working in a psychiatric hospital.

The present study is a descriptive cross-sectional study conducted in Roozbeh Hospital in 2018. The sample size was calculated using Cochran's formula and 112 questionnaires were analyzed. Quality of life was assessed using the 36-item Short Form questionnaire (SF-36). Data analysis was conducted using SPSS software, descriptive statistics, Kruskal-Wallis, Chi-Square and Cramer's post-test.

The findings revealed that the overall score of quality of life was 68.8. The highest mean of quality of life score was related to Physical functioning function (84.2) and energy fatigue had the least score (58.7). Also, the results of the study showed that there was a significant relationship between education groups and quality of life in terms of physical functioning (P-value=0.007); work experience and quality of life in social functioning dimensions (P-value<0.02); between having hospital patient communication and caregivers' communication with the quality of life in energy fatigue and pain dimensions (0.005, 0.05> P-Value); in Roozbeh Psychiatric Hospital staff.

According to the research findings, the quality of life of Roozbeh Psychiatric Hospital staff is moderate and educational and therapeutic interventions are recommended to improve the quality of life of the staff.

This study aimed to explore the process of establishing a non-governmental and nonprofit  hospital, as a corporate infantry, and a model for the establishment of autonomous and corporate hospitals.

This was a qualitative case study. The data were collected by interviewing the founders of Moheb Mehr Hospital, staff and some university officials and charity organizations. The data analysis was conducted based on grounded theory principles and data were coded in three stages of open, axial and selective coding.

The primary factors behind the establishment of Moheb Hospital were the low level of physicians' fees and the physicians’ dual practice in the public and private sectors. The existence of unused spaces at Hashemi-Nejad Hospital and the possibility of contracting supplementary insurance were the secondary factors. The reaction included welcoming from hospital physicians and opposition from the government and the Ministry of Health. A good patient access was created due to the lower charges, in comparison to the private sector, and having contract with the supplementary insurance. The negative comments from the government and the Ministry were gradually adjusted.

The decentralization initiatives of the public sector in hospitals should be considered as a bottom-up process. Instead of turning government hospitals into independent or corporate, it is better to re-establish them in an autonomous or corporate form. Also, before any decentralization action, financial and managerial stability must be created in the organizations. Morevoer, employee benefits must be preserved. Instead of receiving government funding, it is better to use the capacity of the endowment and receive bank loans.

Hospitals are considered as the largest and most costly unit of the health system. The present study aims to determine the efficiency of hospitals in Mashhad.

This is a descriptive-survey study that was carried out in 2016-2017. The population of the study consisted of patients referring to hospitals in Mashhad. For data collection, records were used in hospitals and the SERVQUAL questionnaire. Data analysis was performed in soft Gams software.

The results of the study indicate that in the SERVQUAL section, three dimensions of empathy response and Warranty were the most important dimensions. Also, 3 characteristics of 26 qualitative features of the service were classified as "attractive". 4 qualitative features are classified as "essential" and 16 features in "single-dimensional". The rankings obtained in the bilingual network method are approximately the same and only in the case of the last four ranks of the final ranking is done by the voting method with equal weights. And it was determined that the hospital number (3) is the lowest and hospital number (5) has the best performance.

By combining the fuzzy SERVQUAL method with network data envelopment analysis, we can eliminate weaknesses in the selection of indicators in different layers of network analysis and calculate the efficiency of such networks. Hospitals need to increase and plan appropriately by designing a hospital that has the highest efficiency and optimal utilization of its resources and cost-effectiveness.

Bachground: 

The use of optimal purchasing methods in the medical equipment sector, along with the implementation of state laws and regulations by the government, can serve as a way to move towards smart purchases. To be raised. The aim of investigating the factors affecting the decision making of purchasing capital equipment in hospitals affiliated to Tehran University of Medical Sciences.

In this applied research, which was conducted in the year 2017, the statistical population of the study were directors, heads and supervisors of the diagnostic and therapeutic sections and medical equipment of all hospitals, and managers and experts of medical equipment of the University of Medical Sciences who were 631 They formed. Data gathering tool was a researcher-made questionnaire. After verifying their validity and reliability, the data were collected and analyzed using SPSS software.

The most effective variables of the actual price of capital equipment at purchase time with a regression coefficient of 0.368 and against the least effective variable in this area is the competitive or exclusive sale of the market with a regression coefficient of 0.162.

Therapeutic centers to purchase capital equipment should use standard decision-making criteria. Considering the sensitive role of identifying and selecting the best brand for the purchase of equipment, as well as the costs that these purchases bring to the health system, the use of quantitative and qualitative criteria as well as the use of experts is very important, in this way, equipment Provides economical and quality services to provide the right services.