مجله بیمارستان
سال چهاردهم شماره 1 (بهار 1394)

One of the main challenges of hospital managers is to decide the number of existing beds in each department of the hospital. While، more beds results in an increase in the current cost of the hospital، decreasing the number of beds might cause disorder in patients flow. The main objective of this paper is minimizing the total cost as well as maximizing the patients flow in the network، considering the practical limitations of the hospital. this study is aimed to investigate following subjects: identify the current limitations in changing of department capacity، thorough interview with hospital managers and other personnel in Modares Hospital، cardiac patient flow analysis، simulation of current flow، determining applicable scenarios and choosing the best scenarios by mathematical modeling in order to minimize total cost and maximize patient flow. through lots of existing scenarios، 31 applicable scenarios have been determined by limitations analysis. Finally، 8 best scenarios were found. Generally، results show that decreasing the number of beds in CCU and increasing the number of beds in Post-CCU can improve patients flow، considering cost constrains. The Proposed approach in this study can be a general guide for capacity planning of hospital departments with considering practical limitations. Since some health administrators oppose the creation of post-CCU، it is possible to compare patients flow status in the presence or absence of this department by proposed approach in this paper.

Since training to nurses with low back pain، will be effective at Preventing or reducing physical disability and improve quality of life the purpose of this study was to assess effectiveness of physical health educational program on the quality of life of nursing staff with chronic low back pain working in hospitals in yazd. Methood: This semi experimental study was carried over 119 employees with chronic low back pain working in hospitals in yazd in both intervention (n=60) and control (n=59) groups. The intervention group participated in a training program included a - 180 minutes education session. Data were collected through using the 36-item Short-Form Health Survey questionnaire (SF-36) at base line and 3- month follow up and analyzed using descriptive and analytical statistics. This study showed the physical dimensions of quality of life including physical functioning، role physical، bodily pain and general health in the intervention group with mean age of 72/32،58/18،59/96،69/10 respectively were improved in compare with the same dimensions in control group with mean age of 60/50،47/88،38/05،51/27 at 3- month follow up (P<0/0001). There were no significant improvement in terms of mental component of quality of life in intervention (P=0/855). The results indicated the educational program could be effective on physical functioning، role physical، bodily pain and general health.

At recent years، there was the salient consideration into hospital emergency services. The aim of this study was analyzing contributory factors of clients'' satisfaction in emergency services of Tehran and Shahid Beheshti University Medical Sciences'' selected hospitals. It was a descriptive-analytical and cross-sectional study. The statistical population was clients of emergency departments of selected hospitals. The sample size was calculated 768. 6 hospitals were selected from each university. It included 3 general and 3 specialized hospitals. The instrument was the questionnaire that preparing in 54 questions in 2 sections. Reliability and validity were confirmed by professors and 50-sample pilot study، respectively. The alpha-cronbach was calculated 0. 87. It was analyzed by independent sample t-test، simple linear regression and linear multi-regression. The demographic characteristics of attendants were as follows: 57. 3% women، 56. 8% older than 45، 63. 1% covered by social insurance، 92. 7% urban، 56% married، 58. 7% lower than high school and 68. 4% covered by coinsurance. The payment by clients was higher at Shahid Beheshti University. The most of payments was the mixture of out-of-pocket and insurance. The clients'' satisfaction was higher in admission، guardian، physicians، nursing cadre and environment-services at Tehran university. It was higher in management at Shahid Beheshti university.. Collecting data in the field of patients'' evaluation of services'' quality or accessible medical facilities could would induce to recognizing upgradeable areas health providing system.

Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013.

This interventional research was a before-and-after study. In order to recognize any changes، efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention، descriptive statistics were used.

Findings showed that costs didn’t differ significantly after the intervention، but revenue was a little increased (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases).

Regarding the little positive impact of P4P on costs and revenues and comparing other similar studies، we can conclude that this bonus payment system can be used in all care-providing levels such as primary health care centers، drug stores، diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error.

Emergency operation centers (EOC) have been established in recent years aimed to organization and coordination in disaster times. The centers are responsible for decision-making in response and recovery phases after events. The aim of the study was developing a standard function evaluation tool for EOC. This was a mixed method study with sequential triangulation approach. All EOC in medical universities with at least one year ago establishment (in 2011)، has been studied. We measured the face and content validities. For reliability the Cronbach''s alpha was provided. The most important factors have been determined by an Explanatory factor analysis. The final tool by six domains had 38 questions. All content validities were higher than +0. 6 unless one (+0. 1). Only the activation domain had inappropriate Cronbach (0. 337) and all others were higher than 0. 7. Factor analysis reduced the questions in all domains. There reduced to five (for first domain)، two (for second and third domains) and one (for three last domains). Based on validity and reliability، it seems that the tool is appropriate for EOC'' function evaluation. The high reliability was resulted from closed correlation of questions. The good validity implied familiarity of EOC'' experts on the all asked domains.

Exposure to some organic solvents such as benzene and toluene cause adverse effects on organs and cause the spread of diseases such as cancer، leukemia and adverse effects on the nervous system. Medical staff with long-term exposure to volatile organic compounds including benzene، toluene، xylene and xylene in indoor air in hospitals and serious complications of than in medical staff and hospital staff who are looking for a lot of medical expenses، the importance of this more highlights. The aim of the present study is detect and measure BTEX (benzene، toluene، um - xylene followed - xylene and ethylbenzene) in air and comparison with hospital standards recommended by the technical department of occupational health.

First critical sectors of Imam Hossein hospital such as pathology and emergency was selected. Air sampling was performed using activated charcoal and with the using the health and safety of the United States methods. Using gas chromatography with mass spectrometry and flame detector operation was performed to determine the amount of pollutants. The processing and analysis of data، spss version 13 software was used.

In all parts of the ward، operating room، emergency room، laboratory pollutants benzene، toluene، ethyl benzene and xylene have been identified and followed. The concentration of toluene in waste elimination، landry and pathology parts is 0/5477 mg/m3،0/4052mg/m3 and 0/81 mg/m3 Respectively.

This study shows that pollution exists in all parts of the hospital that is compatible with other studies and This shows the importance of detailed field studies to identify the sources of these pollutants in the environment is sterile، like a hospital.

waste - care centers in terms of their major role in the spread of various diseases and environmental pollution are particularly important. Therefore attention to the performance of non-hazardous hospital waste devices is important. The aim of this study was to determine of functional non-hazardous non-incineration devices of waste in Kerman education hospitals and sirjan hospitals The study is experimental and between March and September the year 2013 at the Engineering Research Center for Environmental Health، Kerman University of Medical Sciences done. Performance of devices in terms of physical، chemical and biological were studied. Mechanical performance with observe and record mechanical index by the thermometer and registers the device done. To evaluate the chemical performance of the devices of a indicator strip and the biological performance of a biological indicator strip was used to study. Among hospitals، 96. 3% of non- hazardous devices of waste، the mechanical performance desired. Chemically، 85. 3% of non- hazardous devices of waste effectively acted. Biologically، 84% of the devices attained to be optimum. Considering thatnon-hazardous non-incineration devices of wastein 4 Kerman education hospitals and 2 sirjan hospitals unable to complete and hundred percent non- hazardous of chemical and biological wastes although in terms of mechanical، temperature and time required non- hazardous process is provided but this scale alone can not be cause to non- hazardous waste so the performance of these devices in hospitals is poor.

This study aimed at investigating the effect of balance between work-life and non-work life in Sanandaj’s hospitals. Balance dimensions include the balancing in family، work، free time، and personal growth. Also، the life quality dimensions include physical، mental، social، and environmental health aspects of life. The statistical population of this study includes personnel of Sanandaj’s hospitals (doctors، nurses، office employees، operating staff، and guards) which sampeling have been selected by cluster sampling and using Cochran formula with a number of 150 people. Collected data was analyzed using the structural equations and AMOS18 software and SPSS20. Results of this study showed that the balance between work-life and non-work life in the hospitals’ personnel had an effect of 0. 70 on their life quality، while the first hypothesis with the title of “The effect of balance in family on the life quality” was rejected because of its critical rate is in the range of hypotheses’ rejection. The effect of three non-work dimension on the life quality of the hospitals’ personnel has been confirmed which can be because of the existed economic conditions and limitations in Sanandaj City.

understanding the patient expectations and perceptions of service quality is one of the requirements for improving quality of health services. The purpose of this study is to evaluate the gap between patient’s expectations and perceptions in five dimensions of service quality in hospitals affiliated with Qazvin University of Medical Sciences.

This cross-sectional study was done on 298 patients at hospitals affiliated with Qazvin University of Medical Sciences; it is designed to evaluate the quality of health services based on client’s expectations and perceptions and to determine the strengths and weaknesses of service quality. Data collection was performed by standardized SERVQUAL questionnaire to measure quality of services. the reliability and validity of this questionnaire has previously been confirmed by studies in Iran and other countries. Data analysis was done using SPSS software and ANOVA test was performed.

The results showed that there was significant correlation between patients’ expectations and perceptions in all dimensions of quality (p<0. 05). The Reliability (2. 36) and Assurance (2. 24) dimensions have the most and responsiveness dimension (1. 98) has the lowest gap. Also (A) and (D) hospitals have the most gap and (C) hospital has the lowest.

The negative gap (expectations more than perceptions) in all dimensions of quality showed that it is necessary to improve service quality in all dimensions. in order to reduce the gap of all five dimensions of quality and provide desired services، it is recommended that hospital managers by planning and their optimal management take the patients’ needs into account.

There are various departments in the hospital that cause the entrance of hazardous، infectious، pathological and radioactive materials into the manufacturing waste of these centers. To prevent the release to the environment of such polluted hospital waste، attention and implementation of waste management principles is required. This study aimed to evaluate the status of waste management in Karaj hospitals. This cross - sectional study was conducted in Karaj during 2011-2013. Using census، Karaj''s hospitals formed population of this study (n=8). Weighting the hospital waste (for 4 months and one week in every month) and completing the checklists were two main ways of data gathering. Data analysis was done using SPSS software. The daily capita of solid waste per active beds، occupied beds and patients were 4. 1، 5. 6 and 9. 4kg/d. The status of hospital solid waste management was moderate in 88% and weak in 12% of hospitals. Furthermore the hospital waste management was evaluated weak in collection، transportation and manpower aspects، moderate in separation and temporary storage aspects and good in disposal of solid waste aspect. Overall، the status of waste management in studies hospitals was far away from the desired level. To improve this status، it is recommended to develop a defined operational plan and control its implementation. Given the main weakness of hospital waste management was related to production، collection، separation، and transportation aspects، hence، more attention to these areas is desired.

Discharge Process is the most important stage affecting in patient’s satisfaction and it is one of the major challenges in hospital management. This study aim to determine the average waiting time of patient discharge process and identify effecting factors of this process in Emam Reza Hospital in Mashhad، in the 2014.

In this cross-sectional survey waiting time of patients discharged from all clinical sections of the Imam Reza hospital in Mashhad were studied. Number of 455 patients were selected and discharge time of them at six different stages (In section، distance between section to the medical record، in medical records، distance between medical records to Accounting، cost calculation and cost payment in accounting) by using stop-watch method were measured. data has been analysed using descriptive and analytical statistics at 0. 05 significant level by SPSS16.

The results showed that the waiting time was 504. 26± 362. 96 Minute. It was statistically differences between different wards of the hospital in which ENT section has the lowest and Burns section has the highest discharge time.

we concluded that the maximum time related to station 1 (Within the medical sector) and station 6 (cost payment) Therefore suggested to perform corrected solution in this stations such as change visit hours and make schedule for sending medical record to the accounting department and helped to reduce patient waiting time.

Hospitals have been known to be especial water consumers and the amount of generated wastewater and their contamination is much more than that of domestic subscribers. Despite increasing concerns about hospital waste management،adequate attention has not been paid to the wastewater produced in hospitals. As there is a separate source of drinking water from that of sanitary uses in hospitals in Qom،the pattern of water consumption and wastewater production in these centers provides valuable information in order to meet estimated water requirement and amount of wastewater produced in the hospitals. The amount of water consumption in hospitals was collected from2008to2013 and according to the information extracted from the questionnaires and conversion ratio of water to wastewater، wastewater volume was estimated. Data was analyzed through SPSS 19. software. Pearson correlation test was utilized to determine relationships between variables. After that، strategies for better management of water and sewage systems were presented along with identifying strengths and weaknesses In the eight hospitals surveyed، the average water consumption was found to be 655. 7 Lit/day. bed and bed and 8. 6 liters per square meter of construction area. There was a statistically meaningful relationship between consumed water in hospitals and construction area (p<0. 05). The average wastewater production was estimated to be 567. 6 Lit/day. bed. The predominant method of wastewater disposal is discharge in the well In order to improve the current situation in these hospitals،it seems inevitable to reconstruct water and wastewater facilities،to use wastewater treatment packages and/or to connect waste water of hospitals to City''s wastewater collection system

Burnout is a phenomenon that often in the system can impact mental health and affect the quality of services provided to clients. Since the subject and center of this professional is human and physical and mental health is the important issue، this study was to examine Correlation between burnout and mental health in medical staffs of the Valyasr hospital in Borujen. In this descriptive-correlational study، that During 1391، 133 medical personnel of the valy Asr hospital in Borujen selected through census. Gathering instrument was demographic information questionnaire، General Health Questionnaire and Mslach Burnout Inventory. Data was analyzed by SPSS/16 and descriptive and analytical tests. These findings indicated that majority of Units the study have the lack of personal accomplishment and psychological disorders and minority report emotional exhaustion. More than two-thirds of the patients showed mild depersonalization. Also between burnout in the all dimensions and mental health، significant reverse correlation was found. According to the nature of job stress and burnout in the medical profession، high prevalence of mental health problems and also inverse correlation in the research findings، it is recommended that the authorities concerned to it and with identifying sources of stress and ways of dealing with it، planning to prevent and resolve the problem.