Journal of Healthcare Quality Research最新文献

英文中文

La experiencia de los cuidadores no profesionales de pacientes crónicos

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-21 DOI: 10.1016/j.jhqr.2025.101130

A. Picón-Santamaría , S. Ballesteros-Peña

Introduction

Population aging and the increase in chronic diseases pose significant challenges to healthcare systems. Informal caregivers play a crucial role in caring for these patients, yet their experiences remain underexplored. This study evaluates the experience of informal caregivers of hospitalized chronic patients.

Materials and methods

A descriptive observational study was conducted at Hospital Santa Marina, Bilbao, between 2023 and 2024. The IEXPAC-Caregivers scale was used to assess the experience of 182 informal caregivers. Data were analyzed using descriptive and inferential statistics. SPSS v.25 software was used for statistical analysis.

Results

The overall average score was 7.1 (± 2.7) out of 10 (Cronbach's α = 0.914). The best-rated items were communication during emergencies and medication administration. However, deficiencies were noted in training, information about available resources, and coordination between services. Significant differences were found in aspects such as emotional support and treatment follow-up based on the gender of the caregiver and the patient.

Conclusions

Informal caregivers play an essential role in the care of chronic patients. There is a need to improve service coordination and provide ongoing training and emotional support to them. Gender differences highlight the importance of personalized approaches to enhance their experience and reduce caregiving burden.

导言人口老龄化和慢性疾病的增加给医疗保健系统带来了巨大挑战。非正式照护者在照护这些病人的过程中扮演着至关重要的角色，但他们的经历仍未得到充分探索。本研究评估了住院慢性病患者非正规护理人员的经历。材料与方法 2023 年至 2024 年期间，毕尔巴鄂圣玛丽娜医院开展了一项描述性观察研究。采用 IEXPAC 护理人员量表对 182 名非正式护理人员的经历进行评估。数据采用描述性和推论性统计方法进行分析。结果总平均分为 7.1 (± 2.7)（满分 10 分）（Cronbach's α = 0.914）。评分最高的项目是紧急情况下的沟通和药物管理。但在培训、可用资源信息和服务协调方面存在不足。在情感支持和治疗跟踪等方面，护理人员和患者的性别存在显著差异。有必要改善服务协调，为他们提供持续培训和情感支持。性别差异凸显了个性化方法的重要性，以增强他们的体验并减轻护理负担。

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引用次数: 0

Improving efficiency in a total hip arthroplasty program

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-17 DOI: 10.1016/j.jhqr.2025.101117

X. Buyse , J.Á. Fernández-Valencia , A. Alías , M. Tió , M. Pablo , A. Serra

Objective

To evaluate the application of Lean Six Sigma methodology to increase efficiency in a morning total hip arthroplasty program and analyze the challenges in improving operating room efficiency.

Methods

A quasi-experimental study with pre-post intervention analysis was conducted in a public university hospital. Multidisciplinary meetings and a retrospective analysis of the previous year were carried out to define improvement points. Study period: June–December 2023, with 24 planned sessions in Monday and Thursday morning modules. Measures implemented included selection of low-complexity cases, early start of surgeries, optimization of changeover times, and use of efficiency-facilitating systems.

Results

The feasibility of performing three procedures in one morning was confirmed, with 72% of cases having surgery times under 90 min. 67% of the proposed target was achieved, despite the loss of an operating room module for four months. The average start time of the first surgery improved from 9:23 ± 54 min to 8:32 ± 22 min. The average number of procedures per module increased from 1.76 to 2.79. The average changeover time reduced from 29 ± 12 min to 18 ± 12 min.

Conclusions

The Lean Six Sigma methodology has improved operating room efficiency for hip arthroplasty by 50%. Identifying easily modifiable stoppers is crucial for successful implementation of improvements in the clinical process. Additional studies are required to address the challenges identified in post-surgery clinical process and to ensure continuous process optimization.

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引用次数: 0

Ethical decisions on the end of life during internal medicine on-call shifts 内科值班期间关于生命终结的伦理决定

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-13 DOI: 10.1016/j.jhqr.2025.101129

R. García Caballero , D. Real de Asúa , K. Olaciregui Dague , G. de vega González , B. Herreros

Objectives

To describe the frequency of decisions of withholding and withdrawing life-sustaining treatment and palliative sedation in patients previously unknown to physicians during on-call.

Methods

Observational study (survey) of Spanish internists.

Results

Two hundred seventy-three surveys. In patients they did not know, 95.2% decided during an on-call whether they should enter the Intensive Care Unit and 89% whether to initiate sedation. Measures most identified as “aggressive”: admission to the Intensive Care Unit, use of invasive techniques, cardiopulmonary resuscitation and invasive treatments. 48.4% make the decision to start sedation as a team and 4 out of 10 do not consult the patient. Decisions are planned most commonly with cancer patients (73%), with heart failure (60.4%) and chronic obstructive pulmonary disease (58%).

Conclusions

During the on-call, almost all internists make decisions about admission to the Intensive Care Unit or about sedation in unknown patients. It is planned more the decisions with cancer patients. The decision to sedate is usually made as a team and the patient is often not consulted.

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引用次数: 0

Data: Europe's own path in artificial intelligence

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-10 DOI: 10.1016/j.jhqr.2025.101126

A. Bahamonde

引用次数: 0

The organizational well-being of healthcare professionals

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-08 DOI: 10.1016/j.jhqr.2025.101125

M. Macías , J.J. Mira , I. Mediavilla , E. Foglia , E. Garagiola , L. Ferrario

引用次数: 0

Failure to rescue in colon surgery 结肠手术抢救失败

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-06 DOI: 10.1016/j.jhqr.2025.101118

J.J. Rubio-García , F. Mauri Barberá , C. Villodre Tudela , J. Ferri Romero , M. Marco Gómez , T. Viñas Martínez , C. Gómez Alcázar , M. Romero Simo , J.M. Ramia-Ángel

Background

Major complications (MC) after colorectal surgery are not uncommon and can have serious consequences for patient survival. Failure to rescue (FTR) is an indicator used to measure the capacity for correct management of MC, calculated as the number of patients who die among all those who present MC.

Methods

Observational study with retrospective data analysis of all patients undergoing scheduled colon cancer surgery at a Spanish university hospital from September-2012 to August-2016. Preoperative, intraoperative and postoperative variables were recorded. Postoperative complications Clavien–Dindo scores > II were considered MC. FTR was defined as death within 90 postoperative days in patients with at least one MC.

Results

A total of 564 patients were included, of whom 140 (24.8%) presented MC. Of these, 22 died, representing an FTR rate of 15.7%. Patients with MC had a mean age of 69.6 years, and 30.7% were women. An open approach was used in 81.4%. Compared with survivors, the group of non-survivors presented a higher proportion of ASA III and IV (P = 0.008), a higher mean age (P = 0.001) and a higher proportion of anastomotic leaks (P = 0.009). Multivariate analysis confirmed that age (OR 1.161; P = 000), anastomotic leak (OR 18; P = 0.001) and sepsis of origin other than anastomotic leak or intra-abdominal collection (OR 26; P = 0.001) were significantly associated with FTR as independent factors.

Conclusion

The FTR rate after colectomy in our series was similar or slightly lower than other series. Age, anastomotic leakage, and sepsis of non-abdominal origin were independent factors associated with FTR. We contend that FTR is an excellent indicator of a center's ability to resolve MC. It is particularly useful for implementing measures to ensure effective treatment of MC.

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引用次数: 0

Textbook outcome in thyroid surgery: A new approach to assess quality in an endocrine surgery unit

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-03 DOI: 10.1016/j.jhqr.2025.101120

D. Costa Navarro , J.J. Rubio-García , A. Gomis-Martín , T. Viñas Martínez , J. López-Noguera , M. Franco-Campello , A. Carrion-Tomás , J.M. Ramia

Background

Thyroidectomy is a term encompassing various surgical procedures involving the thyroid gland. Assessing quality is imperative for patient safety and clinical auditing and textbook outcome (TO) offers more comprehensive information on overall quality than single indicators. This study aims to define the parameters constituting TO in thyroid surgery, evaluate the outcomes based on TO criteria within an endocrine surgery unit at a tertiary hospital, and identify factors associated with failure to achieve TO in these cases.

Methods

A retrospective observational study of consecutive patients undergoing thyroid surgery at the Endocrine Surgery Unit in Spain between January 2020 and December 2022. The analyzed variables included, among others, age and sex, comorbidities, diagnosis, intrathoracic goiter, type of thyroidectomy, and several postoperative complications. The first TO definition in thyroid surgery was made.

Results

A total of 244 patients were included in the study. TOTS was achieved in 153 patients (62.7%), and there were no reported mortalities. Diabetes (18% vs 8.61%) and endothoracic goiter (40% vs 22%) were statistically associated with textbook outcome non-achievement. Also, the endothoracic goiter parameter was identified as a statistically significant predictor of textbook outcome non-achievement.

Conclusion

The implementation of the TO concept in thyroid surgery offers a comprehensive method for assessing surgical quality, encapsulating a range of critical postoperative outcomes. The rate of TO in our serie was 62.7%, identifying that endothoracic goiter is the main parameter of textbook outcome non-achievement.

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引用次数: 0

Análisis de los indicadores de seguridad del paciente en las complicaciones por cuidados durante la hospitalización

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.01.001

F.M. Escandell Rico , L. Pérez Fernández

Objective

To Analyze AHRQ Patient Safety Indicators (PSI) obtained through the Minimum Basic Data Set (MBDS) in improving patient safety.

Method

Observational descriptive and retroprective study. The CMBD hospital discharge registry of 342 hospitals of the National Health System was included. The MBDS indicators and analysis axes were from 2021 and the hospitalization MBDS information included the following general data: total discharges, average stay, average age and % mortality. Four patient safety indicators were analyzed: Pressure ulcers (PSI 03), Iatrogenic pneumothorax (PSI 06), Accidental puncture or tear in adults (PSI 15) and CVC-related to bloodstream infection (PSI 07).

Results

The PSI 06 and PSI 07 categories not only have a higher number of discharges, but also a longer average stay and mortality. In comparison, PSI 03 and PSI 15 categories show a much lower number of discharges, and a lower mortality and average stay. Conditions associated with PSI 06 and PSI 07 categories could be more severe or complex, leading to a longer hospital stay and a higher risk of mortality. According to relative risk analyses, all indicators show a slightly higher mortality risk in men than in women.

Conclusions

Advanced age and serious diagnoses, such as circulatory diseases or neoplasia, are associated with higher mortality and hospital stay. In relation to hospital size, smaller ones show higher risks and worse mortality outcomes. Therefore, these results could guide strategies to optimize resources and focus interventions on the most vulnerable groups.

目的分析通过最低基本数据集（MBDS）获得的 AHRQ 患者安全指标（PSI）在改善患者安全方面的作用：观察性描述和追溯研究。方法：观察性描述和回顾性研究。研究对象包括全国卫生系统 342 家医院的 CMBD 出院登记。MBDS指标和分析轴来自2021年，住院MBDS信息包括以下一般数据：出院总人数、平均住院日、平均年龄和死亡率。对四项患者安全指标进行了分析：压疮（PSI 03）、先天性气胸（PSI 06）、成人意外穿刺或撕裂（PSI 15）和CVC相关血流感染（PSI 07）：结果：PSI 06 和 PSI 07 类别不仅出院人数较多，而且平均住院时间和死亡率也较长。相比之下，PSI 03 和 PSI 15 类别的出院人数要少得多，死亡率和平均住院时间也较短。与 PSI 06 和 PSI 07 类别相关的情况可能更加严重或复杂，导致住院时间更长，死亡风险更高。根据相对风险分析，所有指标均显示男性的死亡风险略高于女性：结论：高龄和严重诊断（如循环系统疾病或肿瘤）与较高的死亡率和住院时间有关。就医院规模而言，规模较小的医院风险较高，死亡率较低。因此，这些结果可以指导优化资源的战略，并将干预重点放在最脆弱的群体上。

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引用次数: 0

Optimización del reprocesado de materiales sanitarios en centros de atención primaria

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.101124

E.A. Sabuco Tébar , Á.R. Sáez Soto , M. Culiañez Alenda , Y. López Benavente , R. López Alegría , F.J. Campayo Rojas

Introduction and objetive

Reprocessing of medical devices in Primary Care Centers (PCC) can be a source of infections. The aim of this study was to improve the quality of reprocessing devices in the PCCs of Area VII-Murcia/Este through an improvement cycle.

Methods

This prospective intervention study. was carried out in 12 PCC, 14 Local Clinics (LC), 4 Oral Health Units (OHU) and the professionals involved in the reprocessing. Between 09/2022-03/2023, a working group was created, and a situation analysis was carried out: inventory of autoclaves, consumption of materials, and visits to the PCCs. Between 04/2023-03/2024, improvement actions were implemented: purchasing plan, use of Chemical Indicators (CHI) and Biological Indicators (BI), training with prior knowledge surveys, work procedure, and processes traceability.

Results

In total 11 autoclaves were acquired. The percentage of BI completion was ≥ 45%, and 80% of professionals were trained. The following improvements were obtained: detergent technical data sheet in the washing Area (45% to 73%), sterilization dates traceability (10% to 78%), sterilization cycles traceability (11% to 66%), use of instrument brush (55% to 74%), bag labeling (45% to 68%), correct storage (45% to 78%), and use of tap water to generate steam (2% to 0%).

Conclusions

The implementation of an improvement cycle, through the training of professionals, standardization of procedures, and traceability of processes, in addition to having an expert nurse as a reference, increases the quality in the reprocessing of medical devices.

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引用次数: 0

Experiencias, percepciones y emociones de los pacientes crónicos hospitalizados tras un programa de intervencion musical

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-02 DOI: 10.1016/j.jhqr.2025.101121

L. Ortiz de Villacián-Fernández , I. Apraiz-Sánchez , N. Martínez-Domínguez , A. Picón-Santamaría , S. Ballesteros-Peña

Aim

Musical interventions for hospitalized patients have shown benefits such as improved mood and reduced stress, but their impact from a qualitative perspective is under-explored. This study aimed to understand the experiences, perceptions, and emotions of chronically ill hospitalized patients who participated in a program of individual micro-concerts during their hospital stay.

Methodology

A qualitative study was conducted in a hospital in Bilbao, Spain, in 2024. Hospitalized patients were offered 20-minute micro-concerts three times a week. Semi-structured interviews were conducted with 21 patients selected through purposive sampling. The interviews were transcribed and analyzed inductively to identify thematic patterns.

Results

The analysis identified four categories. The first was emotional and cognitive well-being, where patients reported improvements in mood and cognitive stimulation. The second category, the operational aspects of the intervention, highlighted the positive perception of the frequency, duration, and personalization of the sessions. The third category was personal evaluation, where the role of the music therapist was highlighted as a key factor in the success of the intervention. Finally, suggestions for improvement included recommendations to extend the program to other areas of the hospital and combine musical interventions with complementary activities.

Conclusions

Personalized musical interventions have a positive impact on the emotional and cognitive well-being of patients. It is essential to design flexible interventions that adapt to individual needs and promote integrated care models.

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引用次数: 0

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