Journal of Healthcare Quality Research最新文献

Introduction: Enhanced recovery program (ERAS program) have revolutionized the world of surgery by reducing postoperative complications and hospital stays. Greater adherence to the protocol results in better outcomes; however, adherence often declines over time. The main objective of this study is to analyze the adherence rate to ERAS strategies and the outcomes of an ERAS colorectal (CRC) program five years after its implementation.

Methodology: This is a descriptive observational study comparing two groups of patients undergoing scheduled CRC surgery under an ERAS program at University Hospital. The first group (ERAS) includes patients operated on during the period immediately following the implementation of the protocol (January 2017-June 2018), while the second group (ERAS 5) includes patients operated on five years after the implementation (January 2022-June 2022).

Results: An increase in the adherence rate to ERAS strategies was observed (88.2% in ERAS vs. 84.2% in ERAS 5, p 0.003), as well as a reduction in healthcare-associated infections (HAIs) (9% in ERAS vs. 25.2% in ERAS 5, p 0.001) and surgical site infections (6% in ERAS vs. 18.2% in ERAS 5, p 0.002). No differences were found in other postoperative complications, functional recovery, average length of stay, and readmission rates.

Conclusions: After five years of implementing an ERAS protocol for CRC in our hospital, we have managed to maintain a high adherence rate to ERAS strategies. There has been a significant reduction in HAIs and surgical site infections.

Objective: To assess whether or not the new appointment management system for hospital outpatient consultations, implementing the use of «mailboxes» (computerized appointment system, based on ideal date), improves adherence to appointments or not.

Method: Before-after study, in which the degree of patient adherence to hospital outpatient appointments is compared, before and after the change in the appointment process (period 2014-2018 vs. year 2022). Statistical analysis was performed with Stata v17.

Results: Adherence to consultations (percentage of consultations performed) remained stable in all years of the period 2014-2018, with an average value of 91%, and increased to 93% in 2022. All characteristics of the consultations were shown to be associated with adherence, but in the multivariate model sex, age group, setting, hospital, functional area and type of activity were significant.

Conclusion: The change made in the appointment management system of hospital outpatient clinics in the Health Area of Santiago de Compostela and Barbanza has proven effective in improving adherence to the consultation. The reduction in the number of absences from consultations reduces waiting lists and improves patient care.

Governance and management, two terms that are barely understood, are precisely defined, and measured. They explain a very important part of the difference between countries, systems, and organizations. Also, in healthcare. The article devotes much attention to the indicators that address the quality of the rules of the game of society, its institutions, showing how the judgment about one or another form of social organization depends on more than one dimension. The good Spanish health system, with a poor prognosis due to its sclerosis of supply and flight to the private sector, needs to be depoliticized and debureaucratized so that the solvency of the health response provides the majority vote necessary for the sustainability of the welfare state. The entire text uses real examples and lands in the Spanish reality, finally distinguishing between what we can influence as citizens and what we as professionals are responsible for.

Introduction: The culture of patient safety is reflected in the behavior of individuals within a healthcare organization, based on knowledge, beliefs, and values aimed at minimizing the harm that patients might suffer. Assessing the perception of safety culture helps in developing and implementing improvement actions.

Materials and methods: A descriptive study conducted in two phases. A patient safety culture questionnaire measuring three dimensions of the safety culture was administered, and improvement actions were developed based on the results.

Results: 300 responses were obtained, with a response rate of 10.2%. 70% were women, 40% were physicians, and 38% were nurses. 37% reported having worked at the hospital for more than 20years. The management support for patient safety dimension received 33% (CI: 29.5-35.7) of positive responses and 27% (CI: 24.3-30.2) of negative responses. The patient safety perception dimension received 67% (CI: 63.8-70.01) of positive responses and 20% (CI: 17.4-22.8) of negative responses. The supervisor/department head support for patient safety dimension received 61% (CI: 57.4-63.9) of positive responses and 19% (CI: 16.3-21.5) of negative responses. After presenting the results to the management team, improvement actions were proposed, which led to greater commitment from the management team to patient safety, increased presence during patient safety rounds, and greater visibility of patient safety-related information available on the intranet.

Conclusions: A low perception of management support was detected, allowing for improvements in this dimension.

Introduction and objectives: The medicine development demonstrates that the traditional bioethical medical care model is not the most adequate. On the other hand, the person-centered clinical method has been winning more space in the medical practice, since it is a humanized method of care that allows best results. In pediatrics, the patient-centered care works a little bit different, since it requires not only the physician-patient relation, but also the integration of the physician-family-patient relation. Thus, the patient-centered care in the pediatric area is understudied, as well as little practiced. In this context, this review has the objective to exposure the actual scenario of the patient-centered care in pediatrics.

Materials and methods: This is a scoping review carried out from the standards of Jonna Briggs Institute (JBI). The database PubMed, Science Direct and BVS were used to search studies between 2012 until 2024. The research was performed with the descriptors "Medicine", "Shared DecisionMaking", "Pediatrics", "Physician-PatientRelations" and "Patient-CenteredCare".

Results: The research identified 27,272 articles, along with 79 met the criteria and were included. Each article was analyzed and allocated in the four pillars of the patient-centered care, which was described and related with the pediatric clinic.

Conclusions: The patient-centered care brings benefits to medical care, especially in the pediatric area. Among them, stands out the increased adherence to treatment, the lowest rates of medical errors, the greater integration of the interprofessional team, the more individual and patient-sensitive investigation, as well as the respect of beliefs and desires, making the results obtained better.

Background and aim: Measuring patient-reported experience measures (PREMs) is essential for the continuous improvement of quality. This study aims to assess the quality perceived by patients in the key care processes of an integrated health area measuring PREM elements, with the goal of identifying opportunities for improvement.

Methods: The research was conducted in the first half of 2023 within a Spanish integrated health area, analysing five key healthcare processes: Primary Care, Emergency Services, Hospitalisation, Consultations, and Surgery. To assess perceived quality, PREM elements such as accessibility, information, and professionalism were measured using the Net Promoter Score (NPS). The Lot Quality Assurance Sampling (LQAS) method was employed to identify specific areas for improvement by detecting rejected lots and optimising sample sizes.

Results: Although the perceived quality was generally high, with good or excellent NPS scores, significant variability was observed between processes. A total of 104 rejected lots (21%) were identified across the processes evaluated. The highest number of rejections occurred in and Emergency Services (67%), with notable issues in accessibility and information.

Conclusions: The study underscores the need for targeted interventions in accessibility and information to enhance the patient experience, particularly in Primary Care and Emergency Services. The measurement of PREM elements using NPS, in conjunction with the LQAS method, proves to be an effective tool for identifying and prioritising areas for improvement, especially when applied on a regular basis.

Objective: To evaluate levels of humanization, professional quality of life, resilience, communication skills, and the use of silence among healthcare professionals in these areas.

Methods: Observational, cross-sectional, and descriptive study conducted in a referral hospital. Data were collected from 152 healthcare professionals through questionnaires assessing professional quality of life (ProQOL), resilience (CD-RISC), humanization (HUMAS), communication skills (EHC-PS), and the use of silence (Q-SPS).

Results: The median age of the professionals was 42 years. They showed moderate levels of compassion satisfaction and resilience (means=23.47 and 29.96) but low levels of humanization (mean=66.09). Emotional exhaustion was significant among physicians (mean=19.19, P=.022), while radiotherapy technicians excelled in empathy (mean=27.33). Significant correlations were observed between compassion satisfaction and optimism (Rho=0.2017, P=.0127), and between productive silence and communication skills (Rho=0.3131, P=.0001).

Conclusions: Strengthening emotional and communication competencies is essential. Interventions should focus on reducing compassion fatigue and enhancing the well-being of healthcare professionals, improving care quality for oncohematology and radiotherapy patients.