Journal of Healthcare Quality Research最新文献_第5页

Analysis of the accuracy of clinical diagnosis in an internal medicine department of a regional hospital: Inter-MONF study 某地区医院内科临床诊断准确性分析：Inter-MONF研究

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-05-14 DOI: 10.1016/j.jhqr.2025.101142

S. Hernández-Dorta , I. Izuzquina-Avanzini , A. Lobelle-Seijas , I. Fernández-Uzquiano , L. Ramos-Rúa , J. López-Castro

Introduction

There are numerous studies examining the diagnostic accuracy of various supplementary tests; however, the literature focused on diagnostic accuracy derived from clinical reasoning and data is limited. Consequently, we conducted a study to assess the diagnostic accuracy of the professionals in the Internal Medicine Department at our hospital and to examine whether there are variations in accuracy related to specific pathologies and across different time periods, particularly before and after the emergence of the SARS-CoV-2 pandemic.

Methods

This is a retrospective, longitudinal, and observational study conducted in the Internal Medicine Department of the Regional Hospital of Monforte de Lemos from 2016 to 2022, encompassing both pre- and post-SARS-CoV-2 pandemic periods. The initial diagnosis made upon patient admission was compared with the final diagnosis at discharge through an independent peer review process.

Results

The diagnostic concordance at admission and discharge was 77.4%, with statistically significant differences observed between age groups (with higher concordance in patients under 55 years of age) and according to sex, with greater concordance in female patients. No differences were found regarding pathology type or temporal cohort.

Conclusions

The diagnostic accuracy of the healthcare professionals in the Internal Medicine Department at Monforte Public Hospital during the study periods was found to be high. Diagnostic concordance was greater in female patients and those under 55 years of age, with no significant differences observed across the most prevalent pathological conditions. Furthermore, the restrictive measures implemented during the SARS-CoV-2 pandemic do not appear to have negative affected diagnostic accuracy when compared to previous periods.

有许多研究检查各种补充测试的诊断准确性；然而，文献集中于诊断准确性来源于临床推理和数据是有限的。因此，我们进行了一项研究，以评估我院内科专业人员的诊断准确性，并检查与特定病理相关的准确性是否存在差异，并在不同的时间段内，特别是在SARS-CoV-2大流行出现之前和之后。方法本研究是一项回顾性、纵向和观察性研究，于2016年至2022年在Monforte de Lemos地区医院内科进行，包括sars - cov -2大流行前后的时期。通过独立的同行评审过程，将患者入院时的初步诊断与出院时的最终诊断进行比较。结果入院和出院时诊断符合率为77.4%，不同年龄组（55岁以下患者符合率较高）、不同性别（女性患者符合率较高）差异均有统计学意义。在病理类型和时间队列方面没有发现差异。结论蒙福特公立医院内科医护人员在研究期间的诊断准确率较高。诊断一致性在女性患者和55岁以下患者中更高，在最常见的病理状况中没有观察到显著差异。此外，与以前的时期相比，在SARS-CoV-2大流行期间实施的限制性措施似乎没有对诊断准确性产生负面影响。

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引用次数: 0

Assessing patient satisfaction and identifying areas for improvement in gynecological care across various healthcare settings at a tertiary teaching hospital in Pakistan: A cross-sectional study 评估患者满意度并确定巴基斯坦一家三级教学医院各种医疗保健环境中需要改进的妇科护理领域：一项横断面研究

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-05-06 DOI: 10.1016/j.jhqr.2025.101132

S.I. Memon , A. Aijaz , R. Jameel , M. Shafique , Y. Khan

Objectives

Patient satisfaction is a key indicator of healthcare quality and essential for improving hospital services. This study aimed to assess patient satisfaction and to identify areas for improvement in gynecological care across inpatient, outpatient, and emergency settings.

Material and methods

We conducted a descriptive, cross-sectional study among 587 gynecological patients at a tertiary care teaching hospital in Karachi, Pakistan. We assessed multiple dimensions of patient care, such as doctor satisfaction, nursing care, housekeeping services, and value for money using simple random sampling. We used a standard questionnaire to gauge patient satisfaction with care and analyzed the data using Statistical Package for the Social Sciences (SPSS) version 21. We considered a p-value of less than 95% to be statistically significant.

Results

The analysis revealed high satisfaction rates across all service areas. Doctor satisfaction scored the highest at 95.4% (95% CI: 0.929–0.978, p < 0.0001), followed by value for money at 90.4% (95% CI: 0.870–0.939, p < 0.0001). Housekeeping and nursing care were rated 86.2% (95% CI: 0.821–0.902, p < 0.0001) and 83.3% (95% CI: 0.790-0.877, p < 0.0001), respectively. The hospital achieved a 98.9% recommendation rate, with 54.3% rating their experience as “Excellent,” 36.9% as “Good,” 7.8% as “Average,” and only 1.1% as “Bad.”

Conclusions

This study highlights high patient satisfaction in gynecological services, reflected in strong recommendations and positive feedback. While physician care is well-rated, improvements in nursing and housekeeping through enhanced communication are needed. These findings support quality enhancement efforts, fostering a blame-free culture and setting a benchmark for similar institutions in Pakistan.

目的患者满意度是衡量医疗服务质量的重要指标，对提高医院服务质量至关重要。本研究旨在评估患者满意度，并确定住院、门诊和急诊妇科护理的改进领域。材料和方法我们对巴基斯坦卡拉奇一家三级护理教学医院的587名妇科患者进行了一项描述性横断面研究。我们使用简单的随机抽样评估了患者护理的多个维度，如医生满意度、护理、家政服务和物有所值。我们使用标准问卷来衡量患者对护理的满意度，并使用社会科学统计软件包（SPSS）第21版分析数据。我们认为p值小于95%具有统计学意义。结果分析显示，所有服务领域的满意度都很高。医生满意度最高，为95.4% (95% CI: 0.929-0.978, p <；0.0001)，其次是物有所值，为90.4% (95% CI: 0.870-0.939, p <；0.0001)。家政和护理评分为86.2% (95% CI: 0.821-0.902, p <；0.0001)和83.3% (95% CI: 0.790-0.877, p <；分别为0.0001)。该医院的推荐率达到了98.9%，其中54.3%的人认为他们的体验是“优秀”，36.9%的人认为是“良好”，7.8%的人认为是“一般”，只有1.1%的人认为是“糟糕”。结论本研究突出了患者对妇科服务的高满意度，表现为强烈的推荐和积极的反馈。虽然医生的护理得到了很好的评价，但需要通过加强沟通来改进护理和家务管理。这些发现支持了提高质量的努力，培养了一种没有指责的文化，并为巴基斯坦的类似机构树立了一个基准。

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引用次数: 0

Beyond administration: The essential role of medical secretaries in the quality of clinical hospital service 超越管理：医务秘书在医院临床服务质量中的重要作用

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-05-05 DOI: 10.1016/j.jhqr.2025.101122

L.M. Ortega , M. Redondo , D. Martín-García

引用次数: 0

The weekend effect in hip fracture: The critical role of resource management 髋部骨折的周末效应：资源管理的关键作用

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Healthcare Quality Research

Pub Date : 2025-04-28 DOI: 10.1016/j.jhqr.2025.101131

J.C. Segura-Nuez , M. Infantes-Morales , A. García-Hernández , J. Segura-Nuez , C. Martín-Hernández , A. Roche-Albero

Introduction and objectives

The “weekend effect” refers to patients admitted at the end of the week who cannot undergo surgery until the beginning of the following week. The objective is to study the relationship between admission on a specific day of the week and the time to surgery.

Material and methods

A retrospective analytical study was conducted, including consecutive patients over 65 years old with a diagnosis of hip fracture admitted to Miguel Servet University Hospital from March 1 to October 31, 2023. Data such as admission day, age, sex, type of fracture, anticoagulant or antiplatelet therapy, and time to surgery were collected. A multivariate analysis was performed to investigate the factors influencing the time to surgery.

Results

A total of 348 patients were included. The average time to surgery for patients admitted on Monday was 2.04 days; Tuesday, 2.06; Wednesday, 2.14; Thursday, 2.94; Friday, 3.24; Saturday, 2.91; and Sunday, 2.17. The multivariate analysis showed that admission on Thursday (p < 0.001), Friday (p < 0.001), or Saturday (p < 0.001) increased the time to surgery compared to admission on Monday. Treatment with vitamin K antagonists (p = 0.006) and direct oral anticoagulants (p < 0.001) also delayed surgery. Subcapital fractures were treated later than basicervical (p = 0.039), pertrochanteric (p = 0.018), and subtrochanteric (p = 0.028) fractures.

Conclusion

In our center, admission on Thursday, Friday, or Saturday significantly increased the time to surgery compared to Monday. This may increase hospital costs and the potential complications related to surgical delay.

“周末效应”是指在周末入院的患者要到下周初才能接受手术。目的是研究一周中某一天入院与手术时间之间的关系。材料与方法回顾性分析研究，纳入Miguel Servet大学医院于2023年3月1日至10月31日连续收治的65岁以上髋部骨折患者。收集入院日期、年龄、性别、骨折类型、抗凝或抗血小板治疗、手术时间等资料。对影响手术时间的因素进行多因素分析。结果共纳入348例患者。周一入院的患者平均手术时间为2.04天；周二,2.06;周三,2.14;周四,2.94;周五,3.24;周六,2.91;周日2点17分。多因素分析显示，周四入院(p <；0.001)，星期五(p <；0.001)，或周六(p <；0.001)，与周一入院相比，手术时间增加了。服用维生素K拮抗剂（p = 0.006）和直接口服抗凝剂(p <；0.001)也延迟了手术。肱骨下骨折的治疗时间晚于基础颈骨折（p = 0.039）、粗隆下骨折（p = 0.018）和粗隆下骨折（p = 0.028）。结论在我中心，与周一相比，周四、周五或周六住院的患者手术时间明显增加。这可能会增加医院费用和与手术延误相关的潜在并发症。

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引用次数: 0

La experiencia de los cuidadores no profesionales de pacientes crónicos 慢性病人的非专业护理人员的经验

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 提高全髋关节置换术的效率

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.

目的评价精益六西格玛方法在晨间全髋关节置换术中提高手术效率的应用，并分析提高手术室效率所面临的挑战。方法在某公立大学附属医院进行干预前后分析的准实验研究。进行了多学科会议和对前一年的回顾性分析，以确定改进点。学习时间：2023年6月至12月，周一和周四上午模块计划24次。实施的措施包括选择低复杂性的病例，尽早开始手术，优化转换时间，以及使用提高效率的系统。结果证实了一个上午进行三次手术的可行性，72%的病例手术时间在90分钟以内。尽管失去了四个月的手术室模块，但仍实现了67%的拟议目标。第一次手术平均开始时间由9:23±54 min提高到8:32±22 min，每个模块平均操作数由1.76个增加到2.79个。平均转换时间从29±12分钟减少到18±12分钟。结论精益六西格玛方法使髋关节置换术的手术室效率提高了50%。识别易于修改的止塞器对于成功实施临床过程的改进至关重要。需要进一步的研究来解决术后临床过程中发现的挑战，并确保持续的过程优化。

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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.

目的描述在当值期间，医生未知的患者决定停止和撤销维持生命治疗和姑息性镇静的频率。方法对西班牙内科医师进行观察性研究（调查）。结果273项调查。在他们不认识的患者中，95.2%的患者在随叫随到时决定是否应该进入重症监护病房，89%的患者决定是否开始镇静。最被确定为“侵略性”的措施：入住重症监护病房、使用侵入性技术、心肺复苏和侵入性治疗。48.4%的医生是作为团队决定开始镇静的，10人中有4人没有咨询患者。癌症患者（73%）、心力衰竭患者（60.4%）和慢性阻塞性肺疾病患者（58%）最常计划做决定。结论：在值班期间，几乎所有内科医生都要决定是否将病人送进重症监护室或是否给未知病人注射镇静剂。癌症患者的决定更多是计划好的。镇静的决定通常是由一个团队做出的，通常不征求病人的意见。

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引用次数: 0

Data: Europe's own path in artificial intelligence 数据：欧洲自己的人工智能之路

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 医疗保健专业人员的组织福利

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.

结直肠手术后的重大并发症（MC）并不罕见，并可能对患者的生存造成严重后果。抢救失败（Failure to rescue， FTR）是衡量MC正确管理能力的指标，以出现MC的患者中死亡的人数计算。方法观察性研究，回顾性分析2012年9月至2016年8月在西班牙某大学医院接受结肠癌手术的所有患者。记录术前、术中、术后各项指标。术后并发症Clavien-Dindo评分；结果共纳入564例患者，其中140例（24.8%）出现MC，其中22例死亡，FTR率为15.7%。MC患者的平均年龄为69.6岁，其中30.7%为女性。81.4%的患者采用开放入路。与存活组相比，非存活组ASA III级和IV级比例更高（P = 0.008），平均年龄更高（P = 0.001），吻合口漏比例更高（P = 0.009）。多因素分析证实年龄(OR 1.161；P = 000)，吻合口漏(OR 18；P = 0.001)和除吻合口漏或腹腔内收集外的脓毒症(or 26；P = 0.001)与FTR作为独立因素显著相关。结论本组结肠切除术后FTR发生率与其他组相近或略低。年龄、吻合口漏和非腹腔脓毒症是与FTR相关的独立因素。我们认为，FTR是一个很好的指标，一个中心解决MC的能力。它是特别有用的实施措施，以确保有效治疗MC。

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引用次数: 0