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Group Antenatal Care Start-Up in the Indian Private Sector: An Implementation Journey to Improve Quality of Care. 印度私营部门的集体产前护理启动:提高护理质量的实施之旅》。
Pub Date : 2024-11-01 DOI: 10.36401/JQSH-24-5
Tara Danielle Kinra, Vanisree Ramanathan, Chinmay Pramod Umarji, Peg Dublin, Sharon Schindler Rising

Introduction: The introduction of the innovative group antenatal and postnatal care model into the private health sector in India has the potential to pivot the experiences of families during pregnancy and beyond. Growing evidence worldwide shows this model moves fragmented healthcare systems toward a more integrated model to improve quality in care and outcomes for mothers and children. The aim of this study was to better understand the challenges and benefits of implementation of the group model of antenatal care in the Indian private health sector for the purpose of improving quality of care.

Methods: Through a collaborative innovation project led by a master's student of public health and an international organization with expertise in implementing this model, an urban 35-bed private hospital in Pune was identified with readiness to explore the model with stakeholders, train hospital staff as facilitators, and initiate group antenatal care. Semi-structured interviews with facilitators, along with feedback from participants in cohorts and observation of the groups by the trainer, were done for qualitative analysis of themes related to the strengths and barriers in implementing the model.

Results: A total of 31 pregnant women participated in two cohorts over their second to third trimesters for group antenatal care with a team of three facilitators from November 2022 to June 2023. On review of experiences in implementing the model, the top strengths demonstrated were meeting of felt needs of the participants, high engagement, and relative advantage of the model. Challenges for implementation included for scheduling and attendance, adapting the model for compatibility, capacity-building, and need for more ongoing planning, monitoring, and evaluation.

Conclusions: Through this innovation project, important lessons were learned for robust planning for a future pilot study. Patient-centered and integrated antenatal care are markers of quality of care that this group model can bring not only in the private healthcare sector but throughout India.

导言:印度私营医疗机构引入创新的产前和产后集体护理模式,有可能改变家庭在怀孕期间及以后的经历。世界范围内越来越多的证据表明,这种模式将分散的医疗保健系统转变为更加综合的模式,从而提高了护理质量,改善了母婴护理效果。本研究旨在更好地了解在印度私营医疗机构实施产前护理小组模式的挑战和益处,以提高护理质量:方法:通过由一名公共卫生硕士研究生和一家在实施该模式方面具有专长的国际组织共同领导的合作创新项目,确定了普纳一家拥有 35 张床位的城市私立医院,该医院已准备好与利益相关者共同探讨该模式,培训医院员工作为促进者,并启动集体产前护理。对主持人进行了半结构化访谈,同时还听取了各组参与者的反馈意见,并由培训师对各组进行了观察,对与实施该模式的优势和障碍有关的主题进行了定性分析:从 2022 年 11 月到 2023 年 6 月,共有 31 名孕妇在第二至第三个孕期参加了由三名培训师组成的两组产前护理小组。在回顾该模式的实施经验时,最大的优点是满足了参与者的需求、参与度高以及该模式的相对优势。实施过程中面临的挑战包括时间安排和出勤率、调整模式以实现兼容性、能力建设以及需要更多的持续规划、监测和评估:结论:通过这一创新项目,我们吸取了重要的经验教训,为今后的试点研究提供了有力的规划。以病人为中心的综合产前护理是优质护理的标志,这种小组模式不仅可以在私营医疗部门,而且可以在整个印度推广。
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引用次数: 0
Accreditation Made Easy: Step-by-Step Guide for Healthcare Institutions. 评审易行:医疗机构分步指南》(Accreditation Made Easy: Step-by-Step Guide for Healthcare Institutions)。
Pub Date : 2024-10-10 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-X5
Ahmed Newera, Fahad Khamis Alomari, Abdullah Muhammad Al-Ghamdi, Mohammed Fouda
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引用次数: 0
Summary of the 5th International Pharmacoeconomics Forum. 第五届国际药物经济学论坛摘要。
Pub Date : 2024-09-25 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-X6
Francisco Nuno Rocha Gonçalves
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引用次数: 0
Prescribing Errors in an Ambulatory Care Setting: Mitigating Risks in Outpatient Medication Orders, Cross-Sectional Review. 门诊护理环境中的处方错误:降低门诊用药单中的风险,横断面回顾。
Pub Date : 2024-09-03 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-2
Wesam S Abdel-Razaq, Ghada Mardawi, Aiman A Obaidat, Lama Aljahani, Maram Almutairi, Reham Almotiri, Nataleen A Albekairy, Tariq Aldebasi, Abdulkareem M Albekairy, Mohammad S Shawaqfeh

Introduction: Prescribing errors (PEs) are the most common type of medication error, which may occur by prescribing the wrong medication, improper dose, dosage, and/or even prescribing a drug to the wrong patient. The present study aims to compile PEs that were generated in an ambulatory care setting at a tertiary-care hospital in Saudi Arabia.

Methods: A retrospective cross-sectional review was conducted for all reported PEs in ambulatory care clinics for 3 years. The potential hazardous outcomes of these PEs were classified according to the medication error index.

Results: A total of 897 records containing 1199 PEs were retrieved. More than a third of prescribers had frequently committed PEs-ranging from 2 to 39 times. The most encountered errors were prescribing incorrect doses, medication duplication, incorrect dosing frequency, and inappropriate duration (34.5%, 14.1%, 11.6%, and 9.8%, respectively). The most frequent mistakes were when prescribing antibiotics (22.9%) and drugs for cardiovascular conditions (18.5%). Most errors were of mild to moderate severity, mostly type-B near-miss errors and did not reach patients. Only two prescription events (0.17%) had severe consequences that required intervention to avoid any subsequent harm or damage.

Conclusion: The current investigation has revealed a substantial percentage of PEs, mostly in internal medicine and cardiology departments. Although PEs are undoubtedly not easy to avoid, monitoring and recognizing these inaccuracies is pivotal to preventing potential harm and promoting patient safety.

导言:处方错误(PEs)是最常见的用药错误类型,可能通过开错药、不适当的剂量、用法和/或甚至给错误的病人开药而发生。本研究旨在对沙特阿拉伯一家三级医院门诊护理环境中发生的用药错误进行汇编:方法:对门诊护理诊所 3 年内报告的所有 PE 进行了回顾性横断面审查。根据用药错误指数对这些 PE 的潜在危险结果进行了分类:结果:共检索到 897 份记录,其中包含 1199 例 PE。超过三分之一的处方者经常发生 PE,次数从 2 次到 39 次不等。最常见的错误是处方剂量错误、用药重复、用药频率错误和用药时间不当(分别占 34.5%、14.1%、11.6% 和 9.8%)。最常见的错误是开抗生素(22.9%)和治疗心血管疾病的药物(18.5%)。大多数错误的严重程度为轻度至中度,多为 B 类近乎失误的错误,且未波及患者。只有两起处方事件(0.17%)造成了严重后果,需要进行干预以避免任何后续伤害或损害:目前的调查显示,PE 占了相当大的比例,主要发生在内科和心内科。尽管 PE 无疑不容易避免,但监测和识别这些不准确性对于防止潜在伤害和促进患者安全至关重要。
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引用次数: 0
Community Health Needs Assessment of Primary Healthcare in Saudi Arabia: A Cross-Sectional Study. 沙特阿拉伯初级医疗保健的社区健康需求评估:横断面研究。
Pub Date : 2024-09-03 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-13
Abderrahmane Derkaoui, Sami A AlShammary, Yacoub Abuzied, Alanoud Alshalawi, Yahya AlAsseri, Khalil Alshammari, Khalid I Alqumizi, Ahmad Bin Nasser

Introduction: Continuous assessment of community health needs is essential to predict, recognize, and act on healthcare issues. Conducting community health needs assessments (CHNAs) in Saudi Arabia has become a priority to overcome the current healthcare challenges and keep pace with the Saudi Arabia 2030 vision. Studies reporting community health needs in Saudi Arabia regions are limited despite the high incidence of chronic diseases. This study aims to understand the community's health problems and the range of healthy behaviors and determine the priority health problems.

Methods: We conducted a cross-sectional study based on the adults in Primary Health Care Centers in Hail, Northern Saudi Arabia, by using the CHNA standard questionnaire. In addition to the demographic information, the questionnaire collects data on personal health status, the health status of adults and children, health facilities access information, receiving of healthcare procedures, traveling for healthcare, source of medical information, safety measures and behaviors, health problems, childcare (special needs), and perceived community problems.

Results: In all, 336 individuals were approached to participate in this study; 303 agreed to participate (response rate: 90%). The analysis comprised 276 individuals after eliminating 27 who did not fulfill the age inclusion criteria or had missing gender data. Of these, 107 (38.8%) were men and 169 (61.2%) were women. Our data revealed that almost half of the participants, 135 (52.9%) constantly or 107 (42%) occasionally, were able to visit the doctors when needed.

Conclusion: Our findings reported positive health behaviors and good accessibility to healthcare services when needed. However, the study findings also revealed healthcare challenges that required urgent action from Hail healthcare leaders. Developing healthcare strategies, screening/prevention programs, and changing healthcare policies in the Hail region are needed to control and prevent health problems and improve the population's health.

导言:持续评估社区健康需求对于预测、认识和解决医疗保健问题至关重要。在沙特阿拉伯,开展社区健康需求评估(CHNAs)已成为克服当前医疗保健挑战、跟上沙特阿拉伯 2030 愿景步伐的当务之急。尽管慢性病的发病率很高,但报告沙特阿拉伯地区社区健康需求的研究却很有限。本研究旨在了解社区的健康问题和健康行为范围,并确定重点健康问题:我们使用 CHNA 标准问卷对沙特阿拉伯北部海尔初级卫生保健中心的成年人进行了横断面研究。除人口统计学信息外,问卷还收集了有关个人健康状况、成人和儿童健康状况、医疗设施使用信息、接受医疗程序、医疗旅行、医疗信息来源、安全措施和行为、健康问题、儿童保育(特殊需求)以及感知的社区问题等方面的数据:本研究共接触了 336 人,其中 303 人同意参与(回复率:90%)。在剔除 27 名不符合年龄纳入标准或性别数据缺失的受访者后,共有 276 人参与了分析。其中 107 人(38.8%)为男性,169 人(61.2%)为女性。我们的数据显示,几乎一半的参与者(135 人(52.9%)经常或 107 人(42%)偶尔能够在需要时去看医生:我们的研究结果表明,参与者的健康行为是积极的,在需要时能够很好地获得医疗服务。然而,研究结果也揭示了医疗保健方面的挑战,需要海尔医疗保健领导者采取紧急行动。海尔地区需要制定医疗保健战略、筛查/预防计划,并改变医疗保健政策,以控制和预防健康问题,提高人口健康水平。
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引用次数: 0
Would Artificial Intelligence Improve the Quality of Care of Patients With Rare Diseases? 人工智能能否提高罕见病患者的护理质量?
Pub Date : 2024-08-02 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-X3
Hana J Abukhadijah, Abdulqadir J Nashwan
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引用次数: 0
Transforming Hospital Quality Improvement Through Harnessing the Power of Artificial Intelligence. 通过利用人工智能的力量改进医院质量。
Pub Date : 2024-08-01 DOI: 10.36401/JQSH-24-4
Hana J Abukhadijah, Abdulqadir J Nashwan

This policy analysis focuses on harnessing the power of artificial intelligence (AI) in hospital quality improvement to transform quality and patient safety. It examines the application of AI at the two following fundamental levels: (1) diagnostic and treatment and (2) clinical operations. AI applications in diagnostics directly impact patient care and safety. At the same time, AI indirectly influences patient safety at the clinical operations level by streamlining (1) operational efficiency, (2) risk assessment, (3) predictive analytics, (4) quality indicators reporting, and (5) staff training and education. The challenges and future perspectives of AI application in healthcare, encompassing technological, ethical, and other considerations, are also critically analyzed.

本政策分析侧重于在医院质量改进中利用人工智能(AI)的力量来改变质量和患者安全。它研究了人工智能在以下两个基本层面的应用:(1) 诊断和治疗;(2) 临床操作。人工智能在诊断方面的应用直接影响到患者护理和安全。同时,人工智能通过简化(1)操作效率、(2)风险评估、(3)预测分析、(4)质量指标报告以及(5)员工培训和教育,间接影响临床操作层面的患者安全。此外,还对人工智能在医疗保健领域应用的挑战和未来前景进行了批判性分析,包括技术、伦理和其他方面的考虑。
{"title":"Transforming Hospital Quality Improvement Through Harnessing the Power of Artificial Intelligence.","authors":"Hana J Abukhadijah, Abdulqadir J Nashwan","doi":"10.36401/JQSH-24-4","DOIUrl":"10.36401/JQSH-24-4","url":null,"abstract":"<p><p>This policy analysis focuses on harnessing the power of artificial intelligence (AI) in hospital quality improvement to transform quality and patient safety. It examines the application of AI at the two following fundamental levels: (1) diagnostic and treatment and (2) clinical operations. AI applications in diagnostics directly impact patient care and safety. At the same time, AI indirectly influences patient safety at the clinical operations level by streamlining (1) operational efficiency, (2) risk assessment, (3) predictive analytics, (4) quality indicators reporting, and (5) staff training and education. The challenges and future perspectives of AI application in healthcare, encompassing technological, ethical, and other considerations, are also critically analyzed.</p>","PeriodicalId":73170,"journal":{"name":"Global journal on quality and safety in healthcare","volume":"7 3","pages":"132-139"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
National Recommendations for Pharmacoeconomic Evaluations Reporting for Reimbursement and Procurement of New Pharmaceutical Applications in Egypt. 埃及新药申请报销和采购的药物经济评估报告国家建议》。
Pub Date : 2024-08-01 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-12
Mary Gamal, Amal Samir Sedrak, Gihan Hamdy Elsisi, Ahmed Elagamy, Ahmed Seyam, Mariam Eldebeiky, Randa Eldessoki

Introduction: To improve resource allocation within our healthcare system, the Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) and Universal Health Insurance Authority (UHIA) established a joint economic evaluation process to support UHIA reimbursement decisions and UPA procurement decisions. The main objective of this study is to describe the developed national pharmacoeconomic guidelines in Egypt, especially for reimbursement and procurement for new pharmaceuticals.

Methods: A focus group was formed as a national initiative activity by governmental authorities in Egypt. The aim of this focus group was to develop national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products. This group consisted of various stakeholders with experience in health economics, outcomes research, public health, and pharmacy practice. To develop our national pharmacoeconomic guidelines, three steps were taken. First, the focus group reviewed the European Network for Health Technology Assessment (EUnetHTA) methods for health economic evaluations for new pharmaceuticals as well as the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines and the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions. Second, the focus group used the EUnetHTA guideline as a reference and adapted it to our local context. The focus group added the value assessment component, using the CADTH and AMCP guidelines. Third, the focus group collected input and feedback from key stakeholders through a focus group by using the quasi-Delphi panel approach.

Results: The results of the focus group are a main structure of national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products, consisting of seven main topics.

Conclusion: Economic evaluation is a core element of Health Technology Assessment, (HTA); therefore, the UHIA and UPA were encouraged to produce unified joint pharmacoeconomic guidelines for innovative products as an initial step in their commitment to implement the use of HTA in decision-making. This standardization of guidelines not only ensures transparency but also guarantees an accurate and transparent process to support evidence-based decision-making. These guidelines are expected to help decision-makers improve their process and attain better health outcomes for Egyptian patients.

导言:为改善我国医疗系统的资源分配,埃及统一采购、医疗供应和医疗技术管理局(UPA)与全民健康保险管理局(UHIA)建立了联合经济评估程序,以支持全民健康保险管理局的报销决策和 UPA 的采购决策。本研究的主要目的是介绍埃及制定的国家药物经济学指南,尤其是用于新药报销和采购的指南:方法:作为埃及政府当局的一项全国性倡议活动,成立了一个焦点小组。方法:作为埃及政府当局的一项全国性倡议活动,成立了一个焦点小组,其目的是为评估创新和高预算药品制定国家药物经济学指南。该小组由具有卫生经济学、结果研究、公共卫生和药学实践经验的各利益相关方组成。为了制定国家药物经济学指南,我们采取了三个步骤。首先,焦点小组回顾了欧洲卫生技术评估网络 (EUnetHTA) 对新药品进行卫生经济学评估的方法,以及加拿大药品和卫生技术局 (CADTH) 的指导方针和管理保健药剂学学会 (AMCP) 的处方集提交格式。其次,重点小组将 EUnetHTA 指南作为参考,并根据本地情况进行了调整。焦点小组利用 CADTH 和 AMCP 指南增加了价值评估部分。第三,焦点小组采用准德尔菲小组方法,通过焦点小组收集主要利益相关者的意见和反馈:焦点小组的成果是用于评估创新和高预算药品的国家药物经济学指南的主要结构,包括七个主要议题:经济评估是卫生技术评估(HTA)的核心要素;因此,鼓励 UHIA 和 UPA 为创新产品制定统一的联合药物经济学指南,作为其承诺在决策中使用 HTA 的第一步。准则的标准化不仅确保了透明度,还保证了支持循证决策的过程准确、透明。预计这些准则将帮助决策者改进其程序,并为埃及患者带来更好的保健成果。
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引用次数: 0
Exploration of Mental Health and Well-Being of Healthcare Professionals During the COVID-19 Pandemic. 探讨 COVID-19 大流行期间医疗保健专业人员的心理健康和幸福感。
Pub Date : 2024-08-01 DOI: 10.36401/JQSH-23-47
Taurzhan K Aldabergenova, Anthony Abiodun Eniola, Bibi-Aisha Sh Orynbayeva, Feruza S Sarsenbayeva, Nurzhamal S Askarova, Sidikat Shitu

Introduction: In response to curbing the spread of SARS-CoV-2, healthcare professionals (HCPs) encounter a multitude of mental stresses. The primary intent was to explore the mental health and well-being experienced by HCPs in Ekiti State, Nigeria, amid the COVID-19 pandemic.

Methods: Data were analyzed using inductive qualitative methodology. The study was undertaken among HCPs in two teaching hospitals in Ekiti State during the SARS-CoV-2 outbreak. Convenience sampling techniques were employed to select participants for this study. A comprehensive interview ranging from 30 to 50 minutes per participant was administered to a sample of 14 HCPs (doctors and nurses) representing various departments within the hospital. The interviews were conducted between March 2020 and May 2020. COVID-19 stressful situations, the physiological consequences of stress, personality, disposition, stress management techniques, and coping mechanisms were evaluated.

Results: The study outcomes indicate that a significant proportion of HCPs currently face mental well-being. The primary sources of stress identified in this study included heavy workloads and pressure from social media platforms and government agencies. The outbreak crisis significantly influenced on their lives and work, with the fear of catching diseases and their anxiety about spreading infections to their loved ones.

Conclusions: HCPs require a secure working environment during the current circumstances, along with an enhanced support system to alleviate stressors. This study contributes to a significant proportion of HCPs currently facing stress.

简介在遏制 SARS-CoV-2 传播的过程中,医疗保健专业人员(HCPs)遇到了许多精神压力。研究的主要目的是探讨尼日利亚埃基蒂州的医护人员在 COVID-19 大流行期间所经历的心理健康和幸福感:采用归纳定性方法分析数据。研究对象是 SARS-CoV-2 爆发期间埃基蒂州两家教学医院的高级专业人员。本研究采用了便利抽样技术来选择参与者。对代表医院各部门的 14 名高级专业人员(医生和护士)进行了每人 30 至 50 分钟的综合访谈。访谈在 2020 年 3 月至 2020 年 5 月期间进行。对 COVID-19 压力情境、压力的生理后果、人格、性格、压力管理技巧和应对机制进行了评估:研究结果表明,目前有相当一部分住院医师面临精神压力。本研究确定的主要压力来源包括繁重的工作量以及来自社交媒体平台和政府机构的压力。疫情危机对他们的生活和工作产生了重大影响,他们害怕感染疾病,担心传染给亲人:结论:在当前情况下,卫生保健人员需要一个安全的工作环境,以及一个强化的支持系统来缓解压力。这项研究为目前面临压力的很大一部分高级保健人员提供了帮助。
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引用次数: 0
Obstacles and Challenges Affecting Quality Indicators in a Complex Tertiary Emergency Center. 影响复杂的三级急救中心质量指标的障碍和挑战。
Pub Date : 2024-07-31 eCollection Date: 2024-11-01 DOI: 10.36401/JQSH-24-10
Mohammad J Jaber, Alanoud A Bindahmsh, Mohammad A Abu Dawwas, Susanna E du Preez, Abeer M Alshodukhi, Ismail S Alateeq, Norah S Binti Abd Rahman

Introduction: Hospital performance is significantly affected by external factors (political and economic) rather than internal factors (effectiveness and efficiency). Emergency department (ED) overcrowding is a significant issue for emergency care services globally, characterized by a rising number of visits and persistent unsolved issues, resulting in increased challenges faced by ED staff and decreased patient satisfaction. This study aimed to explore the obstacles and challenges that cause variation in ED quality indicators (QIs) based on five domains: infrastructure, population, workflow, workforce, and administration.

Methods: A tertiary emergency center in Saudi Arabia administered a questionnaire with standardized measures to 180 nurses, using a cross-sectional descriptive design.

Results: Most nurses (75.5%) believed that crowded waiting rooms in the ED were the most influential factor affecting QIs. Many other challenges were identified, including bed capacity, triage area/workflow, increased volume during peak periods, demand for nonemergency visits, staff and shortages. Significant differences in nurses' responses were found on the basis of education level (for infrastructure only, p = 0.004), specialty (for nursing administration only, p = 0.052), and ED experience (for all variables, p = 0.008-0.039).

Conclusion: The analysis uncovered various critical aspects of infrastructure, workflow, population, workforce, and nursing administration that have a major effect on patient flow in the ED. Comprehending these aspects will greatly affect the quality measures of ED performance and assist policymakers in formulating strategic plans to enhance ED performance. Therefore, successful implementation and optimization of ED resources depend greatly on considering the right decision variables and resource restrictions.

引言医院绩效主要受外部因素(政治和经济)而非内部因素(效益和效率)的影响。急诊科(ED)人满为患是全球急诊服务面临的一个重大问题,其特点是就诊人数不断增加,问题长期得不到解决,导致急诊科工作人员面临更多挑战,患者满意度下降。本研究旨在探讨导致急诊室质量指标(QIs)差异的障碍和挑战,这些指标基于五个领域:基础设施、人口、工作流程、劳动力和管理:方法:沙特阿拉伯的一家三级急诊中心采用横断面描述性设计,对 180 名护士进行了标准化问卷调查:大多数护士(75.5%)认为,急诊室拥挤的候诊室是影响质量指标的最大因素。此外,还发现了许多其他挑战,包括床位容量、分诊区/工作流程、高峰期人流量增加、非急诊就诊需求、人员和短缺等。护士的回答在教育水平(仅针对基础设施,p = 0.004)、专业(仅针对护理管理,p = 0.052)和急诊室经验(针对所有变量,p = 0.008-0.039)方面存在显著差异:分析揭示了基础设施、工作流程、人口、劳动力和护理管理等对急诊室病人流量有重大影响的关键因素。了解这些方面将极大地影响急诊室绩效的质量衡量标准,并有助于决策者制定战略计划,提高急诊室的绩效。因此,成功实施和优化急诊室资源在很大程度上取决于考虑正确的决策变量和资源限制。
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引用次数: 0
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