Search results for: hospital management

Authors: Jalal Abdulkareem Sultan, Abdulhakeem Luqman Hasan

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With the development of health care systems competition, hospitals face more and more pressures. Meanwhile, resource allocation has a vital effect on achieving competitive advantages in hospitals. Selecting the appropriate number of beds is one of the most important sections in hospital management. However, in real situation, bed allocation selection is a multiple objective problem about different items with vagueness and randomness of the data. It is very complex. Hence, research about bed allocation problem is relatively scarce under considering multiple departments, nursing hours, and stochastic information about arrival and service of patients. In this paper, we develop a fuzzy multiobjective bed allocation model for overcoming uncertainty and multiple departments. Fuzzy objectives and weights are simultaneously applied to help the managers to select the suitable beds about different departments. The proposed model is solved by using Artificial Bee Colony (ABC), which is a very effective algorithm. The paper describes an application of the model, dealing with a public hospital in Iraq. The results related that fuzzy multi-objective model was presented suitable framework for bed allocation and optimum use.

Keywords: bed allocation problem, fuzzy logic, artificial bee colony, multi-objective optimization

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Authors: S. Kurt, B. C. Demirbag

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Meeting employees’ expectations from an organization physically and mentally is a result of one’s assessing his or her work and its environment as well as his feeling about them. It was to determine the job satisfaction levels of the nurses in public hospitals. This descriptive study was carried out with 404 nurses (60%) accepting to take part in the study voluntarily and working in the same hospital for at least three months from 673 nurses working in hospitals depending on The Secretaryship of Public Hospital Association in Rize. The study aimed to reach the whole population by not taking samples. The data were collected by the personal information form (16 questions) prepared by the researcher, and the job satisfaction scale (36 articles) between June 1st and August 30th, 2014. According to scale, mean scores of nurses’ job satisfaction were 3.23±0.51. In addition, it was determined that the factors such as nurses’s age, marital status, childbearing, place of duty, position in workplace, being liked of job, education status, work experience, weekly working hours, maturing in professional practice, unit worked, hospital worked and colleagues affected the job satisfaction levels of nurses (p <0.05). In conclusion; the nurses’ general job satisfaction levels were moderate level.

Keywords: hospitals, job satisfaction level, nurses, public hospitals

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Authors: A. Kaeotawee, N. Bunmas, W. Chomthong

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Background: The cancellation of elective surgery is a major indicator of poor operating room efficiency. Furthermore, it is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence and causes of elective surgery cancellation in our setting and to find the appropriate solutions for better quality management. Objective: To determine the incidence and causes of elective surgery cancellations in Songklanagarind Hospital. Material and Method: A prospective survey was conducted from September to November 2012. All patients who had their scheduled elective operations cancelled were assessed. Data was collected on the following 2 components: (1) patient demographics;(2) main reasons for cancellations, which were grouped into patient-related factors and organizational-related factors. Data are reported as a percentage of patients whose operations were cancelled. The association between cancellation status and patient demographics was assessed using univariate logistic regression. Results: 2,395 patients were scheduled for elective surgery and of these 343 (14.3%) had their operations cancelled. Cardiothoracic surgery had the highest rate of cancellations (28.7%) while the least number of cancellations occurred in ophthalmology (10.1%). The main reasons for cancellations were related to the unit's organization (53.6%), due to the surgeon (48.4%). Patient related causes (46.4%), due to non medical reasons (32.1%). The most common cause of cancellation by the surgeon was lack of theater time (21.3%), by patients due to the patient’s nonappearance (25.1%). Cancellation was significantly associated with type of patient, health insurance, type of anesthesia and specialties (p<0.05). Conclusion: Surgery cancellations by surgeons relating to a lack of theater time was a significant problem in our setting. Appropriate solutions for better quality improvement are needed.

Keywords: elective cases, surgery cancellation, quality management, appropriate solutions

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Authors: Mera Ababneh, Sayer Al-Azzam, Karem Alzoubi, Abeer Rababa'h

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Background: Medication errors are among the most common medical errors. Their occurrences result in patient’s mortality, morbidity, and additional healthcare costs. Continuous monitoring and detection is required. Objectives: The aim of this study was to compare medication errors in outpatient’s prescriptions in two different hospitals (paper system vs. electronic system). Methods: This was a cross sectional observational study conducted in two major hospitals; King Abdullah University Hospital (KAUH) and Princess Bassma Teaching Hospital (PBTH) over three months period. Data collection was conducted by two trained pharmacists at each site. During the study period, medication prescriptions and dispensing procedures were screened for medication errors in both participating centers by two trained pharmacist. Results: In the electronic prescription hospital, 2500 prescriptions were screened in which 631 medication errors were detected. Prescription errors were 231 (36.6%), and dispensing errors were 400 (63.4%) of all errors. On the other side, analysis of 2500 prescriptions in paper-based hospital revealed 3714 medication errors, of which 288 (7.8%) were prescription errors, and 3426 (92.2%) were dispensing errors. A significant number of 2496 (67.2%) were inadequately and/or inappropriately labeled. Conclusion: This study provides insight for healthcare policy makers, professionals, and administrators to invest in advanced technology systems, education, and epidemiological surveillance programs to minimize medication errors.

Keywords: medication errors, prescription errors, dispensing errors, electronic prescription, handwritten prescription

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Authors: Jonida Hasanaj

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Abstract: Four years after the pandemic, numerous studies discuss the long-term effects of COVID-19 on patients, with chronic fatigue syndrome being a prominent concern. Understanding the mechanisms behind this syndrome is crucial for developing prevention, treatment, and rehabilitation strategies. The appropriateness of physiotherapeutic treatment in covid 19 and post-COVID-19 patients has remained uncertain due to inconsistent diagnostic criteria, highlighting the need for further research. This paper intends to offer guidelines and specific suggestions for hospital-based physical therapists managing COVID-19 hospitalized patients at ‘’Expert Physiotherapy’ and ’American Hospital’ in Albania using a national approach in accordance with worldwide initiatives. Several studies indicate that chronic tiredness syndrome and high intracranial pressure could result from failure of the post-Covid-19 lymphatic system. Enabling the patient to intensify their physical activity and enhance their ability to move, exercise, and even resume a regular life cycle is the aim of physiotherapy treatment.

Keywords: mobility, physiotherapy, post-covid 19, rehabilitation, results

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Authors: Grace Omowunmi Soyebi

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A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved; this may cause an unexpected to happen to the patient. This data mining application is to be designed using a structured system analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the design and implementation of a computerized medical record system. This computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, data, software development, innovation

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Authors: Nicole Marella G. Tan, Al Joseph R. Molina, Raisa Celine R. Rosete, Soraya Elisse E. Escandor, Blythe N. Ke, Veronica Marie E. Ramos, Apolinario Ericson B. Berberabe, Jose Jonas D. del Rosario, Regina Pascua-Berba, Eileen Liesl A. Cubillan, Winlove P. Mojica

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Emergency risk and health communications play a vital role in any pandemic response. However, the Philippine General Hospital (PGH) lacked a system of information delivery that could effectively fulfill the hospital’s communication needs as a COVID-19 referral hospital. This study aimed to describe the establishment of a communication framework for information dissemination within a tertiary government hospital during the COVID-19 pandemic and evaluated the perceived usefulness of its outputs. This is a mixed quantitative-qualitative study with two phases. Phase 1 documented the formation and responsibilities of the Information Education Communication (IEC) Committee. Phase 2 evaluated its output and outcomes through a hospital-wide survey of 528 healthcare workers (HCWs) using a pre-tested questionnaire. In-depth explanations were obtained from five focused group discussions (FGD) amongst various HCW subgroups. Descriptive analysis was done using STATA 16 while qualitative data were synthesized thematically. Communication practices in PGH were loosely structured at the beginning of the pandemic until the establishment of the IEC Committee. The IEC Committee was well-represented by concerned stakeholders. Nine types of infographics tackled different aspects of the hospital’s health operations after thorough inputs from concerned offices. Internal and external feedback mechanisms ensured accurate infographics. Majority of the survey respondents (98.67%) perceived these as useful in their work or daily lives. FGD participants cited the relevance of infographics to their occupations, suggested improvements, and hoped that these efforts would be continued in the future. Sustainability and comprehensive reach were the main concerns in this undertaking. The PGH COVID-19 IEC framework was developed through trial and testing as there were no existing formal structures to communicate health risks and to properly direct the HCWs in the chaotic time of a pandemic. It is a continuously evolving framework which is perceived as useful by HCWs and is hoped to be sustained in the future.

Keywords: COVID-19, pandemic, health communication, infographics, social media

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Authors: Tedman Cheuk-Yiu Chau, Xavier Harvey, Hung Nguyen

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Defunctioning ileostomies are frequently used as an adjunct to low anterior resection in the surgical treatment of rectal cancer. Despite reducing the rate of clinically relevant anastomotic leak, the burden of defunctioning ileostomy is significant, with up to two-thirds of patients reporting stoma-related morbidity. International data have demonstrated an increased risk of bowel dysfunction and lower quality of life in patients with delayed closure (greater than six months post-surgery). While timely reversal is safe and cost-effective, the time to the reversal in Australian and New Zealand public hospitals is not described in the published literature. Thus, it is important to assess the current timeliness of ileostomy closure in the Australian regional context and examine the reasons for the delay. A retrospective analysis of ileostomy closure in Launceston General Hospital (LGH) patients treated with low/ultra low anterior resection for rectal cancer between 2012 and 2019 was undertaken. 94 cases of rectal adenocarcinoma undergoing ultralow anterior resection were examined over the years between 2012-2019. Amongst these, 21 cases (22.3%) were not reversed due to disease progress, death prior to reversal, or surgical complication. Demographics, disease status, surgical technique, and hospital inpatient events of these cases were examined. An average waiting time of 213.2 days was noted. Reasons for the delay include non-specified/prolonged hospital waiting time (54%), delayed or complicated chemotherapy course (13%), surgical complication (11%), advanced age, and frailty(5%). Complication of a delayed ileostomy reversal includes post-operation ileus and the development of an incisional hernia. We conclude that a delayed reversal of ileostomy can contribute to a higher incidence of stoma-related co-morbidities and contribute to a longer hospital stay and therefore use of public hospital resources.

Keywords: anterior resection, colorectal surgery, ileostomy reversal, rectal cancer

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Authors: Mohamed Abdalla Elamein Boshara, Peter Charles Woods, Nour Eldin Mohamed Elshaiekh

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Knowledge Management has become very important for Disaster Management response and planning. This paper proposes the implementation of a Knowledge Management System with a sustainable data collection mechanism for reliable and timely information management to support decision makers in making the right decisions in the timely manner.

Keywords: knowledge management, disaster management, incident tracking, web application

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Authors: Chia-Jung Chen, Yu-Chi Hsu, June-Dong Lin, Kun-Chen Chan, Chieh-Tien Wang, Li-Ching Wu, Chung-Feng Liu

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With fast advances in healthcare technology, various total laboratory automation (TLA) processes have been proposed. However, adopting TLA needs quite high funding. This study explores an early adoption experience by Taiwan’s large-scale hospital group, the Chimei Hospital Group (CMG), which owns three branch hospitals (Yongkang, Liouying and Chiali, in order by service scale), based on the five stages of Everett Rogers’ Diffusion Decision Process. 1.Knowledge stage: Over the years, two weaknesses exists in laboratory department of CMG: 1) only a few examination categories (e.g., sugar testing and HbA1c) can now be completed and reported within a day during an outpatient clinical visit; 2) the Yongkang Hospital laboratory space is dispersed across three buildings, resulting in duplicated investment in analysis instruments and inconvenient artificial specimen transportation. Thus, the senior management of the department raised a crucial question, was it time to process the redesign of the laboratory department? 2.Persuasion stage: At the end of 2013, Yongkang Hospital’s new building and restructuring project created a great opportunity for the redesign of the laboratory department. However, not all laboratory colleagues had the consensus for change. Thus, the top managers arranged a series of benchmark visits to stimulate colleagues into being aware of and accepting TLA. Later, the director of the department proposed a formal report to the top management of CMG with the results of the benchmark visits, preliminary feasibility analysis, potential benefits and so on. 3.Decision stage: This TLA suggestion was well-supported by the top management of CMG and, finally, they made a decision to carry out the project with an instrument-leasing strategy. After the announcement of a request for proposal and several vendor briefings, CMG confirmed their laboratory automation architecture and finally completed the contracts. At the same time, a cross-department project team was formed and the laboratory department assigned a section leader to the National Taiwan University Hospital for one month of relevant training. 4.Implementation stage: During the implementation, the project team called for regular meetings to review the results of the operations and to offer an immediate response to the adjustment. The main project tasks included: 1) completion of the preparatory work for beginning the automation procedures; 2) ensuring information security and privacy protection; 3) formulating automated examination process protocols; 4) evaluating the performance of new instruments and the instrument connectivity; 5)ensuring good integration with hospital information systems (HIS)/laboratory information systems (LIS); and 6) ensuring continued compliance with ISO 15189 certification. 5.Confirmation stage: In short, the core process changes include: 1) cancellation of signature seals on the specimen tubes; 2) transfer of daily examination reports to a data warehouse; 3) routine pre-admission blood drawing and formal inpatient morning blood drawing can be incorporated into an automatically-prepared tube mechanism. The study summarizes below the continuous improvement orientations: (1) Flexible reference range set-up for new instruments in LIS. (2) Restructure of the specimen category. (3) Continuous review and improvements to the examination process. (4) Whether installing the tube (specimen) delivery tracks need further evaluation.

Keywords: innovation decision process, total laboratory automation, health care

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Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

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This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: awareness, knowledge, osteoporosis, practices

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Authors: Hadeer Hegazy, Wael Ewieda, Ranin Soliman, Samah Elway, Asmaa Tawfik, Ragaa Sayed, Sahar Mousa

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The current healthcare system is facing major challenges in terms of cost, quality of care, and access to services. In response, the concept of value-based healthcare has emerged as a new approach to healthcare delivery. This concept puts the focus on patient values rather than on the traditional medical model of care. To achieve this, healthcare organizations must be agile and able to anticipate and respond quickly to changing needs. Agile management is essential for healthcare organizations to achieve value-based care, as it allows them to rapidly adjust their strategies to changing circumstances. Additionally, it is argued that agile management can help healthcare organizations gain a better understanding of the needs of their patients and develop better care delivery models. Besides, it can help healthcare organizations develop new services, innovate, and become more efficient. The authors provide evidence to support their argument, drawing on examples from successful value-based healthcare initiatives at children’s cancer hospital Egypt-57357. The paper offers insight into how agile management can be used to facilitate the shift towards value-based healthcare and how it can be used to maximize value in the healthcare system.

Keywords: value-based healthcare, agility in healthcare, nursing department, patients outcomes

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: anaemia, haemoglobinopathies, pregnancy, sickle cell disease

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Authors: Thoetchai Peeraphatdit, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham, Niyada Naksuk

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Background: Serum electrolyte abnormalities are a common cause of an acquired prolonged QT syndrome, especially, in the coronary care unit (CCU) setting. Optimal electrolyte ranges among the CCU patients have not been sufficiently investigated. Methods: We identified 8,498 consecutive CCU patients who were admitted to the CCU at Mayo Clinic, Rochester, the USA, from 2004 through 2013. Association between first serum electrolytes and baseline corrected QT intervals (QTc), as well as in-hospital mortality, was tested using multivariate linear regression and logistic regression, respectively. Serum potassium 4.0- < 4.5 mEq/L, ionized calcium (iCa) 4.6-4.8 mg/dL, and magnesium 2.0- < 2.2 mg/dL were used as the reference levels. Results: There was a modest level-dependent relationship between hypokalemia ( < 4.0 mEq/L), hypocalcemia ( < 4.4 mg/dL), and a prolonged QTc interval; serum magnesium did not affect the QTc interval. Association between the serum electrolytes and in-hospital mortality included a U-shaped relationship for serum potassium (adjusted odds ratio (OR) 1.53 and OR 1.91for serum potassium 4.5- < 5.0 and ≥ 5.0 mEq/L, respectively) and an inverted J-shaped relationship for iCa (adjusted OR 2.79 and OR 2.03 for calcium < 4.4 and 4.4- < 4.6 mg/dL, respectively). For serum magnesium, the mortality was greater only among patients with levels ≥ 2.4 mg/dL (adjusted OR 1.40), compared to the reference level. Findings were similar in sensitivity analyses examining the association between mean serum electrolytes and mean QTc intervals, as well as in-hospital mortality. Conclusions: Serum potassium 4.0- < 4.5 mEq/L, iCa ≥ 4.6 mg/dL, and magnesium < 2.4 mg/dL had a neutral effect on QTc intervals and were associated with the lowest in-hospital mortality among the CCU patients.

Keywords: calcium, electrocardiography, long-QT syndrome, magnesium, mortality, potassium

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Authors: Mirim Kim, Won-Oak Oh

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Purpose: The purpose of this study was to identify hospitalized children's fall risk factors, fall prevention status and fall prevention strategies recognized by nurses and caregivers of hospitalized children and present an ecological model for fall preventive management in hospitalized children. Method: The participants of this study were 14 nurses working in medical institutions and having more than one year of child care experience and 14 adult caregivers of children under 6 years of age receiving inpatient treatment at a medical institution. One to one interview was attempted to identify their perception of fall preventive management. Transcribed data were analyzed through latent content analysis method. Results: Fall risk factors in hospitalized children were 'unpredictable behavior', 'instability', 'lack of awareness about danger', 'lack of awareness about falls', 'lack of child control ability', 'lack of awareness about the importance of fall prevention', 'lack of sensitivity to children', 'untidy environment around children', 'lack of personalized facilities for children', 'unsafe facility', 'lack of partnership between healthcare provider and caregiver', 'lack of human resources', 'inadequate fall prevention policy', 'lack of promotion about fall prevention', 'a performanceism oriented culture'. Fall preventive management status of hospitalized children were 'absence of fall prevention capability', 'efforts not to fall', 'blocking fall risk situation', 'limit the scope of children's activity when there is no caregiver', 'encourage caregivers' fall prevention activities', 'creating a safe environment surrounding hospitalized children', 'special management for fall high risk children', 'mutual cooperation between healthcare providers and caregivers', 'implementation of fall prevention policy', 'providing guide signs about fall risk'. Fall preventive management strategies of hospitalized children were 'restrain dangerous behavior', 'inspiring awareness about fall', 'providing fall preventive education considering the child's eye level', 'efforts to become an active subject of fall prevention activities', 'providing customed fall prevention education', 'open communication between healthcare providers and caregivers', 'infrastructure and personnel management to create safe hospital environment', 'expansion fall prevention campaign', 'development and application of a valid fall assessment instrument', 'conversion of awareness about safety'. Conclusion: In this study, the ecological model of fall preventive management for hospitalized children reflects various factors that directly or indirectly affect the fall prevention of hospitalized children. Therefore, these results can be considered as useful baseline data for developing systematic fall prevention programs and hospital policies to prevent fall accident in hospitalized children. Funding: This study was funded by the National Research Foundation of South Korea (grant number NRF-2016R1A2B1015455).

Keywords: fall down, safety culture, hospitalized children, risk factors

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Authors: Maryam Zahmatkesh

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Middle managers form a significant occupational category in organisations. They undertake a vital role, as they sit between the operational and strategic roles. Traditionally they were acting as diplomat administrators, and were only in power to meet the demands of professionals. Following the introduction of internal market, in line with the principles of New Public Management, middle managers have been considered as change agents. More recently, in the debates of middle managers, there is emphasis on entrepreneurialism and enacting strategic role. It was assumed that granting autonomy to the local organisations and the inception of semi-autonomous hospitals (Foundation Trusts in England and Board of Trustees in Iran) would give managers more autonomy to act proactively and innovatively. This thesis explores the hospital middle managers’ perception of and responses to public management reforms (in particular, hospital autonomy) in England and Iran. In order to meet the aims of the thesis, research was undertaken within the interpretative paradigm, in line with social constructivism. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show the different ways middle managers’ autonomy is constrained in the two countries. In England, middle managers have financial and human recourses, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. Unbalanced autonomy causes tension and frustration for middle managers. According to neo-institutional theory, organisations are deeply embedded within social, political, economic and normative settings that exert isomorphic and internal population-level pressures to conform to existing and established modes of operation. Health systems which are seeking to devolve autonomy to middle managers must appreciate the multidimensional nature of the autonomy, as well as the wider environment that organisations are embedded, if they are about to improve the performance of managers and their organisations.

Keywords: autonomy, healthcare organisations, middle managers, new public management

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Authors: Mahmoud A. Amin, Essam Taman, Ahmed Omran, Mahmoud Shawky, Ahmed Mekawy, Abdallah M. Kotkat, Saber Younes, Nehad N. Ghonemy, Amin Saad, Ezz-Aleslam, Abdullah M. Elosh

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Introduction: TMJ is a one-of-a-kind, complicated synovial joint that helps with masticatory function by allowing the mandible to open and close the mouth. True ankylosis is a situation in which condylar movement is limited by a mechanical defect in the joint, whereas false ankylosis is a condition in which there is a restriction in mandibular movement due to muscular spasm myositis ossificans, and coronoid process hyperplasia. Ankylosis is characterized by the inability to open the mouth due to fusion of the TMJ condyle to the base of the skull as a result of trauma, infection, or systemic diseases such as rheumatoid arthritis (the most common) and psoraisis. Ankylosis causes facial asymmetry and affects the patient psychologically as well as speech, difficult mastication, poor oral hygiene, malocclusion, and other factors. TMJ is a technically challenging joint; hence TMJ ankylosis management is complicated. Case presentation: this case is a male patient 25 years old reported to our maxillofacial clinic in Damietta faculty of medicine, Al-Azhar University with the inability to open the mouth at all, with a history of difficulty of mouth breathing and eating foods, there was a history of falling from height at 2006, and the patient underwent corrective surgery before with no improvement because the ankylosis was relapsed short period after the previous operations with that done out of our hospital inter-incisor distant ZERO so, this condition need mandatory management. Clinical examination and radiological investigations were done after complete approval from the patient and his brother; tracheostomy was done for our patient before the operation. The patient entered the operation in our hospital and drastic improvement in mouth opening was noticed, helping to restore the physical psychological health of the patient.

Keywords: temporomandibular joint, TMJ, Ankylosis, mouth opening, physiotherapy, condylar plate

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Authors: Alldila Hendy, Agi Satria

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Background: A colostomy procedure is an important part in the management of surgical procedures in some diseases involving the gastrointestinal tract. So it is necessary to find the factors that influence the occurrence of complications. Methods: This is a retrospective cross-sectional analytic study in Cipto Mangunkusumo Hospital noting medical records of patients after the colostomy from January 2012 to December 2014 at the Division of Digestive Surgery. Results: In 136 cases of post-colostomy, 66 cases have complications, 14 is early-onset, and 52 is late-onset. 70 is without complications. Most complications are dermatitis, which is 31 (22.8%), cases of infection/abscess/fistula and intestinal obstruction are 13 (9.6%) and 5 patients (4.4%). A rare complication is colostomy retraction by 2 patients (1.5%), colostomy prolapse and necrosis/gangrene, which is only 3 patients (2.2%). A colostomy procedure in emergency surgery is riskier than elective surgery for complications after colostomy (p < 0.007, OR 2.85), Based on the operator who performs a colostomy procedure, the consultant had a lower risk of complications than fellow or resident (p < 0.0001). Based on the age factor, where the age of about 50 years has a risk of complications after colostomy (p < 0.018). Conclusion: The timing of operation (emergency or elective), age, and operator who perform a colostomy procedure have a significant relationship with an increased prevalence of complications after colostomy in RSCM.

Keywords: colostomy, complications, factors, procedure

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Authors: Farajallah Adibhashemi

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A retrospective study on causes, surgery findings, results and the follow up of 30 horses with colic in Tehran, Iran. Colic is the main problem horse industry.The causes of colic are related to management like food, sport and medical care. In this study that has been done between 2012-2015 for 30 horses referred to teaching hospital of veterinary medicine faculty of the University of Tehran. Seventy percent of causes was related to management of feeding and twenty percent was for malsporting. The rest of causes was from the anti parasite in bad root. The surgery findings were as follows: 60% displacement of dorsal right and left colon, 20% in impaction of pelvic flexure,10% impaction of the cecum, and 10% impaction of the stomach.

Keywords: horse, colic, Tehran, Iran

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Authors: Daniella Kucsma

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The examination of the Privat Service Organization’s performance evaluation includes several steps that help Public organizations to develop a more efficient system. Public sector organizations have different characteristics than the competitive sector, so it can be stated that other/new elements become more important in their performance processes. The literature in this area is diverse, so highlighting an indicator system can be useful for introducing a system, but it is also worthwhile to measure the specific elements of the organization. In the case of a public service organization, due to the service obligation, it is usually possible to talk about a high number of users, so compliance is more difficult. For the organization, it is an important target to place great emphasis on the increase of service standards and the development of related processes. In this research, the health sector is given a prominent role, as it is a sensitive area where both organizational and individual performance is important for all participants. As a primary step, the content of the strategy is decisive, as this is important for the efficient structure of the process. When designing any system, it is important to review the expectations of the stakeholders, as this is primary when considering the design. The goal of this paper is to build the foundations of a performance management and indexing framework that can help a hospital to provide effective feedback and a direction that is important in assessing and developing a service and can become a management philosophy.

Keywords: health sector, public sector, performance management, strategy

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Authors: Orathai Srithongtham, Ploypailin Mekathepakorn, Tossaphong Buraman, Pontida Moonpradap, Rungrueng Kitpati, Chulapon Kratet, Worayuth Nak-ai, Suwaree Charoenmukkayanan, Peeranuch Keawkanya

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The COVID-19 pandemic was effect to the health security of the Thai people. The PHEM principle was essential to the surveillance, prevention, and control of COVID-19. This study aimed to present the process of prevention and control of COVID-19 from February 29, 2021- April 30, 2022, and the factors and conditions influent the successful outcome. The study areas were three provinces. The target group was 37 people, composed of public health personnel. The data was collected in-depth, and group interviews followed the non-structure interview guide and were analyzed by content analysis. The components of COVID-19 prevention and control were found in the process of PHEM as follows; 1) Emergency Operation Center (EOC) with an incidence command system (ICS) from the district to provincial level and to propose the provincial measure, 2) Provincial Communicable Disease Committee (PCDC) to decide the provincial measure 3) The measure for surveillance, prevention, control, and treatment of COVID-19, and 4) outcomes and best practices for surveillance and control of COVID-19. The success factors of 4S and EC were as follows; Space: prepare the quarantine (HQ, LQ), Cohort Ward (CW), field hospital, and community isolation and home isolation to face with the patient and risky group, Staff network from various organization and group cover the community leader and Health Volunteer (HV), Stuff the management and sharing of the medical and non-medical equipment, System of Covid-19 respond were EOC, ICS, Joint Investigation Team (JIT) and Communicable Disease Control Unit (CDCU) for monitoring the real-time of surveillance and control of COVID-19 output, Environment management in hospital and the community with Infections Control (IC) principle, and Culture in term of social capital on “the relationship of Isan people” supported the patient provide the good care and support. The structure of PHEM, Isan’s Culture, and good preparation was a significant factor in the three provinces.

Keywords: public health, emergency management, covid-19, pandemic

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Authors: Minhui Chiu

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According to relevant studies, clinical nurses have high work pressure and relatively high job adaptation needs. The nurses who work in oncology wards have more adaptation needs when they face repeating hospitalization patients. The aims of this study were to investigate the job stress adaptation and related factors of nurses in oncology wards and to understand the predictors of job stress adaptation needs. Convenience sampling was used in this study. The nurses in the oncology specialist ward of a regional teaching hospital in southern Taiwan were selected as the research objects. A cross-sectional survey was conducted using a structured questionnaire, random sampling, and the questionnaires were filled out by the participating nurses. A total of 68 people were tested, and 65 valid questionnaires (95.6%). One basic data questionnaire and nurses’ job stress adaptation needs questionnaire were used. The data was archived with Microsoft Excel, and statistical analysis was performed with JMP12.0. The results showed that the average age was 28.8 (±6.7) years old, most of them were women, 62 (95.38%), and the average clinical experience in the hospital was 5.7 years (±5.9), and 62 (95.38%) were university graduates. 39 people (60.0%) had no work experience. 39 people (60.0%) liked nursing work very much, and 23 people (35.3%) just “liked”. 47 (72.3%) people were supported to be oncology nurses by their families. The nurses' job stress adaptation needs were 119.75 points (±17.24). The t-test and variance analysis of the impact of nurses' job pressure adaptation needs were carried out. The results showed that the score of college graduates was 121.10 (±16.39), which was significantly higher than that of master graduates 96.67 (±22.81), and the degree of liking for nursing work also reached a Significant difference. These two variables are important predictors of job adaptation needs, and the R Square is 24.15%. Conclusion: Increasing the love of clinical nurses in nursing and encouraging university graduation to have positive effects on job pressure adaptation needs and can be used as a reference for the management of human resources hospitals for oncology nurses.

Keywords: oncology nurse, job stress, job stress adaptation needs, manpower

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Authors: Boularas El-Alia, Arbi Raja, Bachir Bouiadjra Sara, Rezk-Kallah Haciba, Rezkkallah Baghdad

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Objectives : To determine the handling practices of cytotoxic drugs and to describe clinical manifestations expressed by hospital personnel of Sidi Bel Abbes during the year 2014. Methods: Sectional descriptive study conducted in 3 center university hospital units (Hematology, Oncology and Urology) and Gynecology of EHS Sidi Bel Abbes. A questionnaire was administered to hospital workers regulary exposed to cytotoxic drugs. A work-place visit was performed to have an overview about working conditions. The Cytotoxic Contact Index (CCI) was calculated for each nurse on a period of 15 working days. Treatment of the results was done using SPSS software. Results: The survey reveals that 22 men and 58 women are exposed to cytotoxic drugs for an average of 7 years. Many symptoms such as ocular irritation (38,75%), throat irritation (56,25%), headache (68,75%), dizziness (43,75%), nausea (37,5%), metallic taste (30%), were reported with high frequency. Are noted in the offspring, 3 congenital anomalies,2 diaphragmatic hernia and a cleft palate. The Cytotoxic Contact Index (CCI) was higher than 3 among Oncology nurses and higher than 1 for most of the nurses of Hematology and Gynecology service. The wearing of personal protective clothing was not respected by all workers: (22/23) wear gloves and (20/23) wear a mask,(5/23) wear a cap, (2/23) wear glasses. Only 3 nurses have benefited from continuous training on handling cytotoxic drugs. Conclusion: This study shows a high occupational exposure risk to cytotoxic drugs among persons handling these drugs and the necessity to apply rigorously all measures related to personal protection awareness and training of personnel to minimize these exposure.

Keywords: cytotoxic drugs, handling, clinical manifestations, hospital staff

Procedia PDF Downloads 418

Authors: J. Byimana, I. A. Muhire, J. E. Nzabahimana, A. Nyombayire

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Introduction: A successful cardiopulmonary resuscitation during a sudden cardiac arrest can be delayed by different components including new hospital setting, lack of adequate training, lack of pre-established resuscitation team and ineffective communication and lead to an unexpected outcome which is death. The main objective of the study was to assess the readiness of resuscitation teams during cardiac arrest and the organizational approaches that would best support their functioning in a new hospital facility, and to detect any factor that may have contributed to responses. This study analyses the readiness of Resuscitation Team (RT) during cardiac arrest. —Material and methods: A prospective Analytic design was carried out at a newly established United Nations level 2 hospital facility, on four RTM (resuscitation team member). A semi structured questionnaire was used to collect data. —Results: This study highlights indicate that the response time during cardiac arrest simulation meet both American heart association (AHA) and European resuscitation council guidelines. The study offers useful evidence about the impact of a new facility on RTM performance and provides an exposure of staff to emergency events within the Work setting.

Keywords: cardiac arrest, code blue, simulation, resuscitation team member

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Authors: Ji Wen Sun, Nan Ping Shen, Yi Bei Wu

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This study used Nursing Interventions Classification (NIC-6th) to identify the interventions performed in a pediatric cardiology unit, and then to analysis its frequency, time and difficulty, so as to give a brief review on what our nurses have done. The research team selected a 35 beds pediatric cardiology unit, and drawn all the nursing interventions in the nursing record from our hospital information system (HIS) from 1 October 2015 to 30 November 2015, using NIC-6th to do the matching and then counting their frequencies. Then giving each intervention its own time and difficulty code according to NIC-6th. The results showed that nurses in pediatric cardiology unit performed totally 43 interventions from 5394 statements, and most of them were in RN(basic) education level needed and less than 15 minutes time needed. There still had some interventions just needed by a nursing assistant but done by nurses, which should call for nurse managers to think about the suitable staffing. Thus, counting the summary of the product of frequency, time and difficulty for each intervention of each nurse can know one's performance. Acknowledgement Clinical Management Optimization Project of Shanghai Shen Kang Hospital Development Center (SHDC2014615); Hundred-Talent Program of Construction of Nursing Plateau Discipline (hlgy16073qnhb).

Keywords: nursing interventions, nursing interventions classification, nursing record, pediatric cardiology

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Authors: S. Kurian, S. Satpathy, S. K. Gupta, S. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: adverse events, health care technology, medical devices, public sector hospital, reporting systems

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Authors: Degineh Belachew Andarge, Tariku Lambiyo Anticho, Getamesay Mulatu Jara, Musa Mohammed Ali

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Introduction: Tuberculosis (TB) is a communicable chronic disease causedby Mycobacterium tuberculosis (MTB). About one-third of the world’s population is latently infected with MTB. TB is among the top 10 causes of mortality throughout the globe from a single pathogen. Objective: The aim of this study was to determine the prevalence of tuberculosis,rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis, and associated factors among presumptive tuberculosis cases attending the tuberculosis clinic of Adare General Hospital located in Hawassa city. Methods: A hospital-based cross-sectional study was conducted among 321 tuberculosis suspected patients from April toJuly 2018. Socio-demographic, environmental, and behavioral data were collected using a structured questionnaire. Sputumspecimens were analyzed using GeneXpert. Data entry was made using Epi info version 7 and analyzed by SPSS version 20. Logistic regression models were used to determine the risk factors. A p-value less than 0.05 was taken as a cut point. Results: In this study, the prevalence of Mycobacterium tuberculosis was 98 (30.5%) with 95% confidence interval (25.5–35.8), and the prevalence of rifampicin-resistant/multidrug-resistantMycobacterium tuberculosis among the 98 Mycobacteriumtuberculosis confirmed cases was 4 (4.1%). The prevalence of rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosisamong the tuberculosis suspected patients was 1.24%. Participants who had a history of treatment with anti-tuberculosisdrugs were more likely to develop rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis. Conclusions: This study identified relatively high rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis amongtuberculosis suspected patients in the study area. Early detection of drug-resistant Mycobacterium tuberculosis should be givenenough attention to strengthen the management of tuberculosis cases and improve direct observation therapy short-course and eventually minimize the spread of rifampicin-resistant tuberculosis strain in the community.

Keywords: rifampicin resistance, mycobacterium tuberculosis, risk factors, prevalence of TB

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Authors: Jonghoon Chun, Insung Kim, Jonghyun Lim, Gun Ro

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We believe that it is possible to provide a solution to reduce patient safety accidents by displaying correct medical records and prescription information through interactive patient identification. Our system is based on the use of smart bands worn by patients and these bands communicate with the hybrid gateways which understand both BLE and Wifi communication protocols. Through the convergence of low-power Bluetooth (BLE) and hybrid gateway technology, which is one of short-range wireless communication technologies, we implement ‘Intelligent Patient Identification and Location Tracking System’ to prevent medical malfunction frequently occurring in medical institutions. Based on big data and IOT technology using MongoDB, smart band (BLE, NFC function) and hybrid gateway, we develop a system to enable two-way communication between medical staff and hospitalized patients as well as to store locational information of the patients in minutes. Based on the precise information provided using big data systems, such as location tracking and movement of in-hospital patients wearing smart bands, our findings include the fact that a patient-specific location tracking algorithm can more efficiently operate HIS (Hospital Information System) and other related systems. Through the system, we can always correctly identify patients using identification tags. In addition, the system automatically determines whether the patient is a scheduled for medical service by the system in use at the medical institution, and displays the appropriateness of the medical treatment and the medical information (medical record and prescription information) on the screen and voice. This work was supported in part by the Korea Technology and Information Promotion Agency for SMEs (TIPA) grant funded by the Korean Small and Medium Business Administration (No. S2410390).

Keywords: BLE, hybrid gateway, patient identification, IoT, safety management, smart band

Procedia PDF Downloads 294

Authors: D. S. Chakraborty, S. Ghosh, A. Hazra

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Objective: Medication errors are a reality in all settings where medicines are prescribed, dispensed and used. High Alert Medications (HAM) are those that bear a heightened risk of causing significant patient harm when used in error. We conducted a knowledge-attitude-practice survey, among residents working in a teaching hospital, to assess the ground situation with regard to the handling of HAM. Methods: We plan to approach 242 residents among the approximately 600 currently working in the hospital through purposive sampling. Residents in all disciplines (clinical, paraclinical and preclinical) are being targeted. A structured questionnaire that has been pretested on 5 volunteer residents is being used for data collection. The questionnaire is being administered to residents individually through face-to-face interview, by two raters, while they are on duty but not during rush hours. Results: Of the 156 residents approached so far, data from 140 have been analyzed, the rest having refused participation. Although background knowledge exists for the majority of respondents, awareness levels regarding HAM are moderate, and attitude is non-uniform. The number of respondents correctly able to identify most ( > 80%) HAM in three common settings– accident and emergency, obstetrics and intensive care unit are less than 70%. Several potential errors in practice have been identified. The study is ongoing. Conclusions: Situation requires corrective action. There is an urgent need for improving awareness regarding HAM for the sake of patient safety. The pharmacology department can take the lead in designing awareness campaign with support from the hospital administration.

Keywords: high alert medication, medication error, questionnaire, resident

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Authors: J. Silva, P. Arezes, R. Schierl, N. Costa

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In order to study environmental contamination by cytostatic drugs in Portugal hospitals, sampling campaigns were conducted in three hospitals in 2015 (112 samples). Platinum containing drugs and fluorouracil were chosen because both were administered in high amounts. The detection limit was 0.01 pg/cm² for platinum and 0.1 pg/cm² for fluorouracil. The results show that spills occur mainly on the patient`s chair, while the most referenced occurrence is due to an inadequately closed wrapper. Day hospitals facilities were detected as having the largest number of contaminated samples and with higher levels of contamination.

Keywords: cytostatic, contamination, hospital, procedures, handling

Procedia PDF Downloads 280