Quality of healthcare

医疗保健质量
  • 文章类型: Journal Article
    移情在护理中起着重要的作用,可以为患者提供优质的护理并对所提供的服务感到满意。沙特阿拉伯患者互动,包括初步探索,往往不像其他国家那样公式化地启动。在目前的研究中,研究人员旨在强调护士介绍在沙特阿拉伯卫生部医院住院中心创造理想患者体验的关键作用.这项研究是使用国家健康链接/PressesGaney调查对2021年至2022年期间的每一个quint进行的横截面二次数据分析。该方法包括对患者体验管理计划(PXMP)调查的深入分析,该调查是由HealthLinks/PressGaney完成的统一调查。在分析过程中,然而,结果发现有显著差异,因为71.3%的患者对他们的整体患者体验有很好的印象.这是专门为解决个人特征等具体问题而设计的。这项研究的结果有助于理解驱动护士与病人互动的因素,并加强护士向病人介绍的方式,以提高沙特阿拉伯卫生部医院病人的平均满意度。这项研究建议,沙特护士应接受培训,以建立他们与患者的互动融洽关系,因为这促进了以患者为中心,随后患者的体验和护理结果。
    Empathy plays an important role in nursing so that the patients are provided with quality care and are satisfied with the services provided. Saudi Arabian patient interactions, including initial exploring, tend not to be formulaically initiated as in other countries. In this current study, the researcher aimed to highlight the critical role of nurse introductions in creating a desirable patient experience in the inpatient centers of Ministry Of Health hospitals in Saudi Arabia. This study was a cross-sectional secondary data analysis using the National Health Links/Presses Ganey surveys for every quint between the period 2021 and 2022. The methodology comprised an in-depth analysis of the Patient Experience Management Program (PXMP) survey that was involved as the uniform survey concluded by the Health Links/PressGaney. During the analysis, however, the results were found to have significant differences as 71.3% of the patients had a very good impression of their overall patient experience. This was specifically designed to address specific issues such as personal characteristics. The results of this study contribute to the understanding of what drives the nurses-patient interactions and forge the need for enhancing the way nurses are introduced to their patients to increase the average level of satisfaction of patients in the Ministry Of Health hospitals in Saudi Arabia. This study recommends that Saudi nurses should be trained to establish rapport in their interactions with patients as this promotes patient-centeredness and subsequently patients\' experiences and care outcomes.
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  • 文章类型: Journal Article
    背景:高血压,影响全世界数百万人的慢性疾病,是心血管疾病的主要原因。需要采取多学科的方法来减轻疾病的负担,全科医生起着至关重要的作用。因此,全科医生提供标准化且基于最新欧洲指南的高质量护理至关重要.质量指标(QIs)可用于评估绩效,结果,或医疗保健交付过程,并在帮助医疗保健专业人员确定改进领域和衡量实现预期健康结果的进展方面至关重要。然而,已经在有限的程度上研究了在一般实践中评估高血压患者护理的QIs。我们研究的目的是定义一般实践中高血压的质量指标,这些质量指标可从电子健康记录(EHR)中提取,可用于评估和提高一般实践中高血压患者的护理质量。
    方法:我们使用了Rand修改的Delphi程序。我们从欧洲指南中提取了建议,并将其汇总到在线问卷中。小组成员进行了基于SMART原理和EHR可提取性的初始评分,这些结果使用李克特中位数评分进行分析,优先次序和共识程度。召开了一次协商一致的会议,讨论了所有的建议,然后是最后一轮验证。
    结果:我们的研究提取了115条建议。在分析了在线问卷轮和共识会议轮之后,37项建议被接受,75项被排除。在这37项建议中,9个被稍微修改,4个被合并为2个建议,产生了35条建议。最后一组的所有建议都被翻译成合格证明,由7个QIs组成,6QIsondiagnosis,11个QIsontreatment,关于结果的5个QIs和关于后续行动的6个QIs。
    结论:我们的研究在一般实践中得出了35个高血压的QIs。这些QIs,为比利时EHR量身定制,为自动审计和反馈提供坚实的基础,如果适应其他国家的系统,可以大大受益。
    BACKGROUND: Hypertension, a chronic medical condition affecting millions of people worldwide, is a leading cause of cardiovascular diseases. A multidisciplinary approach is needed to reduce the burden of the disease, with general practitioners playing a vital role. Therefore, it is crucial that GPs provide high-quality care that is standardized and based on the most recent European guidelines. Quality indicators (QIs) can be used to assess the performance, outcomes, or processes of healthcare delivery and are critical in helping healthcare professionals identify areas of improvement and measure progress towards achieving desired health outcomes. However, QIs to evaluate the care of patients with hypertension in general practice have been studied to a limited extent. The aim of our study is to define quality indicators for hypertension in general practice that are extractable from the electronic health record (EHR) and can be used to evaluate and improve the quality of care for hypertensive patients in the general practice setting.
    METHODS: We used a Rand-modified Delphi procedure. We extracted recommendations from European guidelines and assembled them into an online questionnaire. An initial scoring based on the SMART principle and extractability from the EHR was performed by panel members, these results were analyzed using a Median Likert score, prioritization and degree of consensus. A consensus meeting was set up in which all the recommendations were discussed, followed by a final validation round.
    RESULTS: Our study extracted 115 recommendations. After analysis of the online questionnaire round and a consensus meeting round, 37 recommendations were accepted and 75 were excluded. Of these 37 recommendations, 9 were slightly modified and 4 were combined into 2 recommendations, resulting in a list of 35 recommendations. All recommendations of the final set were translated to QIs, made up of 7 QIs on screening, 6 QIs on diagnosis, 11 QIs on treatment, 5 QIs on outcome and 6 QIs on follow-up.
    CONCLUSIONS: Our study resulted in a set of 35 QIs for hypertension in general practice. These QIs, tailored to the Belgian EHR, provide a robust foundation for automated audit and feedback and could substantially benefit other countries if adapted to their systems.
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  • 文章类型: Journal Article
    护士使用手机会影响护理质量。本研究旨在探讨医院护士使用手机的后果。采用了定性方法。数据是通过半结构化访谈收集的。护理人员,病人,和他们的亲属参加了这项研究。“无感情护理”类别,“”忽视护理,“”“职业行为受损”和“个人手机是有效护理的障碍”的主题提取。在工作期间使用手机可能会危害患者的安全并破坏护理专业形象。有必要制定有关如何在医院使用手机的指南。
    Using cell phones by nurses can affect the quality of care. This study aimed to explore the consequences of using cell phones by nurses in hospitals. A qualitative approach was used. Data were collected through semi-structured interviews. Nursing staff, patients, and their relatives participated in this study. Categories of \"emotionless care,\" \"neglect in care,\" \"impaired professional behavior\" and a main theme of \"Personal cell phone is a barrier to effective nursing care\" extracted. Using cell phone during work could jeopardize patients\' safety and ruins the nursing profession image. It is necessary to formulate guidelines on how to use cell phones in hospitals.
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  • 文章类型: Journal Article
    目的:严格评估漏诊护理测量方法及其在长期老年护理(LTAC)设置中的应用。
    方法:使用Tawfik指南进行系统审查。
    方法:PubMed,Scopus,WebofScience,搜索了CINAHL和ProQuest。补充搜索来自检索到的记录的参考列表,第一作者“ORCID主页和谷歌对灰色文献的高级搜索”。搜索限制是英语,在2001年1月1日至2022年12月31日期间发布。
    方法:使用COVIDENCE进行筛查,数据提取和质量评价。JBI关键评估工具和COSMIN偏差风险工具用于质量评估。使用叙事分析对数据进行汇总和综合。
    结果:纳入了11个地区的24种出版物,有两种主要的漏诊护理测量方法:修改的标准量表和量身定制的具体方法。它们的应用不一致,产生了不同的测量结果。即使使用最常用的工具也存在挑战,伯恩卡-NH,包括缺乏通过与既定的“黄金标准”进行比较分析的高质量验证,依靠自我管理,对结构的不完整评估和对心理测量学属性的不充分探索。
    结论:全球,在LTAC设置中,测量漏诊护理的仪器在有效性和全面性方面存在不足.需要对理论和实践观点进行进一步研究。
    结论:调查结果强调了建立标准化,在LTAC设置中测量漏诊护理的有效方法。这篇评论呼吁研究人员共同努力,临床工作人员和政策制定者制定和实施循证实践,作为保障生活在LTAC环境中的老年客户福祉的一种方式。
    结论:在LTAC设置中对错过护理的测量依赖于适应急性护理工具。在测量LTAC设置中的错过护理方面存在关键差距。开发新工具可以提高全球LTAC环境中的护理质量和安全性。
    遵守PRISMA准则。
    没有患者或公众捐款。
    OBJECTIVE: To critically evaluate missed care measurement approaches and their application in long-term aged care (LTAC) settings.
    METHODS: Systematic review using Tawfik\'s guideline.
    METHODS: PubMed, Scopus, Web of Science, CINAHL and ProQuest were searched. Supplemental searching was from reference lists of retrieved records, first authors\' ORCID homepages and Google advanced search for grey literature. Search limitations were English language, published between 1 January 2001 and 31 December 2022.
    METHODS: COVIDENCE was utilized for screening, data extraction and quality appraisal. JBI Critical Appraisal Tools and COSMIN Risk of Bias Tool were used for quality appraisal. Data were summarized and synthesized using narrative analysis.
    RESULTS: Twenty-four publications across 11 regions were included, with two principal methods of missed care measurement: modified standard scales and tailored specific approaches. They were applied inconsistently and generated diverse measurement outcomes. There were challenges even with the most commonly used tool, the BERNCA-NH, including absence of high-quality verification through comparative analysis against an established \'gold standard\', reliance on self-administration, incomplete assessment of constructs and inadequate exploration of psychometric properties.
    CONCLUSIONS: Globally, there are deficiencies in the effectiveness and comprehensiveness of the instruments measuring missed care in LTAC settings. Further research on theoretical and practical perspectives is required.
    CONCLUSIONS: Findings highlighted a critical need to establish a standardized, validated approach to measure missed care in LTAC settings. This review calls for collaborative efforts by researchers, clinical staff and policymakers to develop and implement evidence-based practices as a way of safeguarding the well-being of older clients living in LTAC settings.
    CONCLUSIONS: Measurements of missed care in LTAC settings rely on adapting acute care tools. There is a critical gap in measuring missed care in LTAC settings. Developing a new tool could improve care quality and safety in LTAC settings globally.
    UNASSIGNED: Adhered to PRISMA guideline.
    UNASSIGNED: No patient or public contribution.
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  • 文章类型: Journal Article
    背景:在新冠肺炎带来的挑战中,评估印度的医疗质量至关重要,特别是通过患者满意度。
    方法:对查mu和克什米尔的277名参与者进行了横断面调查,利用半结构化问卷和PSQ-18。使用SPSS(v25)进行数据分析,包括卡方检验和描述性分析。
    结果:在277名参与者中,70.8%的人对医疗服务表示高度满意。大多数人(70%)同意医生对医学检查的解释很好。此外,70%的人强烈同意他们的医生办公室装备精良。不满意因素明显较低。发现年龄与饮酒之间存在显着关联(p=0.041),性别和饮酒(p=0.007),性别和烟草使用(p=0.032),教育水平和疫苗接种(p=0.001)。
    结论:该研究强调了大流行期间患者的高满意度。改善初级卫生保健和社区中心的可及性和质量对于有效满足患者需求至关重要。
    BACKGROUND: Amidst the challenges posed by Covid-19, assessing healthcare quality in India is crucial, particularly through patient satisfaction levels.
    METHODS: A cross-sectional survey of 277 participants in Jammu and Kashmir was conducted, utilizing a semi-structured questionnaire and PSQ-18. Data analysis was performed using SPSS (v25) including Chi-Square tests and Descriptive analysis.
    RESULTS: Out of 277 participants, 70.8% expressed high satisfaction with medical care. Majority (70%) agreed that doctors explained medical tests well. Additionally, 70% strongly agreed that their doctor\'s office was well-equipped. Dissatisfaction factors were notably low. Significant associations were found between age and alcohol use (p = 0.041), gender and alcohol use (p = 0.007), gender and tobacco use (p = 0.032), and education level and vaccination (p = 0.001).
    CONCLUSIONS: The study highlights high patient satisfaction during the pandemic. Improving accessibility and quality of primary healthcare and community centres is essential to meet patient needs effectively.
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  • 文章类型: Journal Article
    背景:强大的安全文化对于确保高质量的医疗保健服务至关重要。从护理的角度来看,尤其是在危重患者中,它通过突出需要关注的领域来促进持续改进。
    目的:本研究旨在评估重症监护环境中护士对患者安全文化的看法。
    方法:一项观察性研究在葡萄牙的一家中心医院进行,采用医院患者安全文化调查(HSPSC)问卷。
    结果:该研究包括57名护士,主要是女性(73.7%),年龄25-64大多数参与者是普通护士(77.2%),相当比例(61.4%)在急诊科工作,平均在该设施任职13年。对危重患者安全文化(CPSC)的感知主要为阳性(40.6%),因部门而异,重症监护护士报告的阳性率最高。团队合作被认为是一个强项,收到80.7%的阳性,强调它是CPSC中一个完善的领域,而其他领域被认为需要增强。
    结论:该研究确定了CPSC内部的优势和劣势,为制定有针对性的策略以加强重症监护环境中的患者安全文化奠定基础。
    BACKGROUND: A robust safety culture is essential for ensuring high-quality healthcare delivery. From a nursing perspective, especially among critical patients, it fosters ongoing improvement by highlighting areas that need attention.
    OBJECTIVE: This study aimed to evaluate the perception of patient safety culture among nurses within the critical care environment.
    METHODS: An observational study was conducted at a central hospital in Portugal employing the Hospital Survey on Patient Safety Culture (HSPSC) questionnaire.
    RESULTS: The study encompassed 57, nurses predominantly female (73.7%), aged 25-64. Most participants were general nurses (77.2%), with a significant proportion (61.4%) working in the emergency department and possessing an average tenure of 13 years at the facility. The perception of critical patient safety culture (CPSC) was predominantly positive (40.6%), varying by department, with intensive care nurses reporting the highest positivity rates. Teamwork was identified as a strong point, receiving 80.7% positivity, highlighting it as a well-established domain in the CPSC, whereas other domains were recognised as requiring enhancements.
    CONCLUSIONS: The study pinpointed both strengths and weaknesses within the CPSC, offering a foundation for developing targeted strategies to bolster patient safety culture in critical care settings.
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  • 文章类型: Journal Article
    目的:介绍在维多利亚州心脏病医院(VHH)心脏急诊(CE)最初6个月的经历。主要目的是描述VHHCE患者特征,包括提出投诉,最终诊断和处置。次要目标是报告患者人数,患者来源和质量指标性能,包括40分钟的救护车卸载,等待时间和停留时间(LOS)。
    方法:回顾性研究纳入了2023年3月9日至2023年9月8日接受VHHCE检查的所有患者。从CE电子病历系统生成包含相关临床信息的患者报告。通过全记录审查检查MI诊断的准确性。
    结果:在手术的前6个月中,有3303个CE演示文稿,其中6%是从其他网站转移的。年龄中位数为65岁(四分位数范围[IQR]:53-77),56%为男性;最常见的主诉是心源性胸痛(67%)和心律失常(17%)。承认,出院率和转移率为38%,54%和8%,分别。总的来说,15%被诊断为MI。出院和入院患者最常见的诊断是非特异性胸痛(57%)和ST段抬高MI(22%)。分别。40分钟的救护车卸载达到96%。平均等待时间为6分钟(IQR:3-10)。出院和入院患者的平均CELOS为3.2h(IQR:2.5-4.0)和3.7h(IQR:1.8-6.0),75%和56%<4小时,分别。
    结论:该人群主要患有预期的心血管疾病。一些性能指标,包括EDLOS,被确定为需要干预。
    OBJECTIVE: To profile the initial 6-month experience at the Victorian Heart Hospital (VHH) cardiac emergency (CE). The primary objective was to describe VHH CE patient characteristics, including presenting complaint, final diagnosis and disposition. Secondary objectives were to report on patient numbers, patient source and quality indicator performance including ambulance off-load by 40 min, waiting time and length of stay (LOS).
    METHODS: A retrospective review included all patients who presented to the VHH CE from 9 March 2023 to 8 September 2023. Patient reports containing the relevant clinical information were generated from the CE electronic medical record system. Diagnoses of MI were checked for accuracy by full record review.
    RESULTS: There were 3303 CE presentations in the first 6 months of operation, of which 6% were transferred from other sites. Median age was 65 years (interquartile range [IQR]: 53-77), 56% were males; the most common presenting complaints were presumed cardiac chest pain (67%) and arrhythmia (17%). The admission, discharge and transfer rates were 38%, 54% and 8%, respectively. In total, 15% were diagnosed with MI. The most common diagnoses for discharged and admitted patients were non-specific chest pain (57%) and ST-elevation MI (22%), respectively. Ambulance off-load by 40 min was met for 96%. Median waiting time was 6 min (IQR: 3-10). Median CE LOS for discharged and admitted patients was 3.2 h (IQR: 2.5-4.0) and 3.7 h (IQR: 1.8-6.0), with 75% and 56% being <4 h, respectively.
    CONCLUSIONS: The population predominantly had cardiovascular disease as expected. Some performance indicators, including ED LOS, were identified as requiring intervention.
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  • 文章类型: Journal Article
    背景:患者安全在提供优质医疗保健方面至关重要,并构成了医疗保健系统的全球关注。对分化良好的甲状腺癌患者进行放射性碘治疗并非没有风险。本研究的目的是确定,评估和减轻与此程序相关的风险。
    方法:进行了单中心描述性研究,通过使用FMEA方法建立风险图来进行风险管理。
    结果:基于过程图,分析了处理过程三个阶段的6个子过程和23种故障模式。根据风险优先数(RPN),风险最高的子流程是行政管理(RPN82),其次是治疗本身和治疗后成像(均为RPN70)。整个过程RPN为300(156预处理,74处理和70后处理)获得。与患者直接相关的失败构成高风险。实施核查制度,尽早执行任务和提供高质量的医疗信息是最相关的预防措施。
    结论:FMEA方法在放射性碘治疗风险管理中的应用是提高该过程质量和安全性的宝贵工具。风险图已经能够识别不同阶段的故障,评估其原因和影响,对已识别的风险进行优先排序,并实施可监控的预防和纠正措施,确保所采取的行动的有效性。
    BACKGROUND: Patient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure.
    METHODS: A single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology.
    RESULTS: Based on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented.
    CONCLUSIONS: The application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.
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  • 文章类型: Journal Article
    了解麻醉提供者的性别对患者结局的影响需要仔细的统计分析和许多假设的有效性。英国麻醉杂志最近的一项研究调查了麻醉提供者性别对患者预后的影响,使用来自美国两个学术医疗保健网络的数据。作者表明,女性提供者的性别与术中并发症的风险较低有关。他们还表明,男性和女性提供者在术后结果方面没有有意义的差异。最近有几项研究考虑了医疗保健提供者性别对结果的影响。我们将讨论这些结果的解释以及基本假设的有效性。
    Unravelling the impact of the sex of the anaesthesia provider on the outcomes of patients requires careful statistical analysis and the validity of many assumptions. A recent study in the British Journal of Anaesthesia investigates the effect of anaesthesia provider sex on patient outcomes, using data from two academic healthcare networks in the USA. The authors show that female provider sex was associated with a lower risk of intraoperative complications. They also show that there was no meaningful difference between male and female providers with respect to postoperative outcomes. There have been several recent studies considering the effect of healthcare provider sex on outcomes. We will discuss the interpretation of these results and the validity of the underlying assumptions.
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  • 文章类型: Journal Article
    低收入和中等收入国家的医疗质量构成了重大挑战,导致可治疗条件导致死亡率上升。医疗机构认证是墨西哥前卫生改革的一部分,被提议作为一种提高医疗质量的机制。这项研究评估了墨西哥医院认证的表现,利用有效性指标,效率,和安全。采用纵向方法,采用受控中断时间序列分析(C-ITSA)和固定效应面板分析,来自墨西哥综合医院的行政数据受到审查。结果显示,墨西哥的医院认证未能提高医疗保健质量,令人不安的是,表明与医院死亡率增加相关的表现恶化。在医疗服务资金不足的情况下,事实证明,实施的认证模式在提高护理质量方面设计不足。对公立医院认证模式进行根本性的重新设计势在必行,强调结构强化和标准化流程的激励措施。解决提高医疗质量的关键挑战对墨西哥的医疗保健系统来说是当务之急,需要迅速采取行动,以实现有效获取,作为全民医疗保健覆盖的基准。
    Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico\'s healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.
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