Hospital

Using Clinical Decision Support Systems to Differentiate Cardiac from non-Cardiac Chest Pain

Alireza Kazemi

Background: Despite the fact that only one-third of chest pains occur due to heart diseases, still physicians have tendency to admit most of these patients to reduce risk of negligence and its consequences.Clinical decision support systems (CDSS) enable physicians to distinguish better cardiac from non-cardiac chest pain. This study reviewed articles which focused on this issue.

Materials and Methods: Google scholar and PubMed database were targeted for search. Out of ninety primary matching articles based on the title, abstract and keywords, 28 full texts were relevant which were included in this study.

Results: Included articles were classified into two categories such as managing hospital resources and increasing the accuracy of diagnosis. Study results in the first categoryshowed decrease in both reception and referral time up to 30% and length of hospital stay up to 26% using CDSS. In the second category, the highest reported accuracy of diagnosis was 97% and the maximum sensitivity and specificity were 100% and 89.43% respectively. Even though, the results of a study revealed that the accuracy of decision support system in diagnosing cardiac chest pain was better than the compared cardiologists.

Conclusion: Considering the role of CDSS in managing hospital resources and improving accuracy of diagnosing cardiac chest pain, it is suggested that emergency wards and cardiac screening centers equipped by these systems.

The Effect of Accreditation System on the Key Performance Indicators of Hospitals Affiliated to Tehran University of Medical Sciences: An Interrupted Time Series Analysis in 2012-2014

Mohammad Arab

Background: in order to quality improvement, accreditation standards implemented with focus on the clinical and non clinical services. A nationwide intervention such as hospital accreditation can affect on measures related to the provision of high quality services. Indeed, such devices can be considered as effective tools in macroeconomic health sector policymaking. The main objective of current study was to investigate the effect of accreditation system on the key performance indicators of hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: The study was a semi-experimental and descriptive-analytical one which conducted longitudinal using an Interrupted Time Series Analysis approach. Data related to the key performance indicators including average long of stay, Caesarean percent, turnover rate, patient satisfaction percent, bed occupancy rate, self-ordered discharge from emergency room and net death rate) was accumulated through multiple visits to the hospitals during 2012-2014. STATA software was used for data analysis.

Results: The study results revealed that based on implementation of accreditation model, the average stay of patients in the hospitals cesarean section rate and turn-over intervals decreased, while the percentage of patient satisfaction and bed occupancy average increased. Moreover, self-ordered discharge from emergency room and average of net death rate indicator showed no change.

Conclusion In general, it can be concluded that the health system partially has achieved a part of their objectives means key performance indicators promotion as a result of hospital accreditation implementation in hospitals affiliated to Tehran University of Medical Sciences. In order to assess more accurate investigation and understanding the nature of the system effectiveness, analysis of different aspects of hospitals performance indicators and the nature of their changes in longer period seems to be helpful.

Market of hospital infectious waste treatment facilities in Iran: An oligopoly market

Arash Rashidian

Background: This study aimed at assessing and economic analysis of the existing market of treatment devices of infectious waste in Iranian hospitals.

Material and Methods: In the current descriptive- analytical study which was performed in 2013, the data resulting from national cross- sectional study in Center of Environmental and Occupation Health in 2012 and interview with relevant authorities in 14 Tehran's hospital with at least three years experience using the facilities were utilized.

Results: Until 2012, 883 hospitals have been active in nationwide that more than 64% of them owned by university of medical sciences and SBMU and TUMS with 114 and 45 centers have the highest number of hospitals respectively. Also hospital beds per 1000 population in the country were calculated 1.78. About 80% of hospitals utilized wet thermal and mostly based on autoclave machines for treatment which market share of domestic products is about 55% that Koosha Company, TEM and KAZU have the largest share with 39%, 23.5% and 12.9% respectively.

Conclusion: Existence a large heterogeneity in the type and function of the studied devices has created possible of Cartel in an oligopoly atmosphere which with a targeted regulation and policy making toward protectionism, it can be observed price decreasing, enhancing effectiveness, quality and safety increasing of infectious waste treatment facilities

Attracting Factors Identification of Medical Tourists in Hospitals of Tehran City

Soudeh Bayat

Background: Recently, the medical tourism is developing more and more over the world. Due to the potential of medical tourism in Iran, this study aimed at identifying medical tourism characteristics in terms of tourist destination and therapeutic centers in Iran.

Materials and Methods: According to literature reviews and experts interviews, components of medical tourists attraction were investigated ana a questionnaire provided. After baseline, items which were not valid and reliable omitted and final questionnaire distributed and completed among experts Such as physicions, academic members, managers and medical staff in eight public and private hospitals in Tehran city.

Results: Regarding the study results based on the respondance view, the more and the less important components of medical tourist's attraction in Iran included hospital validity, costs, quality of care, hospital staff training, position and political environment, regulatory policy, infrastructure and location of hospital and economic situation. The main problem of medical tourism represented as lack of obvious treatment process and support system. In similar studies, low tretmant costs in destination country was the important motivation of medical travel and factors such as political, economic, regulations and standards and medical centers validity have been addressed to make decisions about the origin country.

Conclusion: This study based on current and priorities assessed the developing dimensions of the medical tourism in macro and micro levels from perspective of medical tourism activists. Medical tourism development requires comprehensive and integrated approach which has been achived using coordinate cooperation, planning and implementation of micro and macro strategies among relevant organizations.

Assessing the Status of Managers' Leadership Style and Its Relationship with Mental Health Staff of Hospitals Affiliated to Tehran University of Medical Sciences in 2014

Mohammad Arab

Background: Hospital managers inevitably have a major impact on their employees' health and because professional cohesion acheives in the shadow of psychological balance; possessing mental health is important among hospital staff. Therefore, current study aimed to determine the status of managers' leadership style and its relationship with mental health staff of hospitals affiliated to Tehran University of Medical Sciences in 2014.

Materials and Methods: This study was a cross-sectional and descriptive-analytical one and sample size consisted of 91 executives, intermediate managers and 320 employees of hospitals affiliated to Tehran University of Medical Sciences. Fiedler leadership style instrument and general health questionnaire were used. Collected data was analyzed by SPSS software version 22 using descriptive and inferential statistics tests.

Results: Responsive rate was85% (272/320). Most of managers adopted task-oriented leadership style. There was a statistically significant relationship between leadership style and mental health, physical problems, anxiety, social function and depression among staff (P<0.05).

Conclusion: Managers can be effective on mental health staff using relationship-oriented leadership style adoption and it seems necessary to train managers in adopting appropriate leadership models and styles in order to prevent and reduce mental health disorders among employees in different situations.

Challenges in emergency departments in teaching hospitals of Mashhad University of Medical Sciences: A qualitative study

Background: The emergency department is as heart of hospital and is one of the first points of contact for patients with health care system are facing a variety of challenges. This study aimed to explore the challenges of emergency departments in teaching hospitals of Mashhad University of Medical Sciences.

Materials and Methods: This study was carried out through a qualitative approach and phenomenology method in 2013 in Mashhad, Iran. Twenty nurses and two emergency medicine specialists were recruited from four teaching hospitals in Mashhad Iran using purposive sampling. Data were collected through semi-structured in-depth interviews. Interviews were transcribed verbatim and analyzed using conventional content analysis approach according to colaizzi with MAXQDA 3 software.

Results: The results of this study indicated that challenges of emergency department lay in

Three main aspects including: "challenges in Human resources"(personal characteristics, professional characteristics and human resource limitations), "nurses' dissatisfaction"(less quality hospital hoteling and services for staff, disproportion between the workload and salaries, Lack of support from nurses) and " challenges in human resources management "(Structural challenges, the performance challenges and challenges in human resource management). Each theme included several category and subcategory that explain various aspects of the challenges in emergency department.

Conclusion: Human resource limitations, nurses' dissatisfaction and poor management were the most important challenges. Providing adequate human resources, support of nurses and determination guidelines and process for nursing care can reduce these challenges in hospital emergency departments.

Assessing the Relationship between Organizational Climate and Nurses' Job Motivation in Selected Army Hospitals of Tehran City

sanaz zargar balaye jame

Background: Beside qualified and capable nursing personnel, nursing care development requires motivated nurses to work in an appropriate environment. This study aimed at determining the relationship between organizational climate and nurses' job motivation in selected Army hospitals of Tehran city in 2015.

Materials and Methods: In this study was a descriptive -analytical and cross sectional one. The sample size consisted of 340 employed nurses in hospitals with at least one year work experience which were stratified randomly selected based on work experience among four army hospitals in Tehran. Data were collected using two questionnaires including job motivation and organizational climate. In order to data .analysis, descriptive and analytical tests such as Pearson correlation coefficient were utilized.

Results: One hundred and eighty nine of participants (55.4%) were female. Mean age of nurses’ average was 32.22 ±9.8 years. More than half of nurses had evaluated group spirit as high level and hindrance, engagement, intimacy, consideration, spacing, thrust and production emphasis as moderate level. There was a direct significant relationship between all components of job motivation and engagement, intimacy, consideration, spacing, thrust and production emphasis (P<0.05). Furthermore, mental and official components of job motivation had an inverse significant relationship with hindrance component respectively (P=0.014, P=0.019).

Conclusion: Regarding the relationship between all components of the organizational climate with job motivation, attempt to improve these components will have significant impact on motivation improvement, reducing absenteeism and job dissatisfaction.

Planning the Patient Safety Management System Using Failure Mode and Effect Analysis in ICU Care: A Case Study in Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences in Tehran city

jaber hekmatyar

Background: Injuries related to failures and errors due to clinical interventions in patient hospitalization period in hospital are the main reasons of mortality and mortality in worldwide. This study tries to identify and description ICU care failures and assessing the causes of risks, Severity, Occurrence and identifying risk probability ratio and risk prioritizing using FMEA method.

Materials and Methods: This study was carried out in order to evaluating existing situation using Failure Mode and Effect Analysis and utilizes volere logic to plan the patient safety management system. This study performed in the intensive care unit of Loghman Hakim hospital in Iran.

Results: Study finding revealed sixteen routine failures and its priorities which the five main issues were documented as error in decision phase for patients admission or in-admission (PRN 1000), error in discharge time of patient from ICU (PRN 1000), insufficient infection control (PRN 1000) and error in clinical ordering and prescriptions (PRN 800).

Conclusion: The main requirements of the patient safety management identified as planning standards and clinical guidelines, developing evidence based admission and non admission indicators, enacting infection control rules and education of anticipating standards places, hand washing and disinfecting instrument and equipments.

The Impact of Quality Management on Reducing Bill Deductions at Operating Theatre Department of Valiasr Hospital A participatory Action Research

Mahnaz Afshari

Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.

Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department. Related data were collected before and after the intervention to determine the effect of quality management system on deductions.

Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.

Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively

Reform Strategies to Improve Monitoring Performance and Infrastructure Implementation development of the New Scheme of Fee Guidelines in 2014 (A Qualitative Study)

Mohammadreza tavakkoli

Background: In year 1995, new system administration plan of hospitals (fee for service) was notified. This scheme was implemented in hospitals for 20 years. In the early September 2104, new guidelines of performance-based fee for service plan with the aim of deficiencies in the previous plan was reviewed and implemented in hospitals in Isfahan. This study aimed at investigating reform strategies to improve monitoring performance and infrastructure implementation development of the new scheme of fee guidelines in 2014.

Materials and Methods: This study was a qualitative one based of phenomenology. Depth interviews were used to collect data. Eleven individuals assessed including top and middle managers and professors of Isfahan University of Medical Sciences using content analysis method.

Results: In this study, eight main themes and ten sub-themes extracted including appropriate policy making, health management reform in health system, cultural building in monitoring, proper planning, physicians' motivation, infrastructure improvement, improving training, informatics and constructive interactions between senior managers and hospitals' directors.

Conclusion: With the aim of rationalizing the health system, new instructions and fee for service plan should be considered well to tackle weak points. It seems that coping with these weak spots in new fee for service plan, has feasibility to provide more satisfaction among physicians and staff. To achieve main goal of the project which defined as patients and staff satisfaction, using new reform strategies to facilitate plan implementation, continuing observation and stronger mentoring recommended.

Predicting Job Performance Based on Humor Components and Mental Health among Staff of Ziaeyan Hospital

narges tankamani

Background: Hospital staffs including physicians, nurses and crew are exposed to various risks including physical and mental illnesses. The study aimed at predicting job performance based on humor components and mental health among staff of Ziaeyan hospital.

Materials and Methods: This study was a descriptive- analytical one. Sample size was 120 individuals (74 females and 46 males) who selected via non- randomly and Voluntary With a diverse range of staff including nurses, physicians in 2014. After explaining about research type and filling voluntary questionnaires with informed consent, job performance Paterson, Martin et al humor components and Goldberg mental health instruments were disseminated. SPSS Software version 17 utilized to data analysis using regression and cluster analysis.

Results: Among of humor components and mental health, Self-enhancing, depression and social performance predicted job performance positively. Depression has the largest ß coefficient(0.26) for job performance which revealed this variable the strongest one and provided main contribution to explain the criterion variable. Also, there was a statistically difference between negative morbid humor clusters and positive and healthy clusters of humor in the significant level less than 0.05(t= -7.97, p<0.001).

Conclusion: Selection of humor style and enhancing mental health of hospital staff will cause job performance improvement. Regarding stressful environment of hospital, it seems providing better mental health and applying healthy styles of humor as a proper way to staff performance improvement which should be considered.