Hospital

Appointment process of open-heart surgery in Shahid Rajaei Heart Hospital using a discrete event simulation approach

Bakhtiar Ostadi

Background: The waiting list is a list of selected patients in the surgical queue. If demand exceeds capacity, the waiting list grows rapidly, which may lead to unacceptable waiting for patients, especially those in need of acute medical care. Patients waiting for heart surgery are placed on the waiting list for surgery, and sometimes the waiting time is longer than patients expect. Reducing the waiting time for medical services, including heart surgery, is one of the challenges of the health system. In this regard, the present study was performed by identifying an effective solution to reduce the queue length of patients undergoing cardiac surgery.

Materials and Methods: In this article, the process of scheduling open heart surgery at Shahid Rajaei Hospital was reviewed and improved with a discrete event simulation approach in Arena simulation software. After designing the process, the existing bottlenecks leading to the long waiting time of the patients were identified. The waiting time and the number of patients visited were determined as the objective function and the patient flow was improved by presenting improvement scenarios and selecting the best scenario.

Results: Simulation results on 66 selected patients in 7 months from October 2020 to May 27, 2021 show that Scenario number 10 has the most improvement in performance criteria but is not applicable in practice. Therefore, due to system limitations, Scenario 2 was selected as the best scenario. Implementing Scenario 2 could reduce the waiting time by 40 percent and increase the number of patients visited by 21 percent.

Conclusion: Patient prioritization methods allow patients with higher needs to receive more services than those with lower urgent needs, although they also have longer waiting times for patients with lower urgent needs.

A Dynamic analysis of Health care supply and demand management: A Case Study Hospitals of Social Security Organization

Mostafa Rajabi

Background: The outlook for hospital care is changing rapidly. Supply and demand stimuli in the health service system are changing dramatically. The health department of the Social Security Administration has also been challenged by the growing number of patients. This study was conducted to help this organization with the aim of designing a conceptual causal model of the interaction between supply and demand of health care.
Materials and Methods: This research is a qualitative study that was conducted in 2020. It presented a conceptual model in two steps in the first step, semi-structured interviews were used to extract important factors in the supply and demand of health services in hospitals. In the second step, the system simulation approach was used and the feedback relationships between the patient's routes to the hospital and the provision of medical services were presented.
Results: According to the study hypothesis, the prevalence of disease and budget allocation as an indicator of medical need and expected medical demand, positively affect the number of visits to hospitals of the Social Security Organization. Accordingly, four sub-models of patient flow, health care budget, treatment staff (physician, nurse) and hospital capacity were extracted.
Conclusion: Medical budgets allocated to hospitals to improve medical facilities and increase the number of staff, have created positive expectations among social security insured regarding the use of hospital services. Paying attention to providing sufficient manpower (doctor, nurse) and bed capacity with the budget which is spent for this service are the indicators of improving the quality of services.

Presenting a public accountability model based on the use of social media in public universities of medical sciences and hospitals and medical centers in Tehran

Alireza Golabdoost

Background: Social media is one of the low cost tools used by many organizations. The purpose of this qualitative research is to present a public accountability model based on the use of social media in public universities of medical sciences in Tehran.
Materials and Methods: The present study was performed using Clark's position data analysis method. In-depth interviews were conducted with 21 experts in 1400 to extract the main components of this model. The subjects of this study were managers and experts of medical universities in Tehran (Tehran, Shahid Beheshti, Iran) that participants were selected using purposive sampling method of theoretical sampling.
Results: The analysis of the accountability situation in medical universities showed that the "government" is the main and determining factor. Within this factor is the "Ministry of Health". The third factor is the "universities of medical sciences" and the social worlds active in it. The fourth factor is "public relations units", but in the corner of these overlapping factors is the "target community" factor.
Conclusion: The basis of accountability is reporting and information. Universities should give their staff the necessary leeway to report directly. According to the research findings, it is suggested that by forming a specialized department of public relations in relation to public accountability, in addition to identifying capacities, to remove existing barriers.

Spatial analysis and Localization of Selected Pharmacies Distribution of Agonist Drugs for Addiction Treatment Clients in Substance Abuse centers with GIS

Morteza Heidarimozaffar

Field of study and Goals: The provision of medical services and the distribution of agonist drugs in substance abuse treatment centers has led to a lack of attention to patients' treatment plans and a greater focus on drug distribution. In order to separate health and pharmaceutical services that are provided for opioid addicts in drug addiction treatment centers, a study has been designed with the aim of locating the selected pharmacy for the distribution of agonist drugs in District 21 of Tehran Municipality with a spatial approach.
Materials and Methods: This applied research is a descriptive-analytical method. The spatial and descriptive data were collected from the municipality organization and treatment and food and medicine departments of Iran University of Medical Sciences and Health Services and they were analyzed using ArcGIS software. Distribution of pharmacies and drug addiction treatment centers in the study area, locating the appropriate areas, and locating the selected pharmacy were studied by using the kernel density estimation functions, hierarchical analysis, and location model - allocation in two regional and district modes with maximum coverage of drug addiction treatment centers, respectively and analyzed using SPSS software and t-test.
Results: This study shows that the distribution of pharmacies and population in different regions of the study area is commensurate. Based on the results of locating using hierarchical analysis method, all pharmacies in the study area are appropriate to be the pharmacy for distributing the agonist drugs, and the results of the location model – allocation shows that the average time, and distance to access to the selected district pharmacy is 17 minutes and 5.9 km, respectively and for the regional pharmacy is 2 minutes and 0.7 km, respectively.
Conclusion: Separation of medical services and distribution of agonist drugs is essential. The findings of this study indicate that the distribution of agonist drugs through selected regional pharmacies increases access to medicine and the satisfaction of patients.

Designing an intelligent system for predicting chromosomal genetic diseases using data mining

Fariba Salahi

Background and Aim: Today we are witnessing tremendous advances in medical data mining. The data, by analyzing and discovering the relationships between them, can lead to algorithms that help us prevent or treat many diseases. Meanwhile, genetic diseases have attracted a large part of the attention of the medical world because the birth of children with genetic disorders imposes a great financial, psychological and emotional burden on society. Therefore, the aim of this study is to present an algorithm as a secondary screening test before performing cell and molecular tests.

Material and Methods: In this study, 1000 cases of pregnant women who were in moderate or high risk group after screening tests were studied. Their clinical information was stored, missing data was deleted, and records were integrated. Then, using Clementine software, data mining and data correlation were performed, and finally a suitable algorithm for diagnosing the disease was performed. Genetic mutations were identified.

Results: By applying five algorithms, neural networks, support vector machine, binary decision tree, multiple decision tree and logistic regression on the data, it was found that the neural network algorithm with 97.522% accuracy has the highest success rate in Diagnosis of genetic-chromosomal diseases before birth.

Conclusion: The use of genetic algorithm as a screening test causes less people to be candidates for costly and dangerous cellular and molecular tests and can be used as a tool to help detect the disease. To be used in the medical world.

The Relationship between Human Resources Management Functions and Job Burnout from the Perspective of Managers and Staff in Deputy of Health in Iran University of Medical Sciences

Pouran Raeissi

Background and Aim: Burnout is one of the most important factors that reduces the productivity of personnel. Therefore, this study aimed to determine the relationship between human resources management functions and job burnout from the perspective of managers and staff of deputy of Health in Iran University of Medical Sciences.
Materials and Methods: Subjects of this cross-sectional study consisted of 657 managers and staff members of deputy of Health in Iran University of Medical Sciences that 242 individuals were selected according to Morgan's table as the study population. Research data were collected using two questionnaires of burnout and human resources management functions.
Results: 174 (70.7%) participants in the study were women, with mean age and work experience of 41.3 and 15.8 respectively and a standard deviation of 7.35 years. 78.9% of married people and 69.1% of the participants were dissatisfied with the status of their salaries. The dimensions of consequential evaluation, transparent job description and comprehensive training with averages of 4.17, 4.12 and 4.03 out of 7 had the highest score among the various dimensions of human resources functions. Different dimensions of burnout showed that the highest mean was related to feelings of personal inadequacy and depersonalization (4.72). The results of the Pearson correlation test showed that there was a statistically significant relationship between human resources management functions and burnout with a correlation coefficient of -0.439 (P <0.05).
Conclusion: Job burnout can be significantly reduced with the improvement of human resources management functions.

The share of hospital costs from the health expenditures of Iranian households: A retrospective study, 2011-2015

Faroogh Na'emani

Background & Aims of study: Service delivery is known as the most tangible function of the health system and hospitals are the most obvious manifestation of this function. Also, one of the most important factors in creating catastrophic health expenditures is the use of hospital services; therefore, in the present study, an attempt was made to describe the share of hospital service costs from total household health expenditures.
Materials and Methods: The present descriptive study was performed retrospectively for the period of 2011 to 2015. The study was done using the Household Expenditure and Income Survey (HEIS) which is conducted annually by the Statistical Center of Iran (SCI). Based on the designed model, the share of hospital costs from household health expenditure was determined by year and type of services in urban and rural areas.
Results: On average, 18.5% of households used hospital services and about 28.7% of household health expenditure had been spent on receiving health services from hospitals. The average cost of household hospital medical services was 92.4% in urban areas and 91.4% in rural areas. On average, 51% of the cost of household medical services in hospitals was related to public hospitals, and the highest cost spent by households in public hospitals was allocated to surgery.
Conclusion: The share of hospital services costs and the rate of use of these services among Iranian households are significant, which may lead to poverty and catastrophic health expenditures. Therefore, it is necessary for health decision makers to design and implement evidence-based policies to manage and control this part of health costs.

Hospitals Strategic and Operational Plans: Unwillingness, lack of Success, and prosperity: A letter to the editor

Bahman Khosravi