Showing 103 results for Pour
Zhila Najafpour, Mahmood Mahmoodi, Abolghasem Pourreaza,
Volume 13, Issue 4 (3-2015)
Abstract
Background: There is now a global concern about significant numbers of patients who are harmed or faced financial problems.Therefor, interving in organized approach to provide safe services seems necessary. This study is aimed to assess the basic indicators of patient safety in hospitals affiliated with Tehran University of Medical Science.
Materials and Methods: This descriptive–analytical study was conducted in the 5 selected hospitals affiliated with Tehran University of Medical Sciences. The data were collected using patient safety assessment protocol published by WHO(WORLD HEALTH ORGNAZIATION) tool.The questionnaires were filled using variety of different ways such as : interview, observation and documents investigation. The data were analyzed using SPSS software and also with descriptive and analytical tests.
Results: The results showed total average of maintaining the standards was 51.1% which categorized as weak level based on the protocol . The highest and lowest rates of the domains studied were safe environment (68.8%) and continuing education (24.8%) respectively. Farabi and Rasul Akram hospitals had the best and the worst levels of maintaining indicators of patient safety standards .It is worth mentioning that the status of all the hospitals was in the same level. Statistical tests indicate that maintaining the standards does not differ significantly between participating hospitals.
Conclusion: All participating hospitals has a poor performance through developing basic patient safety indicators .Managers` support and staff participation can be helpful to solve the mentioned issues. Paying attention to patient safety in managerial plans and putting equal value to various aspects of patient safety are pivotal
Seyede Mahboubeh Hosseini Zare, Elham Movahed, Abolghasem Pourreza, Abbas Rahimi Foroshani,
Volume 13, Issue 4 (3-2015)
Abstract
Background : Raising number of elderly people in Iran causes new concerns .One of the important issues is Social support. Social support can be critical for older adults because of their common disabilities and unavoidable dependency to maintain and improve of their health status
Materials and Methods: Questionnaires which had been used for measurement of health status and elderly social support has been collected and combined through searching resources in library and web. 5 district ions of Tehran were selected randomly in order to have a efficient sample size .The questionnaires were filled by 140 elders whom were staying in residential homes and 280 above 60 years elderlies whom were living with their families. The date were analyzed by SPSS software.
Results: 406 questionnaires among 420 questionnaires were filled which showed 96.6%. rate of responsibility. Data analysis showed a correlation between status of physical, mental and social health social support.
Conclusion: There is a significant correlation between Social support and physical ,mental, and social status of health
Amir Ashkan Nasiripour, Mehrak Pourmotahari,
Volume 13, Issue 4 (3-2015)
Abstract
Background: Nowadays, quality of working life
as a universal concept of human resource management and organizational development
have been regarded and improving it, is key to successfully managing any
organization. This study was conducted to survey Relationship between Quality of working life
and Work-family conflict among Nurses of Hospitals in Tehran.
Materials
and Methods: This
study is descriptive –analytic that performed cross sectional. The study
population was the nurses of the hospitals of the Tehran University of
Medical sciences (N=215).The data was
gathered using two questionnaires , Quality
of working life components of Casio and questionnaire of work-family
conflict prepared based on Carlson. Cronbach's alpha was used to assess the
reliability of the questionnaire. Spearman correlation test was used for
statistical analysis.
Results:
There was no significant
relationship between Education and work facilities (Quality of working
life components) with the work-family
conflict (p >0.05).but relationship
between the democracy, participation in decision making, job design,
workplace in organization with
the work-family conflict was significant (p <0.05).finally, between Quality of working
life and work-family conflict a significant
relationship was observed (p <0.001).
Conclusion:
Because the
significant relationship was observed between the Quality of working life and
work-family conflict among the nurses, It can be concluded that Work-family
conflict be reduced with improve of Quality of working life.
Hosein Ebrahimipour, Ali Vajaee, Gholam-Abas Nouri, Habib-Allah Esmaeili, Sara Jamili,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Process of discharging patients affects patient’s satisfaction .This is one of the serious challenges that hospital managers face. This study is aimed to determine the average waiting time of patient discharge process and identify influential factors of this process in Imam Reza Hospital in Mashhad in the year of 2014.
Materials & Methods: This is a cross-sectional survey in which waiting time of patients who had discharged from clinical wards of the Imam Reza hospital in Mashhad had been studied. 455 of patients had been selected as samples. The amount of time spent during discharge in six different departments such as inside each ward, from each ward to the medical records unit, inside the medical records unit, from medical records unit to accounting department , during cost calculation and also from cost accounting to cost payment unit) had been determined by using stop-watch method. The data had been analyzed by descriptive and analytical statistics in significant level of 0.05 using SPSS16.
Results: Results showed that waiting time was 504.26± 362.96 Minutes. Patients spent most and least proportion of their waiting time in ENT and Burns wards during discharge.
Conclusion: As noticeable number of minutes spent inside wards and cost payment unit by patients, calls for corrective interventions such as changing visit time and predicting schedules for sending medical record to accounting department could reduce waiting time.
Ali Jannati, Neda Kabiri, Mohammad Asghari Jafarabadi, Behrooz Pourasghari, Babak Bayaz,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013.
Materials & Methods: This interventional research was a before-and-after study. In order to recognize any changes, efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention, descriptive statistics were used.
Results: Findings showed that costs didn’t differ significantly after the intervention, but revenue was a little increased slightly (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases).
Conclusion: Regarding the results of survey , it seems that we can conclude that this bonus payment system can be used in all levels in which care is provided such as primary health care centers, drug stores, diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error.
Seyed Hadi Hosseini , Siavash Fazelian , Javad Heshmati , Mahdi Sepidarkish , Reza Pakzad , Abolghasem Pourreza ,
Volume 14, Issue 2 (8-2015)
Abstract
Background: nutrition department is one of the most important sectors of hospital to improve the patients' health and satisfaction. Lack of standards obsevance causes nosocomial infections and develops health risks. Establishing HACCP standards, many existing shortcomings will be omitted in the hospital nutrition department. This study aimed at assessing the mentioned nutritional standards system in the hospital nutrition department.
Materials and Methods: This cross - departmental study was conducted at Kermanshah University of Medical Sciences' teaching hospitals in 2013. HACCP questionnaire was used. Data collection performed using observation, interviews and questionnaire filling in from hospitals' nutrition department.5-point likert scale used which rating scale was from 1(lowest) to 5(highest).in order to data entry and analysis SPSS software version 18 utilized using tables, graphs and Kruskal-Wallis test.
Results: The mean score and percentage of five areas of HACCP standards were 3.58 and 70.23% respectively which were desirable in seven studied hospitals. There was no significant statistical relation between the mean scores of hospitals in the standards.
Conclusion: Although, the situation was assessed desirable, because of the importance of nutrition department, observance of optimum standards and quality improvement can prevent potential infections in food preparation and distribution and result in patients and staff satisfaction.
Mohammad Javad Kabir , Nahid Jafari , Mohammad Nahimi Tabihi, Ebrahim Mikaniki , Hasan Ashrafian Amir, Seiyed Davoud Nasrollahpour Shirvani, Araslan Dadashi , Ghasem Oveis ,
Volume 14, Issue 2 (8-2015)
Abstract
Background: One of the key duties of family physician is to form health records and provided recording services. This study conducted to form health records and aevaluate health records in family physician program in Northern Province of Iran.
Materials and Methods: This cross-sectional study was carried out in second half 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected using systematic random sampling, and assessed performance recording of all family physicians. A self- designed questionnaire was used which the validity and reliability of were confirmed. Data were analyzed by SPSS18 at the significant level of p<0.05.
Results: Out of the 189 assessed family physicians, the profile of patients referred to the second level and its results were recorded in referral record forms by 43 physicians. Out of 1890 studied families, 1559 families had health record which had filled 892(57%) health record completely. Out of 5869 assessed family members, 4229 patients were examined periodically by their family physician at least once and 1919(46%) results filled entirely. during 559 were reported with health records, among which 892 were filled out completely. There was a significant difference between referral record rates to registered specialist between the Northern Province of Iran (P=0.001).
Conclusion: The quantity and quality of health record formation was not in the expectation level as well and appropriate interventions are needed.
Zohreh Kalani, Zahra Pourmovahed, Ali Akbar Vaezi, Seyede Felor Vaziri,
Volume 14, Issue 3 (9-2015)
Abstract
Background: Using vein by Peripheral Catheter is one of the important ways to provid water, electrolytes, medications and nutrients to patients in hospitals and other therapeutic centers. Phlebitis is an important complication of using peripheral cannula. This study performed to determine the incidence of phlebitis related to peripheral cannulae, and its effecting factors.
Materials and Methods: This prospective and analytical study was conducted in adult's medical- surgical units of Shahid Sadoughi Yazd. Two hundred ninety seven cannulae of 297 patients were assessed. Phlebitis was identified by the presence of at least two following symptoms including local pain, redness, swelling, warmth and palpable venous cord.
Results: The mean of patients' age was 40.82±19.48 (12-91 yrs.). The phlebitis incidence rate was 14.1%. Some factors such as smoking (P=0.007), diabetes (P=0.001) had positive and significant association with phlebitis incidence rate. Odd Ratio for smoking and diabetes were 3.107(CI=1.310-7.372, 95%) and 3.736(CI=1.736-8.039, 95%) respectively.
Conclusion: Study findings revealed that overall incidence rate of phlebitis compare with other similar studies was low. Study results indicated high phlebitis incidence in smokers, diabetic patients, and elder patients which can be prevented by considering phlebitis incidence in impatiens.
Faramarz Pourasghar, Jafarsadegh Tabrizi, Nesa Kavakebi, Ahad Banagozar Mohammadi,
Volume 14, Issue 3 (9-2015)
Abstract
Background: Patient transfer requires the wide variety of functions such as collaboration, appropriate communication and coordination between hospitals and the Center for Treatment Guidance and Information (CTGI). This study aimed at determining the influencing factors in the coordination of patient transfer and also explaining the situation of the CTGI in patient transfer process coordination.
Materials and Methods: This study was a qualitative study (phenomenology) conducted using three Focus Group Discussions (FGD) and thirty interviews with participants who were involved in the process of patient transfer in a referring hospital, six patient receiver hospitals and CTGI in Tabriz. Purposive sampling was used to select study participants. Data was analyzed using content analysis.
Results: The effective factors of the patient transfer coordination were categorized in four main themes including weakness in the exchange of clinical information, data constraints, legal protections weakness and guidelines implementation and lack of clinical empowerment in managing patient. Eighteen sub-themes were identified which include legal protections weakness and guidelines implementation in center for treatment guidance as sector problems.
Conclusion: There are some problems in coordination of patient transfer process which is relate to non adherence a specific procedure for admission , ineffective interactions and information exchange. In order to achieve uninterrupted medical treatment, the patient transfer coordination should be improved. The center for treatment guidance and information should be obtained its position as a supervising authority.
Zahra Jalilibal, Mahyar Kianpour, Fariborz Jolai,
Volume 14, Issue 4 (1-2016)
Abstract
Background: Health care systems especially hospitals often encounter several risks which has weaken efficiency and hospitals performance entirely. Resilience engineering (RE) enables to remain high risk systems stable faced to sudden changes or minimizes negative effects of changes.
Materials and Methods: This study considered a new hybrid framework concept regarding the non-value added waiting time and resilience engineering indices as efficiency indices to evaluate private and public hospitals performance. With the intention of evaluating the hospitals performance, a hybrid framework including simulation and MADM methods utilized. Output-oriented Data Envelopment Analysis (DEA) approach used as MADM method.
Results: The results revealed that RE factors play a significant role in hospitals performance's promotion; also the private hospitals had better performance compared to the public ones.
Conclusions: Study results indicated that teamwork efficiency index compare to other efficiency indices had more effect on hospitals performance. Health system managers should be considered improved performance and efficiency policies and focus more on other RE indices parallel team work index.
Mohamad Mehdi Hazavehei, Fatemeh Noryan, Forouzan Rezapour Sahkolaee, Abas Moghimbayge,
Volume 15, Issue 1 (6-2016)
Abstract
Background: Considering the importance of hand hygiene in nosocomial infections prevention and the low outcomes of performed researches in hand hygiene, this study aimed at assessing the effective factors on hand hygiene using planned behavior model among nursing and midwifery staff in atea hospital of Hamadan in 2015.
Materials and Methods: This study was a descriptive and cross-sectional study in which all nursing and midwifery staff of the Atea hospital selected through census sampling. Hand hygiene behavior was observed and all participants filled out a questionnaire based on Planned Behavior Model. Data was analyzed using descriptive and inferential statistics.
Results: only 31 participants (21.1%) had hand hygiene behavior higher than average and 123 (79.9%) had lower than average. Hand hygiene was in the lowest rate, 21.3% and 13% after patient contact and prior to action aseptic respectively. Knowledge (84%) and attitude (90.4%) about hand hygiene was high, but the level of perceived control, (53.35%) was at the low level. Also, there were significant statistical differences between perceived control and hand hygiene between subjective norms and hand hygiene (p<0.05).
Conclusions: The knowledge and attitude to adopt hand hygiene behavior is not enough alone. Along with staff training, it is necessary to have hospital managers and physicians training, providing appropriate context and omitting barriers to have suitable hand hygiene behavior in practice.
Habib Ebrahimpour, Nourmoohammad Yaghubi, Seyd Saied Zahedi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: The organizational learning has been influenced in different theories and model based on theoretical and practical dimensions in organizations development and provides a favorable context for changing and development. Organizational learning capacity can play a main role in clinical governance implemention.
Materials and Methods: This study was a descriptive- analitical and cross-sectional one which performed during the first six months of 2014. Study population included staff of Ardabil Social Security hospital. One hundred and seventy participants selected using simple random sampling. A four dimensional standard questionnaire of Gumejeet et al and a seven dimensional self administrated questionnaire were conducted to examine organizational learning capacity and clinical governance assessment, respectively. Data analysis was carried out using Pierson Correlation Coefficient and Mulivariate regression analysis. Data was analyzed by SPSS18 software.
Results: Study results revealed that there was a positive and significant relation between organizational learning capacity and clinical governance implementation (R= 0.507). This correlation coefficient was 0.644 in management commitment, 0.498 in systematic approach, 0.446 in open climate and 0.261 in knowledge transfer.
Conclusion: According to the main role of organizational learning on implementing clinical governance, providing an essential background to enforce organizational learning capacity in four components especially management commitment and systematic approach to implement efficient clinical governance is recommended.
Raziye Beyranvand, Farbod Ebadi Fard Azar, Sara Emamgholipour, Mohammad Arab,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Todays, hospitals are facing with shortage of resources and increasing costs challenges, So, cost information and cost calculation of hospital delivered services can be effective in efficient resources allocation and tariff rates reforming and budget. This study aimed at calculating the cost of services and physiotherapy department's income of Sina hospital and comparing with approved tariffs in 2013-2014.
Materials and Methods: This study was a cross sectional and retrospective one. The cost price of 13 physiotherapy services calculated using Activity Based Costing method for physiotherapy unit of Sina hospital of Tehran in 2013-2014. Data collection tool included some forms related to services costs of physiotherapy and related activity centers. Also, in order to estimate cost proportion of other wards in physiotherapy unit, the proportional allocation bases was determined, then direct allocation method was utilized.
Results: The most costs of 13 provided services were less than tariffs in 2013. Generally, the costs pertain of physiotherapy services computed 794286777 Rials which workforce costs (48.4 percent) was the most proportion and then energy buildings depreciation and equipment costs. This issue is due to equipment dependency in physiotherapy unit services.
Conclusions: study results revealed there was difference between real cost of services and approved tariffs, therefore, in order to more accurate pricing, exact calculation methods such as Activity Based Costing recommended. Considering high personnel and capital costs pay special attention to these resources, appropriate use, identifying and omitting wasted costs can be effective in increasing efficiency and saving costs.
Zahra Maebood Mojdehi, Amir Ashkan Nasirirour, Pouran Raeissi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Medical centers and hospitals need to expand internet, Application Service Providing (ASP) to convert it to a long-lasting choice to compete. Hence, the present study carried out with the aim of determining the relationship between quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences with similar hospital information systems.
Materials and Methods: This study was a descriptive-analytical and correlation one. The study population consisted of revenue and clearance employees' unit in selected hospitals. Study method was census using Kim et al questionnaire. Descriptive statistics such as frequency, percentage and average; and inferential statistics like Kolmogorov-Smirnove Test and Pearson correlation coefficient utilized in order to data analysis.
Results: There was a significant positive correlation between quality of Application System Provider variables and users satisfaction in order of severity in system quality (r = 0.734, P = 0.01), service quality(r=0.721, P = 0.01) and information quality(r=0.521, P = 0.01). As, system quality had the most impact on users' satisfaction.
Conclusion: There was a significant relationship between the quality of Application Service Providing (ASP) with the users' satisfaction in selected hospitals of Tehran University of medical sciences. Although, all variables had positive and significant relationship with user satisfaction, their average was less than moderate limit. So, the health managers are advised to consider these issues in management methods.
Hamid Ravaghi, Sima Rafiei, Maryam Mohseni, Peigham Heidarpour, Mohammad Arab,
Volume 15, Issue 3 (8-2016)
Abstract
Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.
Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors and analyzed based on content analysis.
Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.
From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.
Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems.
Ali Zangiabadi, Sharare Saidpour,
Volume 15, Issue 3 (8-2016)
Abstract
Background: The issue of access to urban services is one of the important one that affects different aspects of urban affairs. In some cases, lack of proper access to some land, people's health is exposed to risk, for example Health care services especially in hospitals that impose requirements in a timely and appropriate access to it for all members of society. This study aimed at analyzing the distribution of hospitals and locates new hospitals regards to the lack in Saqqez city.
Materials and Methods: This study was a cross sectional and descriptive one. In order to classify and analyze data, the models of AHP and network analysis have been used. Also, ARC / GIS software and Expert choice has been used to map layers.
Results: According to assessed studies about the distribution of available hospitals and determination of their standard performance, 62.93 percent of the city area has not access to the hospitals.
Conclusion: This study results showed that hospitals in terms of compatibility with other land uses and access is inappropriate in the city. Thus, optimal areas for construction of new hospitals in five final maps from very good to very poor were classified and proposed using combining different layers of effective land uses.
Fereshteh Alizadeh, Seyyed Jamaledin Tabibi, Mohamadreza Maleki, Amirashkan Nasiripour, Abbas Toloie Eshlaghi,
Volume 15, Issue 3 (8-2016)
Abstract
Background: Demographic prediction indicates that Iran population move towards an aged society until 2025, Hence, the need for medical care will be increased. The study aimed at predicting geriatric specialists based on dynamic system approach for the Iranian elderly.
Materials and Methods: After an exploratory study, data gathering and building similar structured in order to determine geriatrics number prediction by considering the important factors. Causal loop diagram to show relationship between variables, stock-flow diagrams for quantitative analysis of system dynamic behavior was conducted and model equations in Vensim software version 5 used.
Results: After simulation, intake students' simulated model revealed increased trend then a sharp decline and finally the pattern had fixed trend from 2009 to 2012. Pattern of physician who was still in study and also graduated physician was in growing trend. Employed physician had growing trend and then it fixed, and retired physician had fixed trend at first and then had an incremental trend. Finally, the various behavior of workforce assessed in three level.
Conclusion: According to increasing growth of the elderly population until 2025, we will encounter with shortage more than 2500 geriatrics which can be compensate by 50% graduated admissions of the major annually.
Sayed Masood Mosavi-Negad, Omid Adeli, Tahere Hariri, Neda Vali-Pour, Zahra Moshkani,
Volume 15, Issue 3 (8-2016)
Abstract
Background: Many hospitals of Iran make use of their therapeutic capacities in order to attract medical tourists and increase revenue and efficiency of their affiliated hospitals. This issue has major benefits for hospital and tourists. This study assessed the potential of medical tourists' attraction in a military hospital in Tehran.
Materials and Methods: This was a descriptive- analytical one which used secondary data to analyze. Data gained from quality improvement and finance offices, recipients of service and health information management units from the first of 2014 to the first semester of 2015. Strategic plan document were used to analyze the opportunities and strengths points.
Results: The mean of studied hospital performance indicators like bed occupancy rate, length of stay, Bed turnover, rate of admissions to bed, mortality and bedsores rates, nosocomial infections, medication error, patients' rights and patient satisfaction were 4.68 , 3.3, 5.1 , 6.6 , 5.2, 1, 69, 9.74 , 70 percent respectively. The strengths points of the studied hospital were diverse expertise, updated equipment and minimum waiting time.
Conclusion: Because of skilled man power, physical resources and especially modern equipment, the hospital does not need huge investment in medical tourists' attraction. This issue will increase admission, productivity and satisfaction of clients and staff.
Dr Zahra Meidani, Gholamabas Moosavi, Dr Yaser Hamidian, Dr Mehrdad Farzandipour, Dr Akbar Aliasgharzadeh, Zahra Nazemi Bidgoli,
Volume 16, Issue 2 (7-2017)
Abstract
Background: Regarding to the importance of controlling health care expenditure, necessity for proper distribution of health care resources and appropriate utilization of hospital resources through inappropriate services reduction for patients, this study aimed to assess suitability of brain CT scans, based on American College of Radiologists (ACR) appropriateness criteria in Shahid Beheshti Hospital affiliated to Kashan University of Medical Sciences (KAUMS).
Materials and Methods: This cross sectional and retrospective study was conducted in internal and surgery triage unites of an academic hospital in KAUMS to determine the appropriateness of brain CT scans. A General physician reviewed 361 medical records of patients through the check list based on ACR appropriateness criteria. Collected data was classified in three areas including appropriate, possibly appropriate and inappropriate. Data was analyzed using SPSS through descriptive statistics such as Index of dispersion and chi-square test.
Results: Study findings revealed that among delivered CT scans, 310 (85.9%) appropriate, 38(10.5%) possibly appropriate and 13(3.6%) were inappropriate. The maximum and the minimum inappropriate brain CT scans rate 4 (4.17 %) were related to patients with Ataxia and zero (0 %) were related to patients with Headache, respectively.
Conclusion: Based on ACR appropriateness criteria, Brain CT scans were not utilized appropriately. In order to depict utilization review of radiology procedure in Iran, Developing a national guideline is necessary. To detect the effective factors regarding formulating targeted intervention, more comprehensive studies in various hospitals, different specialty and radiology modality seems necessary.
Dr Roghieh Bayrami, Dr Hossein Ebrahimipour, Alireza Rezazadeh,
Volume 16, Issue 2 (7-2017)
Abstract
Background: Pre hospital emergency medical service (EMS) as the first line of emergency care and treatment in the out- of -hospital has a considerable importance in the health care system. Planning on finding about strengths and weaknesses and improve the quality of EMS by exploring the problems of this section has considerable important.This study aimed to explore the challenges of pre hospital emergency medical service in Mashhad.
Materials and methods: A qualitative study was done with 14 personnel working in EMS sites in Mashhad using purposeful sampling. Data was collected by semi structured interview and analyzed using conventional content analysis approach according to Graneheim and Lund man 2004 with ATLAS.ti software.
Results: Three general themes were identified including 1) "challenges in Human resources"( Individual characteristics of human resources and personnel's dissatisfaction 2) "challenges in organization" (Structural challenges, lake of equipment and human resource limitation 3) "socio-cultural challenges"(Environmental-social challenges and cultural challenges) were determined.
Conclusion: personnel's dissatisfaction, structural challenges, human resource limitation, lake of equipment and Environmental-social challenges were the most important challenges in pre-hospital emergency system. Organizational independence , create organizational rows, regulation of laws and administrative regulations reform in relation to the range of services offered by emergency personnel, attention to the facilities and cooperation And the participation of other organizations, such as media and traffic to enhance pre-hospital emergency services at the community level can be effective in reducing the challenges in hospital emergency system.
