Showing 7 results for Surgery
Azra Ramezankhani, N Markazi Moghaddam, A Haji Fathali, H Jafari, M Heidari Mnfared, M Mohammadnia,
Volume 8, Issue 3 (2-2010)
Abstract
Background: Operating room efficiency is a major determinant of hospital cost. Maximizing throughput, while maintaining quality, is therefore paramount to maintenance of financial viability. Cancellation of surgery may increase a hospital's cost and affect the efficiency of operating room and waste of resources. This study was conducted to determine the rate and causes of canceled surgeries, and identifies areas for improvement in a teaching hospital in Tehran.
Material & Methods: We carried out a descriptive study of the reasons for canceling scheduled operations. Data were collected during 9 consecutive months. The reasons for cancellation were identified by theatre staff. We grouped all the reasons into 13 reasons. Other necessary information like operated surgery was obtained from IT department. Descriptive statistics (frequency, percentage, 95% confidence interval) were used to analyses of data. Statistical analyses were performed using SPSS and Excel Microsoft office.
Results: in this study, 18.2% of the 3381 scheduled operation were canceled on the day of surgery, 32.1% of them because of vascular surgery, followed by orthopedics (18.7%), general surgery (15.5%) and nose and throat surgery (13.7%). The common reasons for cancellation were lack of theatre time, clinical change in the patient's condition, lack of paraclinic tests and consultant's report on patient flow problems, blood preservation, drug and necessary equipment for surgery.
Conclusion: This study demonstrated that most cancellations of scheduled operation are due to hospital deficiencies and medical team reasons that most of them are preventable. Several changes like better infrastructural facilities, enhanced interdepartmental communication are suggested to try and reduce the cancellation rate.
Iman Dehghan, Dr Bakhtiar Ostadi, Dr Saeid Hosseini,
Volume 17, Issue 4 (2-2019)
Abstract
Background: The operating rooms in each health center are one of the most sensitive units in the center, whereas scheduling and scheduling operations are in particular importance and their optimization has a significant effect on the optimization of the whole complex. The scheduling of heart surgery in addition to the limitations of manpower, time, and facilities includes the limitation of the patient's surgical deadline, which is the purpose of the surgical scheduling given this parameter.
Materials and Methods: In this quantitative study, an algorithm containing 3 + 1 function was proposed. This algorithm also addresses uncertainty while monitoring the limitations of available resources and the maximum delay for surgery. In this study, patients categorize to emergency and non-emergency patients which only the scheduling of non-emergency patients is considered. In this study 343 patient was studied.
Results: Based on a six-month period information reviewing from Shahid Rajaie Cardiovascular Center in Tehran, a 11% improvement has been made in respecting the maximum delay for the patient's referral process. The optimization rate is often related to the difference in patient selection based on their deadline for surgery, which in the present algorithm has been a major contributor to the denial of service patients. Another advantage of the proposed algorithm is the dynamic process of the algorithm and appropriate response to the changes.
Conclusion: The longer the length of the queue, the lower the chance of accepting non-emergency patients with the shorter maximum delays.
Shima Tasharoei, Dr Ali Jahan, Dr Kamran Ghods,
Volume 18, Issue 2 (8-2019)
Abstract
Introduction: Intensive Care Unit (ICU) in hospitals is one of the most sensitive and costly units which is really important due to safety and health of patients during their stay in these units. Hence, considering the potential risks in this unit, treatment operations for eliminating or decreasing risks are very important. Among these intensive care units, the most important one is the open-heart surgery unit which may have irreparable damages due to vulnerability of these patients in the process of their transfer, care, and discharge. The present study aims to identify the potential risks and offer solutions for eliminating or decreasing them.
Method: In this research, we used Failure Mode and Effect Analysis (FMEA) method, which is a very useful method for evaluating and managing the risks, to prioritize risk factors. Due to some limitations of the method, fuzzy FMEA and fuzzy TOPSIS methods were also used in order to have more precise results and then the results were compared with each other.
Results: The suggested approach was implemented in ICU-OH (open-heart) unit of Kowsar hospital in Semnan. Finally, nineteen factors were recognized as major risk factors. Also, corrective actions were determined for all detected risks that can be pursued according to their priorities.
Conclusions: Factors including not observing hemodynamic signs, not considering patient safety and security, and inability to interpret arterial gas valve abnormalities are the three top risk factors that can be addressed through training and having more control on nurses.
Motahareh Payam, Dr Farzad Firouzi Jahantigh,
Volume 18, Issue 3 (10-2019)
Abstract
Background: According to the importance of health and treatment, it is necessary to use suitable models for planning and setting surgery time. In this study, a mathematical model is offered for operational scheduling of surgeries at surgery rooms of hospitals.
Material and Methods: This is an applied study and its data is related to the surgery rooms of Zahedan Al-Zahra eye hospital. Study population was the surgeries performed in March 2016. The mathematical model of scheduling surgeries at the surgery room was optimized in MATLAB2014.
Results: Due to limitations on patient admission capacity in hospital surgery ward, 79 surgeries were called off. In the proposed model, the total waiting time index for performing surgeries was 1547.29, and this index was found to be 1842 without the use of the model. Therefore, the waiting time index was improved by 16%. In accordance with the third purpose (objective) function, the tally of delays for predicted surgery ending time in one month was estimated to be 69.15 hours. The process of each surgery includes four defined activities. The end time of the activities related to each surgery has been examined and it has been optimized according to the existing limitations.
Conclusion: The proposed model can improve the waiting time by 16% and makes it possible to choose the surgical procedures that should be canceled and delayed according to medical priorities.
Ali Akbari Sari, Mahboubeh Bayat, Mohammad Arab, Mehdi Yaseri, Seyedeh Fatemeh Hosseini,
Volume 19, Issue 1 (4-2020)
Abstract
Background: equality in access of health care services is one of the most important goals of Health system .In this study, we provided a description of the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017.
Materials & Methods: This descriptive-analytical study was conducted in 2017 to describe the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Data were gathered through Ministry of Health and Statistical Center of Iran. Gini Coefficient, Concentration Curve ,Multiple Regression and Geographic Maps used by Microsoft R Version 3-6-0 for data analysis.
Results: The highest and lowest ratio of Otorhinolaryngology Head & neck surgery specialists per population in the year 2017 was reported in Tehran (2.31 per 100,000 populations) and Hormozgan (0.39 per 100,000 populations).
Conclusion: There was a considerable disparity between different regions of the country in terms of access to Otorhinolaryngology specialists.
Bahare Rahmani Manshadi, Bakhtiar Ostadi, Amirhosein Jalali,
Volume 20, Issue 2 (9-2021)
Abstract
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.
Sepideh Safaverdikhan, Asgar Aghaei Hashjin, Aidin Aryankhesal,
Volume 20, Issue 4 (12-2021)
Abstract
Introduction: Root cause analysis is one of the most important tools in disaster management that aims to identify the real causes of an issue and find ways to eliminate them. Surgery is one of the areas in which the possibility of clinical error is significant. Therefore, the study aims to explain the weaknesses and challenges of root cause analysis in surgical events and identify the experience of staff around the technology.
Materials and methods: This qualitative study was conducted through interviews in 2021. Twenty members of the root cause analysis team working in teaching hospitals affiliated to Iran University of Medical Sciences were interviewed. After conducting the interviews, MAXQDA software version 10 was used to analyze the thematic content and extract concepts related to the research objectives.
Results: The majority of participants were female, head nurse, aged 30 to 40, work experience of 11 to 15, and employed in Hasheminejad Hospital. The most important weaknesses identified for root cause analysis included the lack of proper implementation of the root cause analysis process and the lack of participation of individuals, hospitals and universities in this process.
Conclusion: Health managers and policymakers should address the weaknesses of root cause analysis by explaining the necessity of the process, root cause analysis immediately after each clinical event, evaluating the effectiveness of root cause analysis, and providing adequate feedback from the authorities. Upstream therapy, creating a culture of root cause analysis, providing the necessary facilities to perform these analyzes, providing clear instructions to encourage and punish employees.
