Tehran University Medical Journal

Background: Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.

Background: Burns are one of the most devastating forms of trauma worldwide. In the elderly, flame and scald burns, or scalds alone, are the major causes of burns, occur at home, particularly in the kitchen and bathroom. Because elderly burned patients suffer from greater morbidity and mortality than younger patients with similar burn extents, preventing burns is paramount to continuing functionality and quality of life. Burns are largely explainable by characteristics of both the individual and the physical environment. Our study aims to analyses the epidemiologic characteristics of burn in the elderly (above 60 years old) in Iran.
Methods: Records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the Shahid Motahari Hospital, Tehran, Iran, between March 2007 and March 2014 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, mortality, severity of burn, length of stay in hospital, and outcomes were reviewed. The information was analyzed by SPSS software, version 18 (SPSS Inc., Chicago, IL, USA). T-test, oneway anova and K square were used.
Results: A total of 374 elderly patients were admitted. Majority of the patients were men 231 (61.8%) and the number of women were 143(38.2%). The most common etiologies were scalds (20.3%) and (oil-benzine-gasoline) (19.8%). The mean age of the patient was 71.5 years, which was average in women (72) and men (70.5 years). There was a statistically significant difference between the mean age in both male and female groups, so that the mean age of women was significantly higher than men (P=0.004). There was a significant correlation between gender and (etiology, hospital stay-mortality) and between treatment outcome and (etiology and motivation) and between motivation and etiology (P<0.001).
Conclusion: Boiling water was the main cause of burning in older women. Diminished senses, concentration disorders, slower reaction time, reduced mobility, and bedridden states may decrease elder's ability to identify fire and also to escape harm.

Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. This study aimed to evaluate the hospital accreditation system.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.

Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Accreditation has an important role in improving the quality, safety, effectiveness and efficiency of hospital services. This study aimed to examine the effects of hospital accreditation program from hospitals managers’ perspective.
Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling.
Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success.
Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.

Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving quality, safety, effectiveness and efficiency of hospital services. A generic questionnaire is usually used to accredit all hospitals. However, specific instruments should be used for evaluation and accreditation of specialized hospitals considering their unique nature and specific requirements. Thus, this study aimed to develop an accreditation model for children hospitals.
Methods: A mixed method approach was used for such a descriptive and cross-sectional study. First, using a comparative study, accreditation standards and measurement criteria of children friendly hospitals were extracted from 10 well-known hospital evaluation and accreditation models and initiatives. Second, complementary interviews with 57 hospitals senior, middle and front line managers and pediatrics doctors and nurses were conducted to identify more children friendly hospital accreditation standards and measurement criteria. Third, children friendly hospital accreditation standards and criteria were modified considering the Iranian context. Finally, five pediatrics doctors reviewed, modified, finalized and confirmed accreditation standards and criteria.
Results: The Iranian framework for accreditation of children-friendly hospitals was consisted of ten standards covering management and leadership, planning and policy making, education, patient management, employee management, resource management, process management, patients’, employees’ and organization results and 132 measuring criteria. Such a systemic framework covers pediatrics hospitals’ structures, processes, outputs and outcomes. A children friendly hospital achieves better results for employees and patients through strong management and leadership, proper planning and policy making, continuous education and training staff and patients and effective management of employees, patients, resources and processes.
Conclusion: The proposed children-friendly hospitals accreditation model can be used for evaluation and accreditation of children hospitals and provide a clear picture of the performance of these hospitals.

Background: Unnecessary patient admission to a hospital refers to the hospitalization of a patient without clinical indications and criteria. Various factors related to the patient (e.g., age, disease severity, payment method, and admission route and time), the physician and the hospital and its facilities and diagnostic technologies affect a patient unnecessary admission in a hospital. Unnecessary patient hospitalization increases nosocomial infections, morbidity and mortality, and decreases patient satisfaction and hospital productivity. This study aimed to measure unnecessary patient admissions in hospitals in Iran.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Background: Medical errors are those errors or mistakes committed by healthcare professionals due to errors of omission, errors in planning, and errors of execution of a planned healthcare action whether or not it is harmful to the patient. Medical error in hospitals increases morbidity and mortality and decreases patient satisfaction and hospital productivity. This study aimed to determine the prevalence of medical errors in Iranian hospitals.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.

Background: The Electronic Health Record contains personalized health care information. Several factors affect the quality of SEPAS (Iranian electronic health record) data, disregarding the types of hospital information system set-up in hospitals. The purpose of this study was to investigate users' views on the factors affecting the data quality of Iranian Electronic Health Record (SEPAS) in hospitals affiliated to Mashhad University of Medical Sciences.
Methods: This descriptive cross-sectional study was conducted in 2018. In this study, the views of supervisors of the SEPAS system, HIS chief officers, and head of health information technology departments of hospitals were evaluated through a valid and reliable researcher-made questionnaire. Content validity ratio and content validity index of the questionnaire were validated as 0.82 and 0.94, respectively. Furthermore, the internal questionnaire reliability was affirmed by Cronbach's alpha of 0.96. Data analysis was conducted using descriptive statistics in the SPSS v.16 software.

Background: Currently many hospitals around the country face increasing demands of their patients and readmission.The rate of readmission is a useful indicator for determining the performance of healthcare system and it shows the quality of services in the medical institutions. Readmissions have high economic, social and financial impact and studying the related factors seems to be high priority for healthcare systems.
Methods: This qualitative study performed by phenomenological method in three educational hospitals in Kerman from April to September of 2017. Data collection was performed through semi-structured interviews using targeted sampling among all patients who were hospitalized at internal medicine wards, nurses who were working in those wards, and in charge physicians. In total twenty patients, fifteen nurses, and five physicians were selected for interviews. The including criteria were for patients, the history of hospitalization at least once, during one month after the initial hospitalization, and for service providers, familiarity with the subject, work experience in the relevant department of at least three years for nurses and five years for physicians. A seven-step clustering method was used to analyze the data.
Results: The analysis of the interviews led to the identification of three main themes and 11 sub-themes. The main themes included patients' characteristics, manpower and clinical factors, hospital, and environmental factors. Some of the sub-codes included economic and living conditions, marriage status, insurance coverage, patients' beliefs and expectations, the presence or absence of underlying disease, education, lifestyle habits, dietary beliefs of hospitalized patients, lack of trust in medical staff, communication and cultural barriers, ignorance of service providers in treatment, lack of facilities, lack of motivation in medical staff, stressors and finally lack of hospital equipment.

Background: Hospital accreditation is a systematic external evaluation of a hospital's structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19.
Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’ directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census.

Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’ readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth  domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

Background: Fetal health diagnostic tests are tools to reduce the incidence of adverse outcomes and neonatal death. However, their diagnostic value is still debated in relation to various outcomes. The aim of this study was to evaluate the value of biophysical profile and sonographic cerebroplacental ratio in predicting childbirth mode and adverse neonatal outcomes.
Methods: In this cross-sectional study, 70 pregnant women (37-41 weeks) who were candidates for termination of pregnancy who were referred to Ayatollah Mousavi Hospital in Zanjan from October 2020 to May 2021 were studied. After selecting the mothers based on inclusion criteria, biophysical profile test (BPP) and CPR sonographic index were performed. Then delivery method, infant weight, fifth minute Apgar score, need for resuscitation and hospitalization of infants in NICU were recorded in each case. T-test, Mann-Whitney test and ROC curve in SPSS 22 software were used for statistical analysis. (P≤0.05).

Results: In this study, the mean (SD) gestational age of participants was 38.56±1.11 weeks. Based on the data, there was a statistically significant relationship between CPR and the infant's need for resuscitation and hospitalization in the NICU (P=0.021) and Apgar score (P=0.042). However, there was no statistically significant relationship between CPR and delivery method, gestational age and birth weight. BPP score was not significantly associated with any of the consequences. Based on the results of the ROC curve, CPR with a cut point of 1.59 with a sensitivity of 88.9% and a specificity of 75% is able to predict the need for resuscitation and hospitalization in the NICU, and with a sensitivity of 83% and a specificity of 54.5%, it is able to predict a low Apgar score. However, BPP score did not have a predictive role in any of the studied parameters. Conclusion: It seems that CPR examination around delivery can be useful in predicting the condition of the baby immediately after birth and preparing the treatment staff for immediate action.

Background: Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.
Methods: A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.

Results: The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period. Conclusion: Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.

Methods: This descriptive-analytical study was carried out cross-sectionally from March 21, 2019 to March 19, 2020, using a simple random sampling method in patients referred to the emergency department of Imam Khomeini Hospital in Urmia. Which was used to collect information from the demographic information checklist and the EDWIN index was calculated. Then the information was entered into SPSS18 software and analyzed with the help of descriptive and analytical statistics. Results: In this study, the results showed that in terms of the frequency of triage level, 5.4% was level one, 65.6% was level two, 26.3% was level three, 2.7% was level four and there was no disease in level five. In terms of shift, 22.5% visited the hospital in the morning shift, 27.6% in the evening shift and 49.9% in the night shift. The average EDWIN index was 2.7±0.75 on holidays and 5.9±4.6 on non-holiday days. Although emergency room congestion was more on non-holiday days, this difference was not statistically significant (P=0.15). Also, the average of EDWIN in the morning shift was 2.5±2.3, in the evening shift it was 0.71±2.16 and in the night shift it was 9.7±5.8 and even though the average of EDWIN in the night shift was higher than in the evening and night shifts, this difference was not statistically significant (P=0.06). Conclusion: The results of the present study indicated that on most of the investigated days, the emergency room was evaluated as crowded based on the EDWIN criteria. Also, there is no significant difference between the busyness of the emergency room according to the holiday or working day, as well as the morning, evening and night shift.

Background: Medical errors are one of the biggest problems of the health system in countries. Identifying the factors responsible for these errors is crucial to designing optimal strategies to reduce such occurrences. The aim of this study was to investigate the type and nature of medical errors.
Methods: In this cross-sectional descriptive study, all documented medical errors that occurred between March 2021 and February 2022 at Firoozgar Educational and Medical Center were thoroughly examined. The data collection involved reviewing records from various departments within the center to ensure a comprehensive analysis of error types. The extracted data were processed and analyzed using SPSS v.22 software, allowing for statistical evaluation and identification of potential patterns or trends in medical errors over the specified period.

Results: A total of 214 cases were reviewed. 45.3% of the recorded medical errors occurred in the morning shift, 20.6% in the evening shift and 34.1% in the night shift. The highest number of medical errors was reported by nurses (40.7%), followed by physicians (16.8%) and paramedics (11.7%). The etiology of most medical errors was systemic errors (63.6%) followed by pharmacological errors (15.4%) and technical errors (13.1%) and the most reported systemic errors were of insufficient supervision. Most of the patients who had medical errors were admitted to the inpatient wards (40.7%) and later to the surgical wards (17.3%) and ICU (12.6%). 62.1% of medical errors did not cause any specific complication and in 33.2% of cases, mild complication, 10.7% moderate complication and 3.3% severe complication occurred for patients. 62.1% of medical errors had no consequences for anyone, and in 36.9% of cases, the consequences of errors were to the patient and 1% of the consequences of errors were to the organization and employees. Conclusion: Most of the reported medical errors were performed by nurses and were uncomplicated errors. Establishing transparent and accurate self-reporting systems is essential to identify medical errors of all employees.

Results: In this study, the results showed that out of 1901 studied patients, 1101(57.9) were male and the rest were female 801(42.1), And the average age of the patients was 61.67±17.13 years, and 1160(60.9) patients did not have drug interactions and 724(39.01) had drug interactions, and the most common type of drug interaction was the moderate type, which was present in 75.1% of cases; And the final clinical outcome of the patients was 1088(57.2) discharge, 296(15.5) personal consent discharge and 506(26.6) death. Also, the most common drug interactions were serotide/salbutamol, azithromycin/ondansetron, and aspirin/nitroglycerin, respectively. And there was no significant relationship between the occurrence of drug interactions and the gender of patients (P=0.27) and finally, the average age of patients with drug interactions was 17.7±61.2 years and in patients without drug interactions was 16.7±61.9 years. Conclusion: The overall incidence of drug interactions in the studied patients was equal to 39.01, and the most common drug interactions in patients were of moderate and mild type; and there was no statistically significant relationship between the age of the patients and the gender of the patients and the incidence of drug interactions.

 

Background: Although the respiratory system is the main element involved in the disease of COVID-19, nevertheless, there are reports of the involvement of other organs and their lesser symptoms. This study was conducted with the aim of investigating the frequency of gastrointestinal symptoms in patients with COVID-19.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.

Results: In this study, the results showed that out of 2580 hospitalized patients, 54% were women and 46% were men. And the average age of the patients was 58.67±17.68. The highest frequency of people was in the age range of 40-59 years (925 people). 64% of patients had at least one gastrointestinal symptom, Each of the symptoms had a different prevalence, Anorexia 40% with a preference for men (57%) and the highest frequency in the age range of 40-59 years (430 people), gastrointestinal bleeding 10% with a preference for men (80%), And the highest frequency in the age range of 60-79 years (112 people), abdominal pain 8% with preference for women (65%) with preference for frequency in the age range of 40-59 years (65 people), vomiting 3% with preference for women (51%) with abundance in the age range of 80-99 years (58 people), diarrhea 1.5% with preference in men (51%) with abundance in the age range of 60-79 years (18 people) and constipation in 0.2% with preference Women (67%), all of whom were over 60 years old. Conclusion: The findings of this study showed that the COVID-19 disease can not only involve the respiratory system but also the digestive system in the course or beginning of the disease.