HOSPITAL
Year:2015 | Volume:14 | Issue:1 (52)|Papers Count:14

Background: Deciding on the number of hospital beds is one of the most serious challenges managers face. More hospital beds result in higher running cost although less hospital beds might cause disorder in patients flow. Minimizing total cost besides maximizing the patients flow in a hospital network, considering the practical limitations is the main objective of this survey.Materials & Methods: This study had main steps to investigate following: identifying current limitations of changing capacity of each ward, by conducting interview with hospital managers and other personnel of Modares hospital, analyzing cardiac patient flow analysis, simulating current flow, determining practical scenarios and choosing the best among them by mathematical modeling could minimize total cost and maximize patient flow.Results: 31 practical scenarios have been determined and analyzed by surveying limitations among all existing scenarios. Finally, eight best scenarios had been selected. Results showed that decreasing the number of beds in CCU and increasing the number of beds in Post-CCU can improve patients flow, considering cost limitations.Conclusion: A recommended approach in this study can be a general guide for capacity planning with taking practical limitations into consideration. This survey could be useful for the managers who are against the benefits of post CCU by comparing the patient flow with and without this ward.

Introduction: Low back pain is a common problem among nurses. the purpose of this study was to assess effectiveness of physical health educational program on the quality of life of nursing staff with chronic low back pain working in hospitals in yazd.Method: This semi experimental study was carried over 119 employees with chronic low back pain working in hospitals in yazd in both intervention (n=60) and control (n=59) groups. The intervention group participated in a training program included a - 180 minutes education session. Data were collected through using the 36-item Short-Form Health Survey questionnaire (SF-36) at base line and 3- month follow up and analyzed using descriptive and analytical statistics.Conclusion: This study showed the physical dimensions of quality of life including physical functioning, role physical, bodily pain and general health in the intervention group with mean age of 72.32, 58.18, 59.96, 69.10 respectively were improved in compare with the same dimensions in control group with mean age of 60.50, 47.88, 38.05, 51.27 at 3- month follow up (P<0.0001). There were no significant improvement in terms of mental component of quality of life in intervention (P=0.855).Results: The results indicated the educational program could be effective on physical functioning, role physical, bodily pain and general health.

Introduction: Major consideration on hospital emergency services had been taken into account in recent years. This study is aimed to analyze contributory factors of clients' satisfaction in services provided in emergency unit of selected hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences.Materials and Methods: This is a descriptive-analytical and cross-sectional study. 768 clients of emergency departments of selected hospitals had been chosen during last year as samples. 3 general and 3 specialized hospitals had been chosen randomly among total hospitals affiliated with mentioned two universities. A questionnaire consisted of 54 questions in 2 sections had been used for data collection. Reliability and validity were confirmed by professors and 50-sample pilot study respectively. The alphacronbach was calculated at 0.87. Responsible rate had been determined at 97.66%. The data had been analyzed by independent sample t-test, simple linear regression and linear multi-regression.Results: The demographic characteristics of attendants were as follows: 57.3% women, 56.8% over 45 years old, 63.1% social insurance coverage, 92.7% urban residents, 56% married, 58.7% low education ( below high school level) and 68.4% complementary insurance coverage. Clients had to pay more for services provided by Shahid Beheshti University. Moreover, majority of the clients paid their expenditures by out-of-pocket and insurance. Clients were more satisfied with admission unit, gaurds, physicians, nursing cadre and environment provided by hospitals of Tehran university. On the other hand, in terms of management, clients were more satisfied with management approach provided by hospitals of Shahid Beheshti university. Totally, women, elderly people, urban residents, individuals who visited physicians out of referral system and also ones who came during physician presence felt more satisfaction. Generally, patients were more satisfied with services delivered by hospital affiliated with Tehran university.Conclusion: Evaluating viewpoints of patients about quality of services result in promoting current trends of providing services.

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 hospital 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.

Background: Emergency operation centers (EOC) have been established in recent years aimed to organize and coordinate through disasters. These centers are responsible for decision-making in response and recovery phases after events. This study is aimed to develop a standard function evaluation criteria for EOC.Materials and Methods: This mixed method study with sequential triangulation approach had been conducted in 1391 among employees of EOCs which have been running experience for minimum of one year. validity and reliability of questionnaire had been confirmed by face and content validity and Cronbach's alpha respectively. The most important factors have been determined by an Explanatory factor analysis which also helped reducing number of questions.Results: Final tool by six domains had 38 questions. All content validities were higher than +0.6 apart from one at +0.1. Only the activation domain had inappropriate Cronbach at 0.337 and all others were higher than 0.7. Factor analysis reduced number of questions in each domain. Explanatory factor analysis reduced number of questions from the views of information assessment, activation and coordination and other domains to 5, 2 and 1 respectively.Conclusion: It seems that mentioned questionnaire could be an appropriate criteria for assessing performance of EOCs due to its validity and reliability according. The high reliability was resulted from closed correlation of. Appropriate quantity of validity implied EOC personnel great depth of knowledge on all questions asked.

Background: Exposure to some volatile organic compounds such as benzene, toluene, ethyl benzene and xylene cause adverse effects on organs and nervous system and moreover causes spread of diseases such as cancer, leukemia which would result in increasing medical expenses. This study is aimed to detect and measure BTEX (benzene, toluene, ethylbenzene and xylene) in air and compare it with recommended standards for hospital.Materials and methods: This study is a descriptive, cross-sectional study in which critical sectors of Imam Hossein hospital such as pathology and emergency had been examined initially. Air samples had been provided by using activated charcoal. During the next phase, identifying the pollutants and determining their amount had been done by using gas chromatography with mass spectrometry and flame detectors.Results: In areas such as parts of the wards, operating room, emergency room and laboratory pollutants benzene, toluene, ethyl benzene and xylene had been identified. The toluene concentration of in waste elimination, landry and pathology parts had been observed at 0.1455 ppm, 0.1087 ppm and 0.215 ppm Respectively. The comparison of these pollutants with threshold limit value (TLV), indicates standard condition.Conclusions: This study shows that selected pollutants exist in all parts of this hospital. Using control measures such as installing vapor recovery systems and monitoring the air of these areas can be useful in reducing the amount of pollutants.

Background: Waste of health care centers is particularly important due to their major role in spreading various diseases and environmental pollution. Consequently, considering function of nonhazardous waste devices in hospitals seems vital. This study is aimed to assess function of nonhazardous non-incineration devices of waste in Kerman educational hospitals and Sirjan hospitals.Materials & Methods: This experimental study had been conducted between March and September in year 2013 at the engineering research center of environmental health affiliated with Kerman university of medical sciences. Physical, chemical and biological function of devices was examined. Mechanical function had been examined by monitoring and recording mechanical index through thermometers and registers of devices. Chemical and biological function had been examined by indicator strip and biological indicator strip respectively.Results: Among hospitals in which the survey had been carried out, 96.3%, 85.3% and, 84% of nonhazardous waste devices had efficient function from mechanical, biological and chemical viewpoints respectively.Conclusion: As the results show, mentioned waste devices are unable to decontaminate hospital waste from hazardous materials chemically and biologically. Although mechanical process is efficient enough by providing required temperature and time, hospitals waste are not yet defined nonhazardous. Thus the final functional assessment is identified as poor outcome.

Background: This study is aimed at investigating the effect of work-life balance in hospitals of Sanandaj. Work-life balance includes different aspects such as: family, work, leisure and personal growth. Moreover, the quality of life had been assessed by physical, mental, social, and environmental dimensions of health.Materials and Methods: The statistical population includes personnel of hospitals of Sanandaj including doctors, nurses, office employees, technicians and guards. 150 individuals had been selected among mentioned population by using cluster sampling and Cochran formula as sampels. The data were analyzed using structural equations and AMOS18 and SPSS20 softwares.Results: The results of this study showed that the main hypothesis of work-life balance among personnel of hospitals had an effect of 0.70 on the quality of their working life. Nevertheless, second hypothesis titled as "The effect of holding the balance in family on quality of life" was rejected because its critical value was in the range of rejecting the hypotheses.Conclusion: Each three non-working dimension had an effect on the quality of life personnel which might be a result of the current economic downturn in Sanandaj.

Background: understanding the patient expectations and perceptions of service quality is one of the requirements for improving quality of health services. The purpose of this study is to evaluate the gap between patient’s expectations and perceptions in five dimensions of service quality in hospitals affiliated with Qazvin University of Medical Sciences.Materials & Methods: This cross-sectional study was done on 298 patients at hospitals affiliated with Qazvin University of Medical Sciences; it is designed to evaluate the quality of health services based on client’s expectations and perceptions and to determine the strengths and weaknesses of service quality. Data collection was performed by standardized SERVQUAL questionnaire to measure quality of services. the reliability and validity of this questionnaire has previously been confirmed by studies in Iran and other countries. Data analysis was done using SPSS software was performed.Results: The results showed that there was significant correlation between patients’ expectations and perceptions in all dimensions of quality (p<0.05). The Reliability (2.36) and Assurance (2.24) dimensions have the most and responsiveness dimension (1.98) has the lowest gap. Also (A) and (D) hospitals have the most gap and (C) hospital has the lowest.Conclusion: The negative gap (expectations more than perceptions) in all dimensions of quality showed that it is necessary to improve service quality in all dimensions. in order to reduce the gap of all five dimensions of quality and provide desired services, it is recommended that hospital managers by planning and their optimal management take the patients’ needs into account.

Background: There are various departments in hospital that produce hazardous, infectious, pathological and radioactive wastes. Utilizing proper methods of waste management is of high priority in order to prevent from releasing these wastes to environment. This study aimed to evaluate waste management efficiency in Karaj hospitals.Material & Methods: This cross - sectional study was conducted in Karaj during 2011-2013. All hospitals of Karaj had been selected as statistical population of this study (n=8) by census. The data had been collected by separating and weighting produced hospital wastes for 4 month (during one week at each month) and filling related checklists of health ministry. Collected Data had been analyzed using SPSS software.Results: The daily capita of waste was 4.1 kg per active bed, 5.6 kg per occupied bed and 9.4 kg per patient. The overall percentage score of present status of hospital waste management was assessed 88% and in 12% which indicate moderate and weak levels respectively. Hospital waste management had been evaluated weak in terms of collection, transportation and personnel but seen from the viewpoint in the separation and temporary storage, it was assessed moderate. However, in terms of disposal, assessment of hospital waste management showed it is in a desirable status.Conclusion: The present status of hospital waste management was far beyond the expectations among studies hospitals. Thus, developing an operational plan and monitoring its implementation is highly recommended to. Given the main weakness of hospital waste management was related to production, collection, separation, and transportation, taking these areas consideration is of high priority.

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.

Background: Hospitals have been known as main water consumers. Moreover, the amount of their produced wastewater and contamination is much more than domestic subscribers. Hospital waste management has recently emerged as an issue of major concerns but wastewater produced has not received sufficient attention. As there is a separate source of drinking water from that of sanitary usage in hospitals of Qom, surveying the consumption of water and the amount of produced wastewater will provide a lot of information in order to estimate amount of water requirement and wastewater produced in the hospitals.Materials and Methods: The amount of water consumption in hospitals had been collected from the year of 2008 to 2013. Collected data and conversion ratio of water to wastewater had been used for estimating the amount of wastewater. The data was analyzed by SPSS 19 software. Pearson correlation test was used to determine the relationships between variables. By identifying strengths and weaknesses of current system, appropriate interventions for better management of water and sewage systems were presented.Results: The average of water consumption was found to be 655.7 liter per day per bed and 8.6 liters per square meter of substructure area among all eight hospitals surveyed. There was a statistically meaningful relationship between consumed water in hospitals and substructure area (p<0.05). The average quantity of wastewater produced was estimated as 567.6 liter per day per bed. The main method of wastewater disposal is discharge in an absorbing well.Conclusion: In order to improve the current situation of mentioned hospitals, reconstructing water and wastewater facilities, using wastewater treatment packages and connecting waste water of hospitals to systems of wastewater collection of city seems inevitable.

Background: Job burnout is an issue which often affects personnel's mental health and quality of services in health systems. This study is aimed to investigate the correlation between burnout and mental health in medical staffs of Valyasr hospital in Borujene due the physical and mental health’s importance of hospitals personnel.Materials and Methods: This is a descriptive and cross-sectional study which has been conducted during the year of 1391. 133 medical personnel of the Valy Asr hospital had been selected by census. All clinical personnel had been participated in the survey apart from physician. A triple questionnaire including demographic information, general health and questions of Maslach Burnout Inventory questionnaire had been used for data collection. The data had been analyzed by ANOVA, Spearman correlation coefficient, chi-square test and SPSS (version 16).Results: The findings revealed that majority of Personnel involved in the survey felt a distinct lack of personal accomplishment and they showed symptoms of mental disorders. Few personnel showed a distinct emotional exhaustion. More than two-thirds of the patients showed mild depersonalization. Significant reverse correlation had been observed between all dimensions of burnout and mental health.Conclusion: The medical profession has a stressful and arduous nature. As survey's findings point to high prevalence of psychological disorders and reverse correlation between mental health and job burnout, it is highly recommended that managers identify sources of stress and plan for applying preventive interventions and solving current problems.