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Kaizen initiatives are core organisational mechanisms in lean healthcare projects. Although they show specific peculiarities (e.g. a narrow goal and an accelerated timeframe), they can vary in the way they are planned and executed. This study investigates what types of configurations of kaizen initiatives (profiled as gestalts of specific characteristics) can exist in healthcare, if they differ for social and technical outcomes, and for their application context (here considered in terms of work area routineness and team composition). The study is based on data from 362 participants to 105 kaizen initiatives implemented in two public hospitals in Italy. It identifies three clusters (i.e. 'hard practices-oriented', 'soft practices-oriented' and 'full-lean adherent' kaizen initiatives) characterised by different social and technical outcomes. The original contribution to the lean healthcare literature is twofold: first, the simultaneous focus on performance improvement (technical outcome) and modification of operators' mindset (social outcome); second, the adoption of a configurational approach to understand how gestalts of many variables explain the dynamics that lead to social and technical outcomes. No significant differences were found among clusters in terms of work area routineness and team composition, which also opens interesting directions for future research. [ABSTRACT FROM AUTHOR]

Many hospitals risk closure owing to rising costs, declining revenue, and reduced profits. Given the importance of identifying factors that impact hospital profitability, our study examines the relationship between tangible assets and the financial performance of hospitals in South Korea. We also investigate the moderation effects of hospital location. Our analysis is based on hospital accounting data provided by public institutions in South Korea and includes medical facilities, machine facilities, structures, buildings, and vehicle assets as tangible assets, which affect three types of return on assets. The results indicate that medical facilities and building assets have a significant positive impact on medical profits but a negative effect on income before reserve funds for essential business and net income, which can be offset by increased vehicle and transportation equipment assets. Operating vehicles and transportation are particularly beneficial for hospitals in Seoul metropolitan areas. This study is meaningful because it uses reliable, externally audited data from an advanced South Korean medical market. Our findings may provide valuable insights for policymakers and hospital management seeking to improve hospital profitability and identify institutions requiring financial assistance not only in South Korea but also in other countries that have advanced medical markets. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsThe demand for simplified languages such as Easy Language has grown, also in healthcare. Despite this, very few studies have examined how healthcare personnel perceive Easy Language, or its effects on healthcare.This qualitative case study was conducted in a Finnish hospital. The data consisted of 14 interviews with hospital management and operational staff on their experiences of implementing and using Easy Language in patient communication.According to the hospital personnel, the experiences of Easy Language use were mainly positive. The staff felt that patient instructions in Easy Language improved communication with customers. They were proud that the values of the hospital’s strategy, especially customer orientation, were realized in practical work. However, operational-level personnel also reported certain challenges, especially regarding the adequacy of resources and training.Considering its modest financial investment, we conclude that the Easy Language project had a positive impact. The hospital staff were satisfied and perceived that health communication in the hospital had improved. Their positive reputation due to their use of Easy Language brought added value to their work. Further studies are needed to measure the direct customer experience and financial effects of using Easy Language. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study is to determine the causal relationships among positive and negative cyberloafing dimensions, safety behaviors and occupational incidents among hospital employees during the COVID-19 pandemic. Methods. Data were obtained from 210 healthcare employees working in public hospitals in Turkey. The data were analyzed using Bayesian network analysis. This study examines the factors that have the most significant impact on occupational incidents through Bayesian belief updating. Results. The findings demonstrated that 28.7% of the sample experienced occupational incidents. Safety behaviors had the strongest impact on occupational incidents. When recovery (66.2%) and developmental cyberloafing (53.1%) are high, and deviant (64.3%) and addictive cyberloafing (35.6%) are low, the probability of safety behaviors increases (79.6%) and occupational incidents decrease. The development dimension of positive cyberloafing and the deviance dimension of negative cyberloafing had the greatest impact on hospital employees’ safety behaviors and occupational incidents. Conclusions. Minor/positive cyberloafing behaviors have a high impact on safety behaviors and occupational incidents, whereas major/negative cyberloafing behaviors have a low impact. Therefore, the hospital administration should specifically control deviant and addictive cyberloafing behaviors. Furthermore, the analysis results recommend that managers consider allowing some positive cyberloafing behaviors to reduce occupational incidents. [ABSTRACT FROM AUTHOR]

Airborne pollen, a significant natural pollutant, restricts outdoor activities and impacts quality of life for sensitive individuals with pulmonary disorders. This study examines trends in airborne pollen concentrations and explores whether air pollution, pollen concentration, or both impact patient counts. The annual pollen trend in Jaipur shows peaks in pollen concentration in March (due to trees, 66%), September (due to weeds, 45%), and December (due to grass, 50%). Among the fifteen taxa examined, Holoptelea integrifolia is the largest pollen emitter in Jaipur, followed by Poaceae, among others. The count of patients arriving for clinical consultations in a hospital shows a strong and positive correlation with weed (Asteraceae spp. and Argemone mexicana) and grass pollen. A linear regression equation is developed (R2 value = 0.835) for forecasting consulting patient counts based on Cassia siamea pollen concentration. This can assist hospital administration in resource management, especially during peak allergy seasons. [ABSTRACT FROM AUTHOR]

Background: Nurses play a critical role in delivering healthcare services, and their perception of the quality of those services is critical to better patient care. This study aimed to capture nurses' perceptions of healthcare services in India. Materials and Methods: An exploratory study design was adopted. 554 nurses from selected public and private hospitals in Kerala, India, were randomly selected for the study. The data were analyzed quantitatively with SPSS 23.0. Results: The perception of nurses in all dimensions of the HQP is observed as high (>3.5), with the exception of their involvement in quality management, which is reported as medium (2.5–3.49). Further, a significant difference between public and private hospitals (p < 0.05) is observed for all variables, except for the perceived effectiveness of quality improvement (p = 0.81) and the availability of training and development opportunities (p = 0.80). Additionally, nurses working in accredited hospitals (mean = 3.78) have more positive perceptions than non-accredited hospitals (mean = 3.69) (p < 0.05). Female nurses show a significantly more positive attitude toward the quality of health services than their male colleagues. Conclusion: The participating nurses were aware of various aspects of the quality management systems in their respective hospitals. In addition, the public and private hospitals and the accredited and non-accredited hospitals differed in their quality practices, as reflected in the nurses' voices. This study would help healthcare policy planners enhance the quality of the public sectors in India. [ABSTRACT FROM AUTHOR]

Introduction: Due to high volatility in the healthcare market and financing of healthcare services, outsourcing has been developed as an efficient method to facilitate financing and providing quality services to clients. The purpose of this paper was to determine the challenges and issues healthcare centers confront during the process of outsourcing while proposing some solutions to overcome the challenges to optimally facilitate the process of outsourcing. Methods: We reviewed papers in multiple databases including PubMed, Scopus and ProQuest, and carried out a qualitative thematic analysis to obtain the major challenges and solutions regarding the process of outsourcing in the healthcare units. Results: Several inter-organizational and intra-organizational challenges exist within the process of outsourcing, while organizational reforms and adopting new initiatives and resources are considered major solutions to resolve challenges within the process of outsourcing in healthcare centers. Main conclusions: A successful experience of outsourcing depends on precise strategic situational analysis before the implementation of such policy. Meanwhile, early assessment and feedback after the implementation of outsourcing in healthcare centers contribute to the successful implementation of such policy in healthcare centers. [ABSTRACT FROM AUTHOR]

Background: Hospitalists may work in a variety of clinical settings to manage COVID-19 cases. However, the extent of their involvement in COVID-19 care is unknown, particularly in hospitals without infectious disease (ID) specialists. Methods: This study aimed to confirm whether hospitalists provided COVID-19 management in various clinical settings when ID specialists were unavailable. We conducted a multicenter cross-sectional study using a web-based questionnaire. The participants were full-time hospitalists working in Japanese academic community-based hospitals. The study period was from 15 January 2021 to 15 February 2021, during Japan's third wave of the COVID-19 pandemic. The primary outcome was the rate of hospitalists participating in COVID-19 inpatient management in hospitals with or without ID specialists. Results: ID specialists were absent in 31% of small hospitals (those with fewer than 249 registered beds), but only 4% of large hospitals (p < 0.001). Hospitalists were more likely to manage both COVID-19 inpatient care and emergency department care in hospitals without than with hospitals with ID specialists (76 versus 56% (p = 0.01) and 90 versus 73% (p = 0.01), respectively). After adjusting for confounders by multivariate analysis, hospitalists who worked in hospitals without ID specialists had higher odds of participating in COVID-19 inpatient care than those who worked in hospitals with such specialists (adjusted odds ratio: 3.0, 95% CI: 1.2–7.4). Conclusion: Hospitalists were more likely to provide COVID-19 inpatient care in various clinical settings in hospitals without ID specialists. [ABSTRACT FROM AUTHOR]

Disclosure of near-miss medical error (ME) and how to disclose ME to patients remain controversial. Furthermore, available guidelines on the disclosure of ME have primarily emerged in developing countries; however, their suitability for Central Asian states is unknown. The objective of this study was to determine the proportion of healthcare professionals (HCPs) intending to disclose MEs and their perceptions pertaining to MEs. We conducted a cross-sectional survey in Kazakhstan using a structured questionnaire to collect data from 109 HCPs about the causes of disclosure MEs and the consequences in their practice. The majority of participants believed that they would be sued if they disclosed errors and near misses. There was a positive relationship between the threat of censure (p = 0.03) and the threat of dismissal (p = 0.01) in HCPs. There was also a significant difference between the distributions of liable for malpractice after disclosing an error to a patient or family member and experience of reporting a ME to administration. In this study, most HCPs reported MEs to a hospital administration, although about half perceived that disclosing MEs to a patient is ethically unnecessary. Poor disclosure could be due to the fear of litigation and dismissal. [ABSTRACT FROM AUTHOR]

To date, it is still largely unclear how the changes, as a result of Covid-19, affect the work environment and the perceived organizational and managerial context (OMC). Through a mixed methods design, this study aims, (1) to identify changes in the hospital OMC before and during the first wave of the Covid-19 crisis; (2) to further analyze and compare the impact of the crisis on the perceptions of the staff. For the quantitative phase, questionnaire measuring the OMC was used in Covid and Non-Covid wards. For the qualitative phase, we performed semi-structured interviews to identify positive and negative elements from the crisis management. Results from linear mixed models highlighted multiple tendencies following the Covid crisis. Differences appeared between Covid and Non-Covid units, with the latter showing greater difficulties following the crisis. A significant increase in participants' scores on interprofessional relationships was reported (P < 0.05). We found a significant decrease in job satisfaction (P < 0.001), absence of burnout (P = 0.001) and perceived efficiency of the service (P < 0.001). These findings suggest that hospital management strategies should aim at providing transformational leadership and information flow, as well as equal support for all working units, so that healthcare professionals feel motivated and work towards a shared meaning. [ABSTRACT FROM AUTHOR]

Our study aims to describe the current state of AME reporting practices and some related factors to provide evidence for patient safety management and hospital quality improvement. A cross-sectional study was carried out at Gia Lai Provincial General Hospital in 2021, applying both qualitative and quantitative research methods. The probability of meeting AME in the study is 19.27%, but only 15.66% of the subjects reported AME. Cognitive and behavioral limitations are significant factors in AME practice. AME training at the hospital has not been widely implemented. 93.98 percent of medical personnel work more than 40 h per week, and 37.95 percent report being overworked. Overworking increases the likelihood of having AME and lowers AME reporting rates. Complicated, time-consuming reporting processes, regulatory systems for reporting adverse events, and insufficient supervisors are all factors that impede AME reporting practices. The practice of AME reporting at Gia Lai Provincial General Hospital is limited and affected by factors such as knowledge and attitudes of medical personnel, work pressure, and the system of regulations and procedures related to AME report. [ABSTRACT FROM AUTHOR]

Critical test results in clinical laboratories are crucial for timely patient care, serving as indicators of potentially life-threatening conditions. Despite their importance, a notable heterogeneity in management practices exists globally. This study investigates the current practices of managing critical results at Danish clinical biochemistry laboratories and identifies areas prone for improvement. A comprehensive online survey was distributed to all 21 Danish clinical biochemistry laboratories regarding their critical result management, including documentation practices, critical limit selection, and quality assurance measures. A total of 17 laboratories (81%) responded. The answers revealed a generally uniform approach to managing critical results, with all laboratories having 24-h reporting, local instructions and using the telephone as communication channel. However, variations were noted in documentation practices and critical limit selection. Notably, 23.5% of the laboratories reported that one out of every ten critical results was not reported, indicating a significant risk of delayed critical results. This is further complicated by the limited use of predefined timeframes for reporting and also, only few laboratories actively monitored response times. The findings emphasize the need for more standardized documentation and evaluation practices to align with international standards and to enhance patient safety. While the laboratories showed a commitment to standardized procedures, the study emphasizes the necessity of a National or Nordic guideline to supplement the ISO 15189:2022. This study is a step towards optimizing critical result management, not only in Danish clinical biochemistry laboratories but also across various laboratory specialties, thereby improving overall laboratory quality, efficiency, and patient safety. [ABSTRACT FROM AUTHOR]

The poor grade subarachnoid haemorrhage patients represent a unique cohort with lack of clear treatment protocol. Most neurosurgical units in the UK will manage them at local hospital until they make a significant recovery, this period can put them at higher risk of rebleed while with aggressive treatment a significant subset can achieve a favourable outcome. Identification of this subset is difficult and decision to treat them is associated with significant commitment of neurosurgical and ITU resources. Recent paper by Szklener has come up with a scale for prognostication in this subgroup of patients. We wanted to check the validity of this scale in our patient population and see if this scale can be used to guide early patient transfer and aggressive management at the Neurosurgical unit. We retrospectively reviewed our referral database for all poor grade subarachnoid patients referred over 2 years. Demographic information, Fisher and WFNS scores, admitting leucocyte count and outcome information as per MRS were obtained. These were scored as per the scale suggested by Szklener. A total of 115 poor grade subarachnoid patients were referred over the study time frame. 47 of them were accepted for admission. 18/47 patients achieved a favourable outcome (GOS4-5). Only 1 patient managed in peripheral hospital had a good outcome. There was a significant association between Szklener's score and achieving a favourable outcome p = 0.002. A selective admission policy could work specially with current economic climate, achieving outcomes comparable to admit-all. However, to optimise outcomes for all patients an aggressive standardised management at peripheral hospitals and a uniform admission policy assisted by Szklener score may be adopted. Szklener's model predicts the outcome better than WFNS and age but more validation is needed. [ABSTRACT FROM AUTHOR]

Overcrowding affects hospital emergency departments (ED) worldwide. Most OR studies addressing overcrowding develop bespoke models to explore potential improvements but ignore the organisational context in which they would be implemented, and few influence practice. There is interest in whether reusable models, for ED crowding and in healthcare generally, could have more impact. We developed a configurable approach for tackling ED overcrowding. A reusable queuing model for exploring drivers of ED performance was augmented by a qualitative approach for exploring the implementation context and a generic framework for assessing the likely compatibility of interventions with a given organisation. At the hospital where the approach was developed it directly informed strategy. We describe reuse of the approach at three hospitals. One project was completed and well-received by hospital management, two were terminated partway when data problems surfaced. The primary contribution of this work is its novelty in considering, alongside quantitative modelling, evidence-based interventions to overcrowding and qualitative assessment of a hospital’s aptitude and capability to adopt different interventions. A secondary contribution is to further the debate on model reuse, particularly by introducing more complex, modelling-centred approaches that acknowledge how models must relate to tangible interventions with reasonable prospects of being adopted locally. [ABSTRACT FROM AUTHOR]

We aimed to determine the epidemiology and clinical management of patients presenting to an Australian tertiary emergency department (ED) with a suspected snake bite. Nepean Hospital covers a geographical area known to harbour venomous elapid snake species. A Retrospective chart review of all patients presenting to Nepean ED from 2011 to 2020 was performed. We searched the electronic medical records (eMR) for triage presentations including search terms of "snakebite", "bite" "envenomation", or "bite-snake" and a discharge or independent diagnosis of "snakebite" or "envenomation". Our review identified 110 patients presenting with snakebite, of whom nine had signs or symptoms indicating envenomation. The most common envenomation syndrome was venom-induced consumption coagulopathy (VICC) and the most commonly suspected culprit snake was the Eastern Brown Snake. Our data broadly agreed with national data on epidemiology and demographics. We noted a satisfactory rate of compliance with local snake bite protocols with evidence of early diagnosis and antivenom administration. We had no cases of anaphylaxis and one case of serum sickness. Our study of a tertiary hospital experience in the management of snake bite demonstrated an appropriate adherence to national guidelines and early clinician recognition of envenomation syndromes. It also demonstrated appropriate antivenom use without obvious time delay. [ABSTRACT FROM AUTHOR]

Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis. Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method. Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81–5.30, p < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50–3.23, p < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92–2.15, p = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes. The prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study. Hospitalized patients with COVID-19 can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features In this study, we externally confirmed the prognostic impact of clinical phenotypes previously identified by Gutierrez-Gutierrez and colleagues in a Spanish cohort of hospitalized patients with COVID-19, and the usefulness of their simplified probabilistic model for phenotypes assignment This could indirectly support the validity of both phenotype's development and their extrapolation to other hospitals and countries for management decisions during other possible future viral pandemics [ABSTRACT FROM AUTHOR]

Hospitals had to adapt quickly when the COVID-19 pandemic broke out in January 2020. This article analyses the organisation of the crisis management efforts of Oslo University Hospital (OUH). The analysis is based on theories that organising is a process of sensemaking, especially in the face of unexpected events. Crises stress test organisations and can highlight important decision patterns and otherwise hidden underlying logics. Theories of emergency and crisis management distinguish between anticipation and resilience. In the analyses of the OUH case, two different emergency logics, planned and ad hoc was identified. The different logics create tension in priorities and the choice of problems and solutions during the pandemic. The analysis was based on 19 in-depth interviews that took place in three clinics at OUH between December 2020 and November 2021, as well as internal audits and documents from OUH and published works. The analysis of OUH show that the resilient, ad hoc emergency logic was mostly present in the first phase of the pandemic and allowed flexibility and fast centralised decision-making. This process-based organising is particularly suitable to tackle crises but face difficulties in normal operations. To learn from past crisis management experiences and develop robust hospitals for the future, a greater awareness of the relationship between different emergency logics and sensemaking in crises is needed. [ABSTRACT FROM AUTHOR]

The present study aims to build a structural model based on Total interpretive structural modeling (TISM) to analyze barriers affecting healthcare waste management (HCWM). Through scanning of literature and expert opinion, a total of fifteen barriers are recognized. Inputs acquired from the professionals in the field are used to develop the TISM model, and Cross impact matrix multiplication is applied to classification investigation to sort out the factors. From the TISM model, five barriers are identified as drivers. We identified two of these five barriers: 'No support from top authorities' and 'No support from the government.' MICMAC analysis classifies four barriers as dependent, five as driving, and the remaining six as linkages. The author's original contribution is to develop a model to analyze barriers influencing HCWM. This paper helps to complete the research gap by providing the different characteristics of barriers. This study clarifies that good coordination of hospitals with other authorities is necessary to properly implement healthcare waste management services. Government support will also play a vital role, and the Involvement of top management of hospitals is required to organize everything properly. Case studies and structural equation modeling (SEM) can be applied to explain further and support the findings. [ABSTRACT FROM AUTHOR]

Hospital pharmacies are experiencing significant rise in demand for medicines for treatment and care of patients admitted to hospitals. Nevertheless, inefficient processes continue to be a problem in hospital pharmacy management, resulting in mismatch between demand and supply, time-consuming manual tasks, out-of-stock situations, medicine expiration, and excessive operating costs. Prior research has addressed various aspects of hospital pharmacy management, but limited studies have focused on discovering hidden patterns and knowledge from large volume of data stored in hospital information systems, which can help improve pharmacy operations. Primary goal of this research is to extract meaningful knowledge from hospital databases to improve pharmacy operations. Hospital pharmacy database from multispecialty hospital in India is used to examine associations among medicines prescribed to hospitalized patients using Apriori approach, which is one of the algorithms of Association Rule Mining. Data comprising 745,176 pharmaceutical item order records were gathered, processed and analyzed. Around sixty-three association rules were discovered. Different measures like support, confidence, and lift are used to evaluate the rules. Rule comprising medicines Atracurium, Febuxostat, and Multivitamins achieved the highest confidence of 87.35%. Discovered rules can help pharmacists to anticipate demand, develop better inventory system, improve operational efficiency and lead to effective healthcare system. [ABSTRACT FROM AUTHOR]

To investigate and describe the protocolized treatment of DOAC-related bleeds in all Dutch hospitals. From August to December 2020 a nationwide survey among all 70 hospitals in the Netherlands was conducted on their protocols for management of bleeding in patients treated with direct oral anticoagulants (DOACs, i.e. apixaban, edoxaban, rivaroxaban and dabigatran). The protocols were assessed the following characteristics: bleeding definitions (mild, moderate and severe bleed), diagnostic parameters (hemoglobin [Hb], loss of blood, surgical procedure needed, etc), first and second choice of treatment, effectiveness criteria and the level of evidence/references upon which protocols were based. All 70 hospitals responded (100%). We received 69 protocols in total, 6 of which were identical because hospitals worked together. In 35 (50%) of the protocols a definition of minor, moderate or severe bleeds was described. Diagnostic parameters for bleeds were present in 2%, 41% and 47% of protocols for a mild, moderate and severe bleed. While the first choice treatment for severe bleeding under dabigatran was idarucizumab in 96% of protocols, considerably more therapeutic options (mostly different prothrombin complex concentrate (PCC) doses) are described for Xa inhibitors. When considering criteria for effectiveness more than 90% of protocols did not have a clear description. This study provides an overview of the current state of protocols for management of DOAC-related bleeding in The Netherlands. Protocols vary in the content of information provided and often do not include information, especially for diagnostic criteria and criteria for establishing the effectiveness of the intervention. The results of this study can assist in improving and harmonizing the protocols. [ABSTRACT FROM AUTHOR]

Hepatorenal syndrome (HRS) is characterized by severely reduced renal perfusion that precipitates rapid morbidity and mortality. Terlipressin is the only US Food and Drug Administration-approved treatment to improve kidney function for adults with HRS with a rapid reduction in kidney function. Prior to the approval of terlipressin, unapproved vasoconstrictive agents used in HRS treatment were octreotide/midodrine and norepinephrine with albumin. A cohort decision-tree model representing a US hospital perspective assessed the clinical outcomes and direct medical costs (based primarily on hospital charges) of treating HRS with terlipressin + albumin (ALB) versus midodrine/octreotide (MID/OCT)+ALB, or norepinephrine (NorEp)+ALB. Treatment efficacy was defined by clinical response (complete/HRS reversal, partial, or no response) based on change of serum creatinine derived from published clinical trial reports. The proportions of patients with complete response were: terlipressin + ALB (36.2%), NorEp + ALB (19.1%), and MID/OCT + ALB (3.1%). Model outcomes included utilization of HRS-related healthcare resources (hospital and intensive care, outpatient and emergency department, dialysis, and transplantations), adverse events, and HRS-related mortality. Outcomes were assessed for the initial hospitalization in the base case and at 30, 60, and 90 days post-discharge. Total costs incurred over the initial hospitalization with terlipressin + ALB were lower vs NorEp + ALB, primarily due to higher ICU costs with NorEp + ALB ($7,433 vs $61,897). TER + ALB was associated with higher total costs vs MID/OCT + ALB due to higher pharmacy costs with terlipressin + ALB. The cost per complete response achieved of terlipressin + ALB ($451,605) was half that of NorEp + ALB ($930,571) and one-tenth that of MID/OCT + ALB ($4,942,123). HRS patients treated with terlipressin experienced better clinical outcomes and a lower cost per treatment response vs other unapproved treatments. ICU days and pharmacy costs were key cost drivers distinguishing the treatment groups. These outcomes suggest that terlipressin is cost-effective on the basis of total cost per response achieved. Hepatorenal syndrome (HRS) is a rare and sudden life-threatening complication of the liver. Patients with HRS should receive immediate treatment with a drug that narrows blood vessels known as a vasoconstrictor. Terlipressin is the most common vasoconstrictor used for patients with HRS. Other common vasoconstrictors are midodrine with octreotide and norepinephrine. This study aimed to compare the cost of terlipressin with those of midodrine with octreotide and norepinephrine while also considering how well each of them worked to reverse HRS. This was done using an economic model. This economic model assessed the costs of the vasoconstrictor drugs and the costs of treating HRS, including costs attributable to drug acquisition, adverse events, organ transplantation, dialysis, and institutional encounters (i.e. hospitalization, ICU, emergency department, and outpatient visits). The magnitude of these costs depends on how well each drug reversed HRS. Based on inputs derived from their respective clinical trials, 36% of patients who were given terlipressin had a complete response (HRS was reversed), 19% of patients who were given norepinephrine had a complete response, and 3% of patients who were given midodrine with octreotide had a complete response. The total cost per patient was approximately $163,481 for terlipressin, $177,298 for norepinephrine, and $155,030 for midodrine with octreotide. When the costs were evaluated against how well the drugs worked to reverse HRS, the lowest cost per HRS reversal was $451,605 when treated with terlipressin. The cost per reversal for norepinephrine was $930,571 and for midodrine with octreotide was $4,942,123. These results show that terlipressin works well and is more cost-effective for US hospitals compared with the other unapproved treatment options for HRS with rapid reduction in kidney function. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to develop and validate an operational flexibility construct that can serve as a general theory in operations management in the context of the hospital industry. The effects of management capability and competitive intensity on operational flexibility and performance relationships are also explored. We used data collected from a sample of 152 administrators of hospitals in the mid-west region of the USA and performed a systematic series of analyses. Following the transformation model, grounded in the fundamental and powerful concept of operations management, we develop a psychometrically validated, 11-item, three-dimensional (input, process, output) scale of operational flexibility (OF) construct for the hospital industry. As the degree of operational flexibility allowed in any transformation system is influenced by management capability, it is established as a complementary mediator in strengthening the OF-performance relationship in the presence of competitive intensity (i.e. moderator). The paper concludes with limitations and directions for future research. [ABSTRACT FROM AUTHOR]

To improve HCWs' productivity, work engagement, and ultimately treatment quality, it is vital to eliminate the root causes of workplace violence within hospital settings and to promote a sense of safety among the staff. Workplace violence can be considered a global challenge and a major occupational issue, especially in developing countries where healthcare services and facilities can be stretched and under-resourced. Commentary Workplace violence (WPV) is defined as a diverse set of maltreating behaviours encompassing bullying, harassment, and abuse pertaining to occupational proceedings. [Extracted from the article]

In the past few years, several cloud services such as IBM cloud services, Microsoft service, Amazon web services as well as Google cloud platform services related databases are rising rapidly all over the world. In the case of a Relational database, it is easy to handle only a small amount of data. So to overcome the shortcomings, this paper proposes a Hospital Management System (HMS) using Mongo DB as a database. The Mongo DB is the classification of a document-related database that comes under the category of NoSQL database which is referred to as a non-relational database. Mongo DB aims in reducing the gap among two different types of scalable key-value databases such as fast and high scalable key-value databases. Also, this database reduces the time delay during the working of four operational modes such as selection, insertion, deletion, and updation. Furthermore, the Enhanced Entity-Relationship Model (EERM) for the HMS that is designed to manage the entire section of the hospital which includes the reception section, casualty section, details regarding the medical treatment, and employees. The HMS stores three million tuple entities and is loaded into the Mongo DB database. Also, the operation based on selection, insertion, deletion, and updation mode is evaluated. Therefore, the experimental analysis reveals that the proposed HMS using Mongo DB provides is highly efficient with less time delay, thus obtaining an effective system. [ABSTRACT FROM AUTHOR]

A death of a nine months old child in Pakistan following the rapid administration of potassium chloride raised serious concerns on the awareness of appropriate use of high alert medications (HAMs) among healthcare professionals (HCPs). This study aimed to ascertain HAMs-related knowledge among hospital pharmacists in Pakistan. A cross-sectional study using exponential non-discriminative snowball sampling was conducted among hospital pharmacists in healthcare settings in Punjab, Pakistan. A validated study tool was used to determine knowledge on administration, regulation, and practices related to the HAMs. Barriers to conducting HAMs training in the hospitals were assessed from an open-ended question. All quantitative data were analyzed using SPSS 22.0 while the content analysis was performed on the qualitative data. A total of 202 hospital pharmacists were included in the study. The mean knowledge score for HAMs administration and regulation were 5.86 ± 1.89 (95% CI 5.60–6.12) and 7.25 ± 1.70 (95% CI 7.02–7.49), respectively. Approximately half of the respondents (49.5%) achieved scores ≥ 70%, demonstrating sufficient knowledge of HAMs. In the multivariable-adjusted model, increasing age and work experience were found to be the positive predictors of good HAMs knowledge. The mean practice score was 36.42 ± 1.97 (95% CI 34.05–38.77), with 62.4% of pharmacists following good HAMs-related practices. We identified several barriers to conducting HAMs training through qualitative analysis. These barriers included lack of knowledge, poor attitude and behavior of medical and paramedical staff, false beliefs, lack of active support by hospital administration, lack of cooperation between HCPs, lack of opportunities, heavy workload, insufficient human resources, financial constraints, and lack of motivation. A significant proportion of the hospital pharmacists had unsatisfactory knowledge and practices of HAMs. These findings underscore that training on HAMs should be conducted periodically as a part of hospital-based pharmacy education to maximize drug safety. [ABSTRACT FROM AUTHOR]

This study investigates factors predicting hospitality management students' intention to enter employment in the hospitality industry upon graduation. Survey data were collected from 591 hospitality management students in a hotel management school in the Netherlands. Results of multiple regression analyses showed that study progress negatively predicted, while preferences for large organisations, engaging work content and growth opportunities positively predicted students' intention to enter the hospitality industry. Supplementary analyses further revealed that among higher study year students, growth opportunity was the most crucial predictor for intention to enter the industry. Theoretical and practical implications were discussed. [ABSTRACT FROM AUTHOR]

Research on mechanisms that lead to the successful involvement of citizens, particularly citizen advisory panels, in policy-making processes is limited. In this paper, we use unique longitudinal data to examine how power and information asymmetries within a citizen advisory group influence a policy-making process and its outcomes. We studied the case of a public hospital where the hospital management involved a citizen advisory panel (CAP) and the general public to help decide what hospital services should be cut. We found that female CAP members perceived more power asymmetry while male CAP members experienced more process satisfaction. Older CAP members perceived more information asymmetry. Our findings show that the policy-making management team's commitment to the process can reduce skepticism by citizens regarding the value of their involvement and facilitate decision quality and process satisfaction. Policy makers were able to effectively share technical policy information with citizens in an easily digestible format over time and to achieve effective citizen participation in the policy-making process. [ABSTRACT FROM AUTHOR]

Motivated by reasons such as patients' needs, lack of resources, technologies or skills, and quality, hospital managers may engage in cooperative behaviours. We study the determinants of patients' transfers, a specific form of cooperation, and quantify its association with the quality delivered by the origin and destination hospital. Using Italian administrative data, we handle the network structure embedded in the data by adopting an over-dispersed Poisson mixed model. The results show a positive relationship between hospital cooperation and quality. The introduction of transferal protocols that exploit information on hospital quality may further improve the overall quality of the healthcare sector. [ABSTRACT FROM AUTHOR]

A retrospective study from 2015 to 2020 comparing overall survival (OS) outcomes of a cancer unit and centre for presumed early stage endometrial cancers is presented. Cancer centres manage these presumed early endometrial cancer (EC) in situations of complex co-morbidities, surgical challenges as well as their own local unit patients. Our analysis compares 138 patients at KMH (unit) and 282 patients at RDH (centre) on OS, patient demographics, grading histology and final histology. Patients with presumed early stage EC can be reassured regarding no difference in OS between the cancer unit and centre management (p =.05). However, rates of minimal access surgery were higher at the cancer centre compared to the unit (93.2% versus 68.1%). The rates of upstaged disease were 4% and 8.8% at the cancer unit and centre respectively (p =.096). Sentinel node biopsy and genomic assessment may change future thresholds for centre-level management due to rates of upstaged disease. What is already known on this subject? Presumed lower risk endometrial cancers (endometrioid grades 1 and 2) have a rate of occult nodal involvement of only 1.4%. The BGCS does not recommend lymphadenectomy for low-risk endometrial cancers. These low-risk endometrial cancers should be managed with a hysterectomy and bilateral salpingo-ophrectomy via minimal access surgery. In view of the low rates of occult nodal involvement in low-risk endometrial cancer, surgery can be offered at a cancer unit. What do the results of this study add? Our study demonstrates there is no disadvantage in overall survival in the surgical management of presumed low-risk endometrial cancers at cancer units and centres. However, cancer centres have higher rates of minimal access to surgery despite managing a more elderly population. Our rates of upstaged disease of 4% and 8.8% at the cancer unit and centre indicate a potential benefit of pelvic lymph node assessment. What are the implications of these findings for clinical practice and/or further research? Sentinel lymph node biopsy does not have the surgical morbidity associated with systematic lymph node dissection. Therefore, when applied to presumed early stage endometrial cancer, there are potential changes in the threshold for centre-level management to improve overall survival. [ABSTRACT FROM AUTHOR]

This article has multiple implications for state-owned hospitals. The authors show that state-owned hospitals will try to meet the financial targets required by the supervisory authorities. When the central government expects a certain financial outlook, hospitals will manage their accounts to comply with these expectations. Oversight authorities and legislators need to be aware of this tendency and its implications for audits. The article identifies the factors that affect the manipulation of earnings so that strategies can be set to predict and avoid such behaviours. ABSTRACT Using agency theory, this article evaluates the extent to which Greek state-owned hospitals followed earnings management techniques to affect reported earnings and which accrual accounts are relevant to explain discretionary accruals. Covering the period from 2009–2019, the analysis reveals that the Greek state-owned hospitals try to report small surpluses. Accrual-based accounts and changes in their value between successive years provide evidence of relevance for earnings management. [ABSTRACT FROM AUTHOR]

This paper investigates medical device selection problem in healthcare organizations. As compared to numerous research works on supplier/equipment selection problems in diverse areas of applications, surprisingly, the number of works is less in case of the healthcare industry. In this paper, as a case study, we consider MRI (Magnetic Resonance Imaging) system selection problem in private hospitals. Because of non-radiation and advanced technology, MRI has emerged as the imaging modality of choice in diagnostic and monitoring treatment. In this study, we identify 16 brands (alternatives) of MRI systems and select 10 selection criteria that are chosen with the consultation of a group of experts in the field of hospital management. Methodological framework as suggested to deal with the device selection problem includes an integrated MCGDM (multi-criteria group decision-making) approach which is a combination of fuzzy PSI (preference selection index) method and fuzzy MARCOS (measurement of alternatives and ranking according to compromise solution) method. To cope with the vagueness in linguistic evaluation done by the decision makers, fuzzy numbers have been used in the representation of linguistic terms. The integrated fuzzy MCGDM method is applied to evaluate and rank the alternatives, and the results are analyzed through a comprehensive sensitivity analysis. Total 100 scenarios are created by changing the weight of each criterion as computed using fuzzy PSI technique to examine the effects of change of the weights of the criteria on the ranking results. It is observed that out of 100 scenarios, alternative 8 (A8) remains the best option for 96 scenarios, and it is the second-best option only for the remaining 4 scenarios. Also, the results of the hybrid fuzzy MCGDM technique have been compared with the results obtained by using other MCGDM methods. [ABSTRACT FROM AUTHOR]

Although hospitals increasingly consider solutions based on information technolgy (IT) for revenue cycle management, contextual constraints and numerous IT investment alternatives make it difficult to identify and realize appropriate solutions. Thus far, however, health IT theory has been silent on how IT can support financial and administrative purposes within hospitals, focusing instead on IT for clinical support. Against this backdrop, we report on an action research project involving IT-enabled revenue cycle transformation in a financially strapped rural hospital. Our research contributes to health IT theory by expanding the discourse to include revenue cycle transformation and by demonstrating how resource-constrained hospitals can improve their financial performance through selective investments in low-cost IT solutions across the revenue cycle. We also contribute to action research methodology by generalizing our interventions to propose digital options inquiry—a systematic approach to business process transformation that combines digital options theory with diagnostic process mapping—to help researchers and practitioners jointly understand and transform business processes. [ABSTRACT FROM PUBLISHER]

This is a study on the critical strategic factors of hospital management. The research was done in one single hospital at central Taiwan with questionnaires distributed to three levels of hospital executives. The senior managers' level includes the board of director, hospital president, and hospital vice superintendent. The mid-level executives' level includes the head of medical department, head of surgical department, head of nursing department, and all chiefs of other departments and divisions. The elementary supervisors' level includes the leaders of technician departments and staffs. This study uses Grey Relational Analysis to analyse the critical strategic factors and to realize the extent of emphasis put on by different levels of executives. The results show that four key strategies of hospital operation are the customer relationship, human resource and talent training, incentive measures and corporate culture, and self-funded medical treatment. [ABSTRACT FROM AUTHOR]

In order to control the spread of the COVID-19 epidemic across the country, China has used all available resources to build infectious disease hospitals in various ways. These hospitals include three modes and adapt to different disease levels: temporary emergency hospitals; makeshift hospitals by transforming public buildings; and existing general wards transformed into infectious wards. Through the practice of several projects, on the basis of the original standard system, China urgently issued a series of relevant standards and guidelines to guide the construction of temporary hospitals. As one of the earliest cases of temporary emergency infectious disease hospital, the Thunder God Mountain Hospital adopted a prefabricated modular design concept in plan design, plane design and component design, and also combined the application of Building Information Modeling (BIM) and Computational Fluid Dynamics (CFD) technology. Based on industrialized module processing and manufacturing, combined with an efficient on-site construction management system, the problem was solved of completing the construction in a very short time, which played a key role in controlling the epidemic situation. [ABSTRACT FROM AUTHOR]

Copyright of Public Money & Management is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the literature, tactical plans of elective patients aim at increasing hospital efficiency through a better resource utilisation, although hospitals claim that patient satisfaction, usually measured by the waiting time, is also important. In this regard, the purpose of this paper is to show how patient satisfaction can be associated with any tactical plan, by developing a method to compute exact waiting time distributions. We also present a procedure to calculate the exact levels of resource utilisation. Therefore, with our procedures, hospital managers can determine the operational performance of their tactical plan. We then explore two strategies to improve tactical plans in terms of waiting time: slack planning and smooth allocation. A case study based on data from a Dutch cardiothoracic surgery centre shows that slack planning leads to a trade-off between waiting time and hospital efficiency. When slack planning is combined to smooth allocation, additional improvements of the waiting time can be reached. [ABSTRACT FROM PUBLISHER]

Evidence from multiple countries suggests poisons centres create value in several ways including the provision of expert clinical advice, decreased hospital length of stay and triage of exposures enabling safe management without further medical utilisation. Data specific to the New Zealand context are lacking. Therefore, this study aimed to estimate one aspect of poison centre value, namely the potential savings to the health system related to triage advice provided by the New Zealand National Poisons Centre (NZNPC). A prospective survey was conducted over a 2-week period where eligible NZNPC callers – who were advised their exposure did not require further medical assessment – were asked what alternative action they would have taken in the hypothetical absence of the NZNPC. The potential cost savings associated with the alternative actions respondents would have taken were calculated using publicly available information and extrapolated to the population level using annual NZNPC call numbers for 2019. Among 554 eligible callers, 399 were recruited to participate and 396 provided responses. The single most common alternative action was "search the Internet" (54/396, 14%). In-person medical assessment would have been sought by 25% (100/396), and 39% (154/396) would have called an alternative provider within the healthcare system. The estimated cost associated with alternative actions for the study period was NZ$25,637. When extrapolated to the 2019 year, the potential savings from avoided healthcare utilisation was NZ$1,061,551. In 2019, in the absence of NZNPC triage advice, a conservatively estimated NZ$1,061,551 would have been spent on healthcare related to poisoning exposures that were appropriate for management without further medical utilisation. It is important to note that this estimate is only one aspect of the total value created by the NZNPC and is consistent with findings of value from other poisons centres internationally. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has affected numerous conditions in nurses' jobs, which led to stress. Stress in neonatal intensive care unit (NICU) nurses is different from other units due to neonates' fragility. This study aims to identify the perceived effect of the COVID-19 pandemic in NICU nurses' stress levels and its related factors. This cross-sectional study took place in Hasan Sadikin General Hospital Bandung, Indonesia, in October – December 2020, involving 23 NICU nurses. Subjects filled in the online questionnaires for three different time frames: before the pandemic, at the onset of the pandemic, and in the new normal era. Data were analyzed using Friedman test, post hoc Wilcoxon test, and Bonferroni correction. There was significant difference in nurses' stress before the pandemic, at the onset of the pandemic, and in the new normal era. The stress increased at the onset of the pandemic and then decreased in the new normal era. The COVID-19 pandemic increased stress level and affected workloads, work-safety, interpersonal relationships, family problems, and economic problems. With these findings, we recommend the hospital management do a regular stress screening on NICU nurses and refer to the psychiatric department if nurses experience stress. [ABSTRACT FROM AUTHOR]

Background: Clinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients' quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital. Methods: A before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4–12 mg/L), phenytoin (10–20 mg/L), or valproic acid (50–100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test. Results: A total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists' intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018). Conclusion: Epilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient's response and determine the most effective treatment with the fewest adverse drug reactions. Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04967326 [ABSTRACT FROM AUTHOR]

Emergency department (ED) crowding is a universal health issue that affects the efficiency of hospital management and patient care quality. ED crowding frequently occurs when a request for a ward-bed for a patient is delayed until a doctor makes an admission decision. In this case study, we build a classifier to predict the disposition of patients using manually typed nurse notes collected during triage as provided by the Alberta Medical Center. These predictions can potentially be incorporated to early bed coordination and fast track streaming strategies to alleviate overcrowding and waiting times in the ED. However, these triage notes involve high dimensional, noisy, and sparse text data, which make model-fitting and interpretation difficult. To address this issue, we propose a novel semiorthogonal nonnegative matrix factorization for both continuous and binary predictors to reduce the dimensionality and derive word topics. The triage notes can then be interpreted as a non-subtractive linear combination of orthogonal basis topic vectors. Our real data analysis shows that the triage notes contain strong predictive information toward classifying the disposition of patients for certain medical complaints, such as altered consciousness or stroke. Additionally, we show that the document-topic vectors generated by our method can be used as features to further improve classification accuracy by up to 1% across different medical complaints, for example, 74.3%–75.3% accuracy for patients with stroke symptoms. This improvement could be clinically impactful for certain patients, especially when the scale of hospital patients is large. Furthermore, the generated word-topic vectors provide a bi-clustering interpretation under each topic due to the orthogonal formulation, which can be beneficial for hospitals in better understanding the symptoms and reasons behind patients' visits. for this article are available online. [ABSTRACT FROM AUTHOR]

In any organization, the capability, knowledge and skills play a significant role in success of an employee. For instant, in hospital management, the performance evaluation of an employee is mainly based on qualitative in nature. Evaluation of certain factors such as uncertainty, vagueness and imprecision is based on the decision making ability of the evaluator. The performance evaluation for promotion, incentives, bonuses, growth and development of any employee should be recognized in effective and efficiency manner with appropriate ratings. Therefore, this paper aims to design and implement a multi criteria performance evaluation for hospital employees to get promotion, incentives, bonus, growth and development. In this paper, we propose an Interval Valued Fuzzy Weighted Distance Algorithm (IVFWDA) for performance evaluation. The expected interval and the actual interval of the work achievement, management skill, personal quality, care, safety and risk management features are extracted by Interval Valued Fuzzy Soft Matrix (IVFSM) and it is effectively done using the proposed algorithm. An example is presented as a case study to illustrate the proposed algorithm. Implementation of the proposed algorithm in Maple is also discussed with sample computations. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the state-of-the-art analysis of some subarea of healthcare, surgery planning and scheduling, hospital operation management and regional healthcare delivery.

Effective appointment scheduling system is very important to the efficiency of the clinic and the satisfaction of the patients. In practice, the clinic scheduler usually assigns the patients to an available slot before the call terminates and the appointment time can’t be adjusted any more. In this paper, a sequential appointment scheduling method is proposed to balance the benefits of clinic and patients’ satisfaction considering patient choice and service fairness simultaneously. It determines the optimal booking number of patients and optimal scheduling time for each patient to maximise the profit of the outpatient clinic over a session-day. The profit considered in this paper is the total revenue of all arriving patients minus the cost of waiting time, idle time and overtime, which not only considers the rewards from booking decision, but also precisely formulates the charge on service process depending on scheduling. A general patient choice behaviour is incorporated into the model as well. Two myopic scheduling algorithms are developed to optimally solve the sequential appointment scheduling problems with and without considering service fairness, respectively. Particularly, instead of exhaustive search in every step, a property is identified to speed the search process by reducing search space in the proposed myopic scheduling algorithms. After analysing the effects of model parameters on the optimal schedule and system performances, some insights are obtained to help clinics manage sequential appointment requests. The results show that the objective function evolution is unimodal and the allowance of patient choice can increase the number of patients seen in a day, but lower down the expected profit on account of less flexibility. The clinics provide uniform service to patients arriving in different intervals at the expense of less mean and larger variance of the profit. [ABSTRACT FROM PUBLISHER]

This paper studies the admission and premature discharge decisions in the intensive care unit (ICU). While the previous admission policy first come, first served treated all patients equally, this paper divides patients into two classes. One class (class 1) is the more critical patients who cannot be prematurely discharged to other hospital units. The other class (class 2) is patients who can be prematurely discharged to other hospital units in order to accommodate new class 1 patients. We formulate a dynamic programming model to determine the best policy for allocating available beds to different classes of patients and reducing premature discharging costs. By analysing the model, we conclude that there is a threshold (i.e. a fixed number of available beds) for class 2 patients in each time period. If the number of available beds is lower than the threshold, the request of a class 2 patient will be rejected. Otherwise, he/she will be accepted. We find that the survival benefits follow a marginal diminishing effect. The management team can decide how many beds should be allocated to ICU by considering the balance of budget and survival benefits. We also establish the lower and upper bounds of probability that a patient is admitted and prematurely discharged on the same day. The bounds can be used to evaluate our policy and adjust the parameter to improve the policy. The computational experiments illustrate that the proposed policy is better than the traditional policies and the obtained threshold is lower than the threshold that premature discharging is not permitted. The average survival benefits are computed with all initial states. The proposed method is effective and can help ICUs to obtain a relative high survival benefits per day. [ABSTRACT FROM PUBLISHER]

Emergency medical services (EMS) are dedicated to provide urgent medical care to any person requiring it and to ensure their transport to a hospital or care facility, if required. Moreover, in many contexts, EMS also have to provide transportation services for patients need to go from one hospital to another or between their home and the hospital. For such organisations, efficient strategies for managing the ambulance fleet at their disposal have to be selected, but the highly random and dynamic nature of the system under study makes this a challenging task. Most of the published studies which have considered these issues have done it focusing on a specific EMS context, one city or one territory for instance. However, it is possible to identify several common characteristics and processes from one EMS context to another. This is the purpose of the generic discrete event simulation-based analysis tool proposed here, which can be adapted to a wide range of EMS contexts. In particular, it explicitly considers the two types of tasks that can compose the mission of an EMS: serving emergency requests and providing transports between care units/hospitals/patients’ homes. [ABSTRACT FROM PUBLISHER]

This study aims to clarify the factors influencing the financial burden of medical waste management (MWM) on public hospitals, and develop a best-reduced model for predicting MWM cost for hospitals. The medical waste generation rate was computed considering the hospital type and its location. MWM cost in selected hospitals was calculated using the variable pricing method. The mean medical waste generation rate was 0.70 kg per bed per day and 11 kg per surgical procedure. On average, with a daily 420 kg medical waste generated, urban hospitals were the major sources of medical waste. MWM cost in urban hospitals was much greater than that in rural hospitals. The results present an evaluation of how well MWM cost can be predicted by the number of surgical procedures, outpatients and distance of the hospital from the city centre. This study highlights the fact that cost-saving strategies at hospital organizational level are essential for reducing the enhanced MWM cost in hospitals. [ABSTRACT FROM AUTHOR]

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 [[5]]. The accreditation committee should manage the process of hospitals' accreditation and provides necessary documents for the accreditation council to decide about the outcome of a hospital' accreditation status. As a result, a hospital that achieves the accreditation status from an accreditation body may not get the approval of another accreditation body. Therefore, some changes in the structure and functions of the accreditation body, accreditation standards, accreditation methods, and surveyors are required to achieve consistency in accreditation results. [Extracted from the article]

Nowadays, learning for success and development is necessary for every organization. In the event of disregarding learning, the individuals will incur heavy costs. The aim of this study is the comparison and ranking of hospitals considering organizational learning (OL) criteria among the staffs of the hospital. A total of 850 persons form five hospitals were selected randomly. For data collection, Templeton, Louis and Snyder OL questionnaire is used. The questionnaire has eight criteria. The popular software, EXPERT CHOICE is used for data analysis. As a result, the highest score is devoted to the communications based on the paired comparison of the criteria with the aim of the study and the lowest score is devoted to the performance assessment and considering OL factors and Analytical hierarchy process, the hospitals are prioritized and ranked. Based on the research findings, the increase of communications among the staffs of the hospital leads to the increase of learning in the organizations; therefore, it will be effective and valuable in the better performance of the organization and its development. [ABSTRACT FROM AUTHOR]

Copyright of Service Industries Journal is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: An urgent need for coronavirus infectious disease (COVID-19) treatment has resulted in off-label drug use. Although previous studies had investigated the adverse drug reaction (ADR) of the medications for COVID-19 in their respective local settings, the safety profile in a Malaysian setting remains unknown. Our study aims to establish the incidence of ADR for drugs used in COVID-19 management in a Malaysian tertiary hospital. Methods: This retrospective observational study enrolled patients started on drugs for COVID-19 in Sungai Buloh Hospital from 1 March 2020 to 31 May 2020. The clinical staging of COVID-19 patients was decided by the treating physician in accordance with the Clinical Management of Confirmed COVID-19 Case in Adults (Annex 2E). Suspected ADRs were evaluated with a trigger tool of pre-defined laboratory values or the adverse events listed in the registered product insert. Causality assessment was conducted when an ADR was suspected using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system, and only cases classified as certain, probable and possible ADR were considered. Data analysis was completed with descriptive, univariate and multivariate analysis. Results: The study (N = 1,080) identified 217 patients (20.1%) who experienced ADR, with 246 adverse events detected. Most events were related to the gastrointestinal (43.5%), hepatobiliary (36.2%) and cardiac (16.3%) systems. The most commonly suspected drugs were atazanavir (52.7%), chloroquine (36.8%) and lopinavir/ritonavir (34.6%). The independent risk factors of ADR were female (adjusted odds ratio (OR): 1.53; 95% CI 1.06–2.20; P = 0.024), diagnosis of COVID-19 stage 3 (adjusted OR: 2.58; 95% CI 1.20–5.55; P = 0.015) and stage 4 (adjusted OR: 4.17; 95% CI 1.79–9.73; P = 0.001), and the number of COVID-19 drugs (adjusted OR: 3.34; 95% CI 2.51–4.44; P < 0.001). Only 49 adverse events (19.9%) were manually reported by healthcare professionals, with hyperbilirubinaemia (65.3%) and QT prolongation (28.6%) most frequently reported. Conclusion: Medications used in COVID-19 management had resulted in one in five patients experiencing ADR. Our study has provided an overview on incidence of ADR for off-label use of medications used in COVID-19 management, which suggests a similar safety profile when used for FDA-approved indications. [ABSTRACT FROM AUTHOR]