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Objectives: to describe, from literature, the characteristics of patient safety culture in Brazilian hospitals that applied the Hospital Survey on Patient Safety Culture. Methods: this is a scoping review. A search was performed in the databases LILACS, PubMed, SciELO, CINAHL, Web of Science, Scopus and in the CAPES Dissertations and Theses Database in September and October 2020. Results: thirty-six studies were identified. Nine studies identified strengthened areas such as: “teamwork within the units”, “expectations of supervisor/boss and actions promoting safety”, “organizational learning”, “support of hospital management for patient safety” and “frequency of report of events”. As a critical area, the dimension “non-punitive response to error” was evidenced in 30 of 36 studies. Conclusions: the identification of areas of strength and critical areas of safety culture is relevant to encourage improvement of patient safety problems in an institution. RESUMEN Objetivos: describir, a partir de la literatura, las características de la cultura de seguridad del paciente en los hospitales brasileños que aplicaron el Hospital Survey on Patient Safety Culture. Métodos: esta es una revisión de alcance. Se realizaron búsquedas en las bases de datos LILACS, PuBMed, SciELO, CINAHL, Web of Science, Scopus y el Banco de Disertaciones y Tesis CAPES en septiembre y octubre de 2020. Resultados: se identificaron 36 estudios. Nueve estudios identificaron áreas fortalecidas como: “trabajo en equipo dentro de las unidades”, “expectativas del supervisor/jefe y acciones que promuevan la seguridade”, “aprendizaje organizacional”, “apoyo a la gestión hospitalaria para la seguridad del paciente” y “frecuencia de notificación de eventos”. Como área crítica, la dimensión “respuesta no punitiva al error” se evidenció en 30 de los 36 estudios. Conclusiones: la identificación de áreas de fortaleza y áreas críticas de la cultura de seguridad es relevante para incentivar la mejora de los problemas de seguridad del paciente en una institución. RESUMO Objetivos: descrever, a partir da literatura, as características da cultura de segurança do paciente nos hospitais brasileiros que aplicaram o Hospital Survey on Patient Safety Culture. Métodos: trata-se de uma scoping review. Foi realizada busca nas bases de dados LILACS, PuBMed, SciELO, CINAHL, Web of Science, Scopus e no Banco de Dissertações e Teses da CAPES, em setembro e outubro de 2020. Resultados: foram identificados 36 estudos. Nove estudos identificaram áreas fortalecidas como: “trabalho em equipe dentro das unidades”, “expectativas do supervisor/chefe e ações promotoras da segurança”, “aprendizado organizacional”, “apoio da gestão hospitalar para a segurança do paciente” e “frequência da notificação de eventos”. Como área crítica, a dimensão “resposta não punitiva ao erro” foi evidenciada em 30 dos 36 estudos. Conclusões: a identificação de áreas de força e áreas críticas da cultura de segurança é relevante para incitar a melhoria de problemas de segurança do paciente em uma instituição.

Cilj: Evaluirati ponovni prijam unutar 30 dana od otpusta u Klinici za dječju kirurgiju kao indikator kvalitete kirurškog rada. Metode i materijali: Iz pisanog protokola Klinike za dječju kirurgiju KBC-a Split i arhive povijesti bolesti retrospektivno smo prikupili podatke sve djece koja su ponovno primljena u bolnicu unutar 30 dana od otpusta u periodu od 1. siječnja 2017. do 31. prosinca 2019. godine. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, komorbiditeti, primarna dijagnoza, uzrok ponovnog prijama, vrsta prvog prijama (žurno/elektivno), duljina primarne i ponovne hospitalizacije te vrijeme proteklo od otpusta do ponovnog prijama. Rezultati: U trogodišnjem istraživanju ukupno je zabilježeno 5392 prijama (2017., n=1821; 2018., n=1806; 2019., n=1765). Od toga je bilo 1014 (55.6%) elektivnih prijama u 2017., 953 (52.8%) u 2018. i 950 (53.8%) u 2019. godini. U trogodišnjem razdoblju stopa ponovnog prijama unutar 30 dana od otpusta iznosila je 0,79%, odnosno 0.82% u 2017., 0.99% u 2018. i 0.57% u 2019. godini (P=0.348). U djece koja su ponovno primljena unutar 30 dana najčešća primarna dijagnoza bila je akutni apendicitis (n=19; 44,2%), a najčešći razlog ponovnog prijama je komplikacija kirurške rane (n=13; 30%). Udio broja ponovnih prijama tijekom trogodišnjeg istraživanja je za 3,2 puta veći kod žurnih nego kod elektivnih prijama (P75%) koja su ponovno zaprimljena unutar 30 dana od otpusta bila su starija od 8 godina. Zaključci: Ponovni prijam unutar 30 dana jest kvalitetan i reproducibilan indikator kvalitete rada u dječjoj kirurgiji. Udio ponovnih prijama unutar 30 dana znatno je veći kod žurnih prijama, a apendektomija je najčešći postupak koji je povezan s ponovnim prijamom unutar 30 dana., Aim: The aim of this study was to compare 30-day readmission (ReAd) rate from discharge in our clinic within three year period and to note could it be a quality-of-care indicator in pediatric surgery. Methods and materials: The case records of the patients that were readmitted within 30 days of primary surgery from January 1st 2017 to December 31st 2019 were identified retrospectively, for each year separately. Demographic data (age, gender, pre-existing comorbidities), diagnosis and the treatment on primary admission, length of hospital stay, and diagnosis with treatment on readmission, were collected. For each year ReAds were identified and divided into two groups (emergency and elective) based on the nature of the primary surgery. Outcomes were compared between two groups. Results: A total of 5392 admissions were identified among three years (2017, n=1821; 2018, n=1806; 2019, n=1765). There was 1014 (55.6%) elective admissions in 2017, 953 (52.8%) in 2018 and 950 (53.8%) in 2019. The overall ReAd rate was 0.79%, or 0.82%, 0.99% and 0.57% for years 2017, 2018 and 2019, respectively (P=0.348). The most common cause for ReAd was appendicitis (n=19; 44,2%) related followed by surgical site infection in different subfields (n=13; 30%). The share of the number of ReAds during the three-year period is 3.2 times higher for emergency admissions than for elective admissions (P75%) of all ReAd in all three years occurred in children above age of 8. Conclusions: ReAd is a reproducible and good quality-of-care indicator in pediatric surgery. An incidence of ReAd is significantly higher in emergency admissions and an appendectomy is the most common procedure associated with ReAd.

Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death> 2500g and> 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with >2500g and > 37 weeks for more than one day, Apgar 2500g and>37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators. Resumo Objetivos: analisar os resultados adversos em maternidades de ensino de Maceió, Alagoas, Brasil. Métodos: estudo transversal, retrospectivo e analítico, com amostra aleatória de 480 prontuários de puérperas de parto cirúrgico de 2016, utilizando-se o Adverse Outcome Index: morte materna intra-hospitalar, morte neonatal intra-hospitalar >2500g e >37 semanas, rotura uterina, admissão materna não planejada em unidade de terapia intensiva, trauma de parto no recém-nascido, retorno à sala cirúrgica, admissão em unidade intensiva neonatal com >2500g e >37 semanas por mais de um dia, Apgar 2500g e >37 semanas por mais de um dia (52,5%), hemotransfusão materna (20,8%) e admissão materna não planejada em terapia intensiva (17,8%). Conclusão: evidenciou uma elevada parcela de nascimentos com resultados não desejáveis, o que proporcionou a análise do panorama dos desfechos desfavoráveis relacionados à segurança em maternidades através do uso de indicadores.

Introducción: La prolongación de estancia hospitalaria es un fenómeno poco estudiado en Colombia; respecto al caso de las estancias por bronquiolitis, surge la necesidad de identificar los factores que condicionan el número de días de hospitalización. Objetivo: Identificar los factores de ingreso que se encuentran asociados a permanencia hospitalaria en pacientes con diagnóstico de bronquiolitis en el Hospital Universitario Santa Clara, de Bogotá, Colombia. Método: Se realizó un análisis de una cohorte histórica de 175 pacientes que ingresaron a urgencias y posteriormente fueron hospitalizados por bronquiolitis a partir del 5 de enero del 2015 hasta 5 de enero del 2016. Se utilizó un análisis de supervivencia en donde se evaluaron factores sociodemográficos, antecedentes del paciente, variables de ingreso a urgencias además y tratamiento al ingreso. La regresión de Cox fue hecha para determinar factores asociados a mayores días de hospitalización. Resultados: Se encontró que la edad con un HR: 1,03 IC 95% (1.00-1,06), paciente institucionalizado HR: 0,56 IC 95% (0,36-0,85), prematuridad HR: 0,48 IC 95% (0,31-0,76). Hipertensión pulmonar HZ: 0,42 IC 95% (0,20-0,86), hipoxemia HZ: 0,63 IC95% (0,45-0,89), reduce la velocidad de egreso hospitalario en días. Conclusiones: El aumento en la edad de los niños es un factor que influye de manera inversa en el riesgo de prolongar la estancia hospitalaria. Por su parte, factores como ser pacientes institucionalizados, tener antecedentes de prematuridad, hipertensión pulmonar o de hipoxemia al ingreso, aumenta las posibilidades de prolongar el egreso hospitalario. Magíster en Epidemiología Maestría Introduction: The prolongation of hospital stay is a little studied phenomenon in Colombia; Regarding the case of stays due to bronchiolitis, there is a need to identify the factors that condition the number of days of hospitalization. Objective: To identify the admission factors that are associated with hospital stay in patients diagnosed with bronchiolitis at the Santa Clara University Hospital, Bogotá, Colombia. Method: A historic cohort analysis of 175 patients admitted to the emergency department and subsequently hospitalized for bronchiolitis from January 5, 2015 to January 5, 2016 was performed. A survival analysis was used in which sociodemographic factors were evaluated, patient's history, emergency admission variables and treatment at admission. The Cox regression was made to determine factors associated with longer days of hospitalization. Results: It was found that the age with a HR: 1.03 IC 95% (1.00-1.06), institutionalized patient HR: 0.56 IC 95% (0.36-0.85), prematurity HR: 0, 48 IC 95% (0.31-0.76). Pulmonary hypertension HZ: 0.42 IC 95% (0.20-0.86), hypoxemia HZ: 0.63 IC 95% (0.45-0.89), reduces the speed of hospital discharge in days. Conclusions: The increase in the age of children is a factor that inversely influences the risk of prolonging hospital stay. On the other hand, factors such as institutionalized patients, having a history of prematurity, pulmonary hypertension or hypoxemia on admission, increase the chances of prolonging hospital discharge.

Made available in DSpace on 2019-10-06T16:14:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-10. Added 1 bitstream(s) on 2019-10-09T18:35:14Z : No. of bitstreams: 1 S1983-14472019000200405.pdf: 243455 bytes, checksum: 94f9eda3e1add32b3efc04c5dc4658c6 (MD5) OBJETIVO: Analisar as notificações de incidentes relacionados aos medicamentos potencialmente perigosos dispensados em um hospital de ensino do interior de São Paulo. MÉTODOS: Estudo descritivo, retrospectivo com abordagem quantitativa dos dados provenientes da análise das notificações em farmacovigilância que ocorreram no período de janeiro de 2009 a dezembro de 2014, a partir de tabelas e gráficos, apresentando as frequências absolutas/relativas. RESULTADOS: Das 786 notificações de farmacovigilância, 188 foram relacionadas aos medicamentos potencialmente perigosos, sendo 36,7% de ineficácia terapêutica, 32,44% queixa técnica, 15,95% reação adversa, 7,44% flebite, 5,13% extravasamento, 1,06% erro de dispensação, 0,53% erro de administração e 0,53% erro de medicação. Os profissionais que mais notificaram foram enfermeiros. Os grupos farmacológicos de maior notificação foram drogas com ação sobre sistema nervoso (35,63%). CONCLUSÃO: A análise demonstrou que houve um número de notificações expressivo e necessidade de adoção de estratégias a fim de garantir maior segurança do paciente. OBJECTIVE: To analyze the reports of incidents related to potentially hazardous medications distributed at a teaching hospital in the interior of São Paulo. METHODS: A descriptive, retrospective study with a quantitative approach of data from the analysis of pharmacovigilance notifications that occurred between January 2009 and December 2014, from tables and graphs, showing the absolute/relative frequencies. RESULTS: From 786 reports of pharmacovigilance, 188 were related to potentially hazardous medicines, 36.7% of which were ineffective, 32.44% were technical complaints, 15.95% were adverse reactions, 7.44% were phlebitis, 5.13% were extravasation , 1.06% dispensing error, 0.53% administration error and 0.53% medication error. The professionals who most notified were nurses. The most commonly reported pharmacological groups were drugs with action on the nervous system (35.63%). CONCLUSION: The analysis showed that there were a significant number of reports and the need to adopt strategies to ensure greater patient safety. OBJETIVO: Analizar las notificaciones de incidentes relacionados a medicamentos potencialmente peligrosos suministrados ​​en un hospital de enseñanza del interior de San Pablo. MÉTODOS: Estudio descriptivo, retrospectivo, con abordaje cuantitativo de los datos provenientes del análisis de las notificaciones en farmacovigilancia que ocurrieron en el período de enero de 2009 a diciembre de 2014, a partir de tablas y gráficos, presentando las frecuencias absolutas/relativas. RESULTADOS: De las 786 notificaciones de farmacovigilancia, 188 fueron relacionadas a los medicamentos potencialmente peligrosos, siendo 36,7% de ineficacia terapéutica, 32,44% queja técnica, 15,95% reacción adversa, 7,44% flebitis, 5,13% extravasación, 1,06% error de dispensación, 0,53% error de administración, y 0,53% error de medicación. Los profesionales que más notificaron fueron enfermeros. Los grupos farmacológicos de mayor notificación fueron drogas con acción sobre el sistema nervioso (35,63%). CONCLUSIÓN: El análisis demostró que hubo un número de notificaciones expresivas y necesidad de adopción de estrategias a fin de garantizar mayor seguridad al paciente. Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB). Botucatu Universidade Estadual Paulista (Unesp) Faculdade de Medicina de Botucatu Departamento de Enfermagem. Botucatu Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB). Botucatu Universidade Estadual Paulista (Unesp) Faculdade de Medicina de Botucatu Departamento de Enfermagem. Botucatu

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2019-03-01T15:40:49Z No. of bitstreams: 1 Elizienne de Sousa Costa Horvath.pdf: 1096038 bytes, checksum: fb99a083b281bfc3b9f5b535c423dda7 (MD5) Made available in DSpace on 2019-03-01T15:40:49Z (GMT). No. of bitstreams: 1 Elizienne de Sousa Costa Horvath.pdf: 1096038 bytes, checksum: fb99a083b281bfc3b9f5b535c423dda7 (MD5) Previous issue date: 2018-02-08 Introduction: The use of protocols such as the standard operating procedure assists in the sequencing and standardization of the pipeline to be taken, which facilitates the decisions of health professionals. In Brazil there is a shortage of data in the obstetrics and neonatal context, there is a lack of instruments and standardization of protocols for this purpose. Method: descriptive, qualitative study of technology validation of type development research. Objective: To evaluate a protocol in the model of standard operating procedure for implementation of the instrument defined as Safety Thermometer in Maternity in a public university hospital. Results: The results were obtained in two stages, the first consisted in the process of elaboration of the protocol by the researchers and validation by the committee of 12 specialists in obstetric nursing, professionals of the study unit, the analysis was done through the Content Validation Index (value of reference IVC = 0.80) using a semi-structured questionnaire with a Likert scale (1 to 4), the IVC scores of the specialists ranged from 0.84% to 1.0 and the concordance percentage was 98.7%. The second stage of the study consisted of the application of the instrument Maternity Safety Thermometer. The data obtained in this stage showed that the majority of the women was submitted to caesarean section 20 (64.5%). Of those who had vaginal deliveries, there was perineal trauma in 4 (12.8%) and 1 (3.2%) episiotomy; 3 (9.6%) had hemorrhage, the transfusion rate was 3.2% and that of infections 4 (12.8%). Of the newborns, 14 (45.2%) of the babies had to be transferred, 11 (35.5%) of which were foreseen. From the perception of the woman, 39.1% reported being separated from the baby and 7.4% were left alone, 38.4% considered that they were not taken seriously when showing concern. The indicator free of damage was 9.6%. Conclusion: The Maternity Safety Thermometer Protocol in the standard operating procedure format presented acceptable psychometric indicators of acceptable content validity, corroborating the use of the instrument considered easy to apply and enabling the production of safety indicators for obstetric and neonatal care. Introdu????o: O uso de protocolos como o procedimento operacional padr??o auxilia na sequ??ncia e padroniza????o de condutas a serem tomadas, o que facilita as decis??es dos profissionais na ??rea da sa??de. No Brasil, h?? uma escassez de dados sobre seguran??a no contexto obst??trico e neonatal, tamb??m h?? falta de instrumentos e de padroniza????o de protocolos para esse fim. M??todo: Estudo descritivo, qualitativo de valida????o de tecnologia do tipo pesquisa de desenvolvimento. Objetivo: Avaliar um protocolo no modelo de procedimento operacional padr??o para implementa????o do instrumento definido como Term??metro de Seguran??a na Maternidade em um hospital universit??rio p??blico no munic??pio de S??o Paulo. Resultados: Os resultados foram obtidos em duas etapas, a primeira consistiu no processo de elabora????o do protocolo pelas pesquisadoras e valida????o pelo comit?? de 12 especialistas em enfermagem obst??trica, profissionais da unidade de estudo, a an??lise ocorreu por meio do ??ndice de Valida????o do Conte??do (valor de refer??ncia do IVC=0,80) por meio de um question??rio semiestruturado com escala Likert (1 a 4), os resultados de IVC das especialistas variaram entre 0,84% e 1,0 e a porcentagem de concord??ncia foi de 98,7%. A segunda etapa do estudo, consistiu na aplica????o do instrumento Term??metro de Seguran??a na Maternidade. Os dados obtidos, nessa etapa, demonstraram que a maioria das mulheres foi submetida ?? cesariana 20 (64,5%). Das que tiveram partos vaginais, houve trauma perineal em 4 (12,8%) e 01 (3,2%) episiotomia; 3 (9,6%) tiveram hemorragia, a taxa de transfus??o foi de 3,2% e a de infec????es 12,8%. Sobre os rec??m-nascidos, houve necessidade de transfer??ncia de 14 (45,2%) dos beb??s, sendo que 11 (35,5%) estavam previstas. Da percep????o da mulher, 39,1% referem terem sido separadas do beb?? e 7,4% terem sido deixadas sozinhas, 38,4% consideram que n??o foram levadas a s??rio ao demonstrar preocupa????o. O indicador livre de dano foi de 9,6%. Conclus??o: o Protocolo Term??metro de Seguran??a na Maternidade no formato de procedimento operacional padr??o apresentou indicadores psicom??tricos de validade de conte??do aceit??veis, corroborando para o uso do instrumento considerado de f??cil aplica????o e possibilitando a produ????o de indicadores de seguran??a da assist??ncia obst??trica e neonatal.

Submitted by CAMILA POLO CAMARGO DA SILVA null (kmilapolo@hotmail.com) on 2018-04-05T18:42:16Z No. of bitstreams: 1 Camila Polo -.pdf: 1528568 bytes, checksum: 2e153d63546ea9e58530f410d2449df8 (MD5) Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-06T15:16:56Z (GMT) No. of bitstreams: 1 silva_cpc_dr_bot.pdf: 1528568 bytes, checksum: 2e153d63546ea9e58530f410d2449df8 (MD5) Made available in DSpace on 2018-04-06T15:16:56Z (GMT). No. of bitstreams: 1 silva_cpc_dr_bot.pdf: 1528568 bytes, checksum: 2e153d63546ea9e58530f410d2449df8 (MD5) Previous issue date: 2018-02-06 O objetivo deste estudo foi implementar e analisar o comportamento temporal de indicadores de qualidade do processo de trabalho do setor de Ressonância Magnética (SRM) de um Hospital de Ensino. Estudo descritivo de abordagem quantitativa de delineamento misto de série de transversais e de dados secundários. A pesquisa foi realizada no SRM de um Hospital de Ensino, sendo localizado no interior do estado de São Paulo vinculado à Secretaria de Estado de São Paulo, sendo este hospital a maior instituição pública vinculada ao Sistema Único de Saúde (SUS) na região. Os dados foram obtidos por meio do processo de trabalho do setor durante treze meses (março de 2015 a março de 2016) a fim de identificar os indicadores de estrutura, processo e resultado. Para o indicador de satisfação aplicou-se o instrumento Service Quality Gap Analysis (SERVQUAL) em pacientes ambulatoriais SUS que foram escolhidos aleatoriamente na rotina de atendimento. Foram acompanhados quinze indicadores, sendo, dois de estrutura, dez de processo e três de resultado. Como principais resultados, para o indicador estrutura foi implantado o registro do evento relacionado a paralisação do aparelho. No indicador de processo o período do estudo totalizou em 257 dias úteis, 4357 exames realizados, com média de 18,9 atendimentos/dia, tendo o máximo de 25 atendimentos, taxa de extravasamento de contraste durante o período foi de 0,1%. No indicador de resultado identificou-se que a média de tempo de espera para realização do exame de 184 dias sendo o mínimo de 0 e o máximo de 937 dias e o tempo médio para o laudo foi de 51,8 dias sendo o mínimo de 0 dias e máximo de 293. O instrumento SERVQUAL foi aplicado em 465 pacientes ambulatoriais do SUS, os quais referiram alto nível de satisfação com o serviço prestado. Foi calculado o Alfa de Cronbach do instrumento, sendo 0,97 para o atendimento ideal e 0,96 para o atendimento recebido demonstrando e confirmando a consistência interna do instrumento. A análise dos indicadores possibilitou compreender as falhas existentes no serviço com possibilidade de apoiar as transformações necessárias com base em evidências, tanto na esfera assistencial quanto gerencial. O paciente ambulatorial apresentou elevado nível de satisfação quando comparada as opiniões entre o ideal com o recebido, evidenciando que o paciente vinculado ao sistema público evita em criticar o serviço apesar do tempo de espera para o exame e para o laudo. The objective of this study was to implement and analyze the temporal behavior of quality indicators of the work process in the Magnetic Resonance sector (MRS) in a Medical School Hospital. It is a quantitative-approach descriptive study of a cross-sectional and mixed design with secondary data. The research was conducted in the MRS of a Medical School Hospital located in the interior of São Paulo state linked to the São Paulo State Secretariat. This hospital is the largest public institution attached to the Unified Health System (UHS) in the region. The data were obtained through the work process of the sector for thirteen months (March 2015 to March 2016) in order to identify the structure, process and outcome indicators. For the satisfaction indicator, the Service Quality Gap Analysis (SERVQUAL) instrument was applied to outpatient UHS patients who were randomly chosen in the care routine. Fifteen indicators were followed: two structure ones, 10 process ones, and three result ones. As main results, the report of the event related to equipment shutdown was implemented for the structure indicator. In the process indicator, the study period was 257 workdays, 4357 examinations performed, with an average of 18.9 appointments/day, with a maximum of 25 appointments, and the contrast extravasation rate during the period was 0.1%. In the outcome indicator, it was found that the average waiting time for an examination was 184 days, being the minimum zero and the maximum 937 days, and the average waiting time for the report was 51.8 days, with a minimum of zero and maximum of 293 days. The SERVQUAL instrument was applied in 465 outpatient UHS patients, who reported a high level of satisfaction with the service provided. The Cronbach's alpha of the instrument was calculated, being 0.97 for the ideal care and 0.96 for the care received demonstrating and confirming the internal consistency of the instrument. Analyzing the indicators enabled the understanding of the existing flaws in the service with the possibility of supporting the necessary transformations based on evidence, in both care and management. The outpatient patients presented a high level of satisfaction when comparing their opinions between the ideal and the received care, which evidences that the patients associated to the public system avoid criticizing the service despite the long time they wait for the examinations and the reports.

OBJECTIVE To describe the workload of the nursing team and relate it with patient safety outcomes in clinical and surgical inpatient units of a university hospital. METHOD Cross-sectional study, carried out from October 2013 to September 2015. The factor under study was the workload, expressed as the ratio between the mean number of patients and the number of nursing professionals in 24 hours and in the day shifts. RESULTS The sample consisted of 157,481 patients, 502 nursing professionals and 264 observations of safety outcomes. The ratios of patients per nurse and per nursing technician in day shifts indicate a mean estimate of 14-15 and 5-6 patients per professional, respectively. There was a significant association between the workloads in the inpatient units and average length of stay, urinary infection related to invasive procedure and the satisfaction of patients with nursing care. CONCLUSION The increase in the workload of the nursing team had an impact on quality of care and safety for patients. An adequate staffing promotes a safer care environment. Resumen OBJETIVO Describir la carga de trabajo del equipo de enfermería y establecer asociación con resultados de seguridad del paciente en unidades de estancia hospitalaria clínicas y quirúrgicas de un hospital universitario. MÉTODO Estudio transversal llevado a cabo de octubre de 2013 a septiembre de 2015. El factor en estudio fue la carga de trabajo, expresada por la razón entre el número medio de pacientes y de profesionales de enfermería en 24 horas y en el período diurno. RESULTADOS La muestra comprendió a 157.481 pacientes, 502 profesionales de enfermería y 264 observaciones de los resultados de seguridad. Las razones de pacientes por enfermero y técnico de enfermería en el diurno señalan una estimación media de 14-15 y 5-6 pacientes por profesional, respectivamente. Hubo asociación significativa entre las cargas de trabajo de las unidades de hospitalización y los resultados referentes al promedio de permanencia hospitalaria, infección urinaria relacionada con procedimiento invasivo y la satisfacción de pacientes con el cuidado de enfermería.CONCLUSIÓNEl aumento de la carga de trabajo del equipo de enfermería tuvo impacto en resultados de calidad de la asistencia y de seguridad para los pacientes. La adecuación del cuadro de personal proporciona un ambiente de cuidado más seguro. Resumo OBJETIVO Descrever a carga de trabalho da equipe de enfermagem e estabelecer associação com resultados de segurança do paciente em unidades de internação clínicas e cirúrgicas de um hospital universitário. MÉTODO Estudo transversal, realizado de outubro de 2013 a setembro de 2015. O fator em estudo foi a carga de trabalho, expressa pela razão entre o número médio de pacientes e de profissionais de enfermagem em 24 horas e no período diurno. RESULTADOS A amostra abrangeu 157.481 pacientes, 502 profissionais de enfermagem e 264 observações dos resultados de segurança. As razões de pacientes por enfermeiro e técnico de enfermagem no diurno indicam uma estimativa média de 14-15 e 5-6 pacientes por profissional, respectivamente. Houve associação significativa entre as cargas de trabalho das unidades de internação e os resultados referentes à média de permanência hospitalar, à infecção urinária relacionada a procedimento invasivo e à satisfação de pacientes com o cuidado de enfermagem. CONCLUSÃO O aumento da carga de trabalho da equipe de enfermagem teve impacto em resultados de qualidade da assistência e de segurança para os pacientes. A adequação do quadro de pessoal proporciona um ambiente de cuidado mais seguro.

BACKGROUND: Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities. METHODS: We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland. Indicators of quality of care were established for anaemia control, calcium and phosphate product, serum albumin, pre-dialysis blood pressure (BP), type of vascular access and dialysis adequacy (spKt/V) and their baseline values were related to 3-year survival. The modified Charlson co-morbidity index (including age) and transplantation status were also considered as a predictor of survival. RESULTS: Three-year survival was obtained for 96% of the patients; 39% (211/541) of these patients had died. The 3-year survival was 50, 62 and 69%, respectively, in patients who had 0-2, 3 and >or=4 fulfilled indicators of quality of care (test for linear trend, P < 0.001). In a Cox multivariate analysis model, the absence of transplantation, a higher modified Charlson's score, decreased fulfilment of indicators of good clinical care and low pre-dialysis systolic BP were independent predictors of death. CONCLUSION: Good clinical care improves survival in HD patients, even after adjustment for availability of transplantation and co-morbidities.

Objetivo: Descrever a carga de trabalho da equipe de enfermagem e estabelecer associação com resultados de segurança do paciente em unidades de internação clínicas e cirúrgicas de um hospital universitário. Método: Estudo transversal, realizado de outubro de 2013 a setembro de 2015. O fator em estudo foi a carga de trabalho, expressa pela razão entre o número médio de pacientes e de profissionais de enfermagem em 24 horas e no período diurno. Resultados: A amostra abrangeu 157.481 pacientes, 502 profissionais de enfermagem e 264 observações dos resultados de segurança. As razões de pacientes por enfermeiro e técnico de enfermagem no diurno indicam uma estimativa média de 14-15 e 5-6 pacientes por profissional, respectivamente. Houve associação significativa entre as cargas de trabalho das unidades de internação e os resultados referentes à média de permanência hospitalar, à infecção urinária relacionada a procedimento invasivo e à satisfação de pacientes com o cuidado de enfermagem.Conclusão: O aumento da carga de trabalho da equipe de enfermagem teve impacto em resultados de qualidade da assistência e de segurança para os pacientes. A adequação do quadro de pessoal proporciona um ambiente de cuidado mais seguro. Objective: To describe the workload of the nursing team and relate it with patient safety outcomes in clinical and surgical inpatient units of a university hospital. Method: Crosssectional study, carried out from October 2013 to September 2015. The factor under study was the workload, expressed as the ratio between the mean number of patients and the number of nursing professionals in 24 hours and in the day shifts. Results: The sample consisted of 157,481 patients, 502 nursing professionals and 264 observations of safety outcomes. The ratios of patients per nurse and per nursing technician in day shifts indicate a mean estimate of 14-15 and 5-6 patients per professional, respectively. There was a significant association between the workloads in the inpatient units and average length of stay, urinary infection related to invasive procedure and the satisfaction of patients with nursing care. Conclusion: The increase in the workload of the nursing team had an impact on quality of care and safety for patients. An adequate staffing promotes a safer care environment. Objetivo: Describir la carga de trabajo del equipo de enfermería y establecer asociación con resultados de seguridad del paciente en unidades de estancia hospitalaria clínicas y quirúrgicas de un hospital universitario. Método: Estudio transversal llevado a cabo de octubre de 2013 a septiembre de 2015. El factor en estudio fue la carga de trabajo, expresada por la razón entre el número medio de pacientes y de profesionales de enfermería en 24 horas y en el período diurno. Resultados: La muestra comprendió a 157.481 pacientes, 502 profesionales de enfermería y 264 observaciones de los resultados de seguridad. Las razones de pacientes por enfermero y técnico de enfermería en el diurno señalan una estimación media de 14-15 y 5-6 pacientes por profesional, respectivamente. Hubo asociación significativa entre las cargas de trabajo de las unidades de hospitalización y los resultados referentes al promedio de permanencia hospitalaria, infección urinaria relacionada con procedimiento invasivo y la satisfacción de pacientes con el cuidado de enfermería. Conclusión: El aumento de la carga de trabajo del equipo de enfermería tuvo impacto en resultados de calidad de la asistencia y de seguridad para los pacientes. La adecuación del cuadro de personal proporciona un ambiente de cuidado más seguro.

Background: The fairness of quality assessment methods is under debate. Quality indicators incorporating the longitudinal nature of care have been advocated but their usefulness in comparison to more commonly used cross-sectional measures is not clear.Aims: To compare cross-sectional and sequential quality indicators for risk factor management in patients with type 2 diabetes.Methods: The study population consisted of 1912 patients who received diabetes care from one of 40 general practitioners in The Netherlands. Clinical outcomes, prescriptions, and demographic data were collected from electronic medical records. Quality was assessed for glycemic, blood pressure, and lipid control using indicators focusing on clinical outcomes, and treatment in relation to outcomes. Indicator results were compared with a reference method based on national guidelines for general practice.Results: According to the reference method, 76% of the patients received management as recommended for glycemic control, 58% for blood pressure control, and 67% for lipid control. Cross-sectional indicators looking at patients adequately controlled gave estimates that were 10-25% lower than the reference method. Estimates from indicators focusing on uncontrolled patients receiving treatment were 10-40% higher than the reference method for blood pressure and glycemic control. Sequential indicators focusing on improvement in clinical outcomes or assessing treatment modifications in response to poor control gave results closer to the reference method.Conclusions: Sequential indicators are valuable for estimating quality of risk factor management in patients with diabetes. Such indicators may provide a more accurate and fair judgment than currently used cross-sectional indicators.

This study aimed to develop indicators to evaluate the care for neurocritical patients. Methodological study for development and validation of indicators of health evaluation, conducted on the Intensive Care Unit of a large hospital. The opinionated validation method was used, where seven experts (five nurses and two doctors) participated on the content analysis through operational manual from May to August 2012. The values obtained from the expert judgment were all above 80%, in which the literature reference was above 75%. The results revealed that all the indicators were considered valid as regards the agreement percentage. Therefore, it is possible to establish reliable indicators to evaluate the proposed care and establish the quality of the service. From the theoretical prerequisites, its use will support the control of assistance quality whilst collaborates with designing intervention plans.

This study aims to determine the occurrence of adverse events related to the use of enteral nutrition in patients hospitalized at the University Hospital of Santa Maria (HUSM), based on the quality indicators. This is an exploratory study, longitudinal, descriptive study with a quantitative approach. Follow-up of 46 adult patients of both sexes aged was conducted from 18 years in the use of enteral nutritional therapy in the Intensive Care Unit and Adult Medical Clinic II, in the period January-May 2012. To collect the a semistructured data form with information about the identification data, sociodemographic and data quality indicators (inadvertent output, tube obstruction and received diet volume) was used. Among the patients treated there was a predominance of males (71.7%), aged between 41 and 80 years (69.6%), skin color / Caucasians (93.6%), single (51.1 %) with incomplete 1st grade (53.2%) and from Santa Maria (53.2%). The diagnoses had a higher frequency were related to neurological disorders (N = 18), respiratory (N = 12) and neoplastic (N = 12). The average number of days in which patients used the probe to enteral feeding was 18.5 days (SD = 8.6), minimum of three and maximum of 30 days. Among the reasons that led to the suspension of the diet are: pause for body care (N = 2, 2.4%), exams and procedures (N = 46, 54.8%), for nausea and vomiting (N = 29 , 34.5%) and delay in installation of new bottle for not available in the unit (N = 7, 8.3%). In the study period 39 inadvertent exits the probe and tube obstruction occurred, showing incidence rates of 4.6% and 2.1%, respectively. On average, patients stopped receiving 176.4 ml (± 117.8), with a median of 81.4 ml. 72 drugs administered by tube feeding of patients who used NE were also identified. We conclude that the use of quality indicators in nursing constitutes a useful tool to assess the quality of care. Este estudo tem como objetivo verificar a ocorrência de eventos adversos relacionados ao uso de nutrição enteral em pacientes internados no Hospital Universitário de Santa Maria (HUSM), tendo por base os indicadores de qualidade. Trata-se de um estudo exploratório, longitudinal, descritivo, com abordagem quantitativa. Foi realizado acompanhamento de 46 pacientes adultos de ambos os sexos com idade a partir de 18 anos, em uso de terapia nutricional enteral, na Unidade de Terapia Intensiva Adulto e Clínica Médica II, no período de janeiro a maio de 2012. Para a coleta dos dados foi utilizado um formulário semiestruturado com informações sobre os dados de identificação, caracterização sociodemográfica e dados sobre os indicadores de qualidade (saída inadvertida, obstrução da sonda e volume recebido da dieta). Dentre os pacientes acompanhados houve predomínio do sexo masculino (71,7%), com faixa etária entre 41 e 80 anos (69,6%), de cor da pele/raça branca (93,6%), solteiros (51,1%), com 1º grau incompleto (53,2%) e procedentes de Santa Maria (53,2%). Os diagnósticos que apresentaram maior frequência estavam relacionados aos distúrbios neurológicos (N=18), respiratórios (N=12) e neoplásicos (N=12). A média de dias em que os pacientes utilizaram a sonda para alimentação enteral foi de 18,5 dias (DP= 8,6), mínimo de três e máximo de 30 dias. Dentre os motivos que levaram à suspensão da dieta estão: pausa para higiene corporal (N=2; 2,4%), realização de exames e procedimentos (N=46; 54,8%), por náusea e vômito (N=29; 34,5%) e demora na instalação de novo frasco por não haver disponível na unidade (N=7; 8,3%). No período avaliado ocorreram 39 saídas inadvertidas da sonda e uma obstrução da sonda, evidenciando taxas de incidência de 4,6% e 2,1%, respectivamente. Em média os pacientes deixaram de receber 176,4 ml (±117,8), com mediana de 81,4 ml. Também foram identificados 72 medicamentos administrados pela sonda de alimentação dos pacientes que fizeram uso de NE. Conclui-se que o uso de indicadores de qualidade na enfermagem se constitui em uma ferramenta útil para avaliar a qualidade da assistência.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-12-27T18:26:23Z No. of bitstreams: 1 Greice Menezes 2013.pdf: 62868 bytes, checksum: eb72c63de0731e9748e876b92ecae460 (MD5) Made available in DSpace on 2013-12-27T18:26:23Z (GMT). No. of bitstreams: 1 Greice Menezes 2013.pdf: 62868 bytes, checksum: eb72c63de0731e9748e876b92ecae460 (MD5) Previous issue date: 2013 O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) é um estudo de coorte composto de 15.105 adultos acompanhados para avaliar o desenvolvimento de doenças crônicas, especialmente diabetes e doença cardiovascular. Seu porte, natureza multicêntrica e diversidade de medidas exigiram mecanismos ágeis e efetivos de garantia e controle de qualidade. Entre as atividades de garantia de qualidade (aquelas desenvolvidas antes de iniciar a coleta de dados), destacam-se: seleção criteriosa dos instrumentos de pesquisa, treinamento e certificação centralizados, pré-testes e estudos pilotos, e elaboração de manuais de operações para os procedimentos. As atividades de controle de qualidade (realizadas durante a coleta e processamento dos dados) foram efetuadas mais intensivamente no início, quando as rotinas ainda não estavam estabelecidas. Entre elas, ressaltam-se: observação periódica dos aferidores, estudos de teste reteste, monitoramento dos dados, rede de supervisores e visitas cruzadas. Dados que estimam a confiabilidade das informações obtidas atestam que as metas de qualidade foram alcançadas. São Paulo

Estudo descritivo, de natureza qualitativa, tipo estudo de caso, acerca do discurso dos pacientes sobre qualidade das oficinas terapêuticas em saúde mental. Utilizamos como guias os Indicadores de Qualidade de Projeto, conjunto de técnicas elaboradas e testadas na área educacional, cuja finalidade é avaliar projetos educacionais. Este propiciou atender ao objetivo de apontar as características de qualidade das oficinas terapêuticas, a partir da fala dos pacientes. O estudo baseou-se em conceitos pautados em cidadania, também contemplados na proposta de reabilitação psicossocial que orienta a assistência em saúde mental do Instituto de Psiquiatria do Rio de Janeiro. A análise dos dados foi realizada através da análise de discurso. Nossas reflexões basearam-se nos dados obtidos de 12 entrevistas realizadas em uma oficina terapêutica do Hospital-dia do Instituto de Psiquiatria. Através dos dados percebemos que a participação dos pacientes psiquiátricos nestas oficinas pode estar associada a quatro desejos principais: melhores relações sociais, diminuição de sintomas, ajuda com respeito e alguma remuneração. This is a descriptive, qualitative case study about the speech of patients related to the quality of the therapeutic workshop on mental health. As guidelines we used the Project Quality Indexes, a set of techniques carried out and tested in the field of education, used in evaluating educational projects. Their use favored reaching the goal of the study: to point out the quality characteristics of therapeutic workshops based on patient commentary. The study was based on concepts guided by citizenship and contemplated in the psychosocial rehabilitation proposal that orients mental health care at the Psychiatric Institute in Rio de Janeiro, Brazil. Data was analyzed through speech analysis. Our reflections were based on the data obtained from 12 interviews carried out in a therapeutic workshop of the Psychiatric Institute Day-Hospital. From this data, we have perceived that psychiatric patient participation in these workshops may be associated to four main desires: better social relationships, decreased symptoms, aid with respect, and some remuneration. Es un estudio descriptivo, de naturaleza cualitativa, del tipo estudio de caso, acerca del discurso de los pacientes sobre la calidad de los talleres terapéuticos en salud mental. Utilizamos como guías los Indicadores de Calidad de Proyecto, un conjunto de técnicas elaboradas y probadas en el área educacional, cuya finalidad es evaluar proyectos educacionales. Con ese método se pudo atender nuestro objetivo: señalar las características de calidad de los talleres terapéuticos, a partir de lo que dicen los pacientes. El estudio se apoyó en conceptos basados en la ciudadanía, y también incluidos en la propuesta de rehabilitación psicosocial que orienta la asistencia en salud mental del Instituto de Psiquiatría de Rio de Janeiro. El análisis de los datos se realizó mediante el análisis de discurso. Nuestras reflexiones se basaron en los datos obtenidos en 12 entrevistas realizadas en un taller terapéutico del Hospital-día del Instituto de Psiquiatría. Los datos obtenidos permiten percibir que la participación de los pacientes psiquiátricos en esos talleres puede estar asociada a cuatro deseos principales: mejores relaciones sociales, disminución de síntomas, ayuda con respeto y alguna remuneración.

Sabe-se bem que as pessoas se comportam de acordo com a com que elas estão sendo avaliadas. No campo da assistência à saúde, a busca por uma avaliação sistemática com o objetivo de avaliar a efetividade de um sistema, criou a necessidade de se trabalhar com indicadores de desempenho, ferramentas adotadas com sucesso pela indústria e pelo sistema bancário. Entretanto, no contexto da saúde, esses recursos continuam sendo um desafio real. Na assistência à saúde, as falhas podem ser direcionadas a erros humanos que poderiam impor implicações pessoais e de confiabilidade. Portanto, a pesquisa que objetiva melhorar os processos de avaliação institucional é necessária para mudar a atual cultura. Este estudo foi realizado a fim de criar um modelo sistêmico de avaliação de performance de eventos de saúde, por meio da monitorização de indicadores de processos. O evento escolhido foi à dor e os indicadores desenvolvidos para iniciar a construção do modelo foram relacionados à atenção à dor aguda no perioperatório. Um estudopiloto foi realizado para avaliar variáveis relacionadas com o desempenho de processos e da Instituição. Os resultados indicam que o modelo testado propicia grande potencial para avaliar Sistemas de Saúde e estabelecer boas práticas. It is well known that people behave according to the way they are being evaluated. In the healthcare environment, the search for a systematic evaluation with the purpose to assess the effectiveness of a system created the need to work on performance indicators, successfully adopted tools by the industries and banking systems. However, in the health context these resources remain a real challenge. In the former they are being used to control and even admonish the staff, since individuals are under the influence of different managing styles. In healthcare, the flaws can be addressed to human errors which might impose personal and reliability implications. Therefore, the research aiming to improve the institutional evaluation processes is required to change the present culture. This study was carried out to create a systemic model of performance evaluation of health events, through the processes indicators monitoring. The chosen event was the Pain and the indicators developed to start the model construction were related to the atention to the acute pain in the perioperatory period. A pilot study was carried out to evaluate the variables connected to the processes and institution performance. The results indicate that the model tested offers great potential to evaluate health systems and establish good practices.

Background: The fairness of quality assessment methods is under debate. Quality indicators incorporating the longitudinal nature of care have been advocated but their usefulness in comparison to more commonly used cross-sectional measures is not clear. Aims: To compare cross-sectional and sequential quality indicators for risk factor management in patients with type 2 diabetes. Methods: The study population consisted of 1912 patients who received diabetes care from one of 40 general practitioners in The Netherlands. Clinical outcomes, prescriptions, and demographic data were collected from electronic medical records. Quality was assessed for glycemic, blood pressure, and lipid control using indicators focusing on clinical outcomes, and treatment in relation to outcomes. Indicator results were compared with a reference method based on national guidelines for general practice. Results: According to the reference method, 76% of the patients received management as recommended for glycemic control, 58% for blood pressure control, and 67% for lipid control. Cross-sectional indicators looking at patients adequately controlled gave estimates that were 10-25% lower than the reference method. Estimates from indicators focusing on uncontrolled patients receiving treatment were 10-40% higher than the reference method for blood pressure and glycemic control. Sequential indicators focusing on improvement in clinical outcomes or assessing treatment modifications in response to poor control gave results closer to the reference method. Conclusions: Sequential indicators are valuable for estimating quality of risk factor management in patients with diabetes. Such indicators may provide a more accurate and fair judgment than currently used cross-sectional indicators.

The economic and clinical burden of ventilator-associated pneumonia (VAP) is uncontested. In many hospitals, VAP surveillance is conducted to identify outbreaks and to monitor infection rates. Here, we discuss the concept of benchmarking in health care as modeled on industry, and we contribute personal arguments against considering the VAP rate as a potential candidate for benchmarking or for monitoring the quality of patient care. Accurate benchmarking of VAP rates currently seems to be unfeasible, because the patient case mix is often too diverse and complicated to be adjusted for, and diagnostic criteria and surveillance protocols vary. Thus, the risk of drawing inaccurate comparisons is high. In contrast, some risk factors for VAP are modifiable and can be monitored and used as quality indicators. Process-oriented surveillance permits bypass of case-mix and diagnostic constraints. A well-defined interhospital surveillance system is necessary to prove that interventions on procedures do really lead to a reduction of VAP rates.

Background Cancer multidisciplinary teams (MDTs) are established in many countries but little is known about how well they function. A core activity is regular MDT meetings (MDMs) where treatment recommendations are agreed. A mixed methods descriptive study was conducted to develop and test quality criteria for observational assessment of MDM performance calibrated against consensus from over 2000 MDT members about the “characteristics of an effective MDT”. Methods Eighteen of the 86 ‘Characteristics of Effective MDTs’ were considered relevant and feasible to observe. They collated to 15 aspects of MDT working covering four domains: the team (e.g. attendance, chairing, teamworking); infrastructure for meetings (venue, equipment); meeting organisation and logistics; and patient-centred clinical decision-making (patient-centredness, clarity of recommendations). Criteria for rating each characteristic from ‘very poor’ to ‘very good’ were derived from literature review, observing MDMs and expert input. Criteria were applied to 10 bowel cancer MDTs to assess acceptability and measure variation between and within teams. Feasibility and inter-rater reliability was assessed by comparing three observers. Results Observational assessment was acceptable to teams and feasible to implement. Total scores from 29 to 50 (out of 58) highlighted wide diversity in quality between teams. Eight teams were rated either ‘very good/good’ or ‘very poor/poor’ for at least three domains demonstrating some internal consistency. ‘Very good’ ratings were most likely for attendance and administrative preparation, and least likely for patient-centredness of decision-making and prioritisation of complex cases. All except two characteristics had intra-class correlations of ≥0.50. Conclusions This observational tool (MDT-OARS) may contribute to the assessment of MDT performance. Further testing to confirm validity and reliability is required.

BackgroundHigh hospital volume is associated with better outcomes after oesophagectomy and gastrectomy. In the Netherlands, a minimal volume standard of 10 oesophagectomies per year was introduced in 2006. For gastrectomy, no minimal volume standard was set. Aims of this study were to describe changes in hospital volumes, mortality and survival and to explore if high hospital volume is associated with better outcomes after oesophagectomy and gastrectomy in the Netherlands.MethodsFrom 1989 to 2009, 24,246 patients underwent oesophagectomy (N=10,025) or gastrectomy (N=14,221) in the Netherlands. Annual hospital volumes were defined as very low (1–5), low (6–10), medium (11–20), and high (⩾21). Volume–outcome analyses were performed using Cox regression, adjusting for year of diagnosis, case-mix and the use of multi-modality treatment.ResultsFrom 1989 to 2009, the percentage of patients treated in high-volume hospitals increased for oesophagectomy (from 7% to 64%), but decreased for gastrectomy (from 8% to 5%). Six-month mortality (from 15% to 7%) and 3-year survival (from 41% to 52%) improved after oesophagectomy, and to a lesser extent after gastrectomy (6-month mortality: 15%-10%, three-year survival: 55–58%). High hospital volume was associated with lower 6-month mortality (hazard ratio (HR) 0.48, P