The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

Does adherence to a quality indicator regarding early weaning from invasive ventilation improve economic outcome? A single-centre retrospective study

ObjectivesTo measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.DesignRetrospective observational single-centre study, based on electronic medical and administrative records.SettingIntensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.ParticipantsRecords of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom 583 were eligible adults for further analysis. Patients’ weaning protocols were evaluated for daily adherence to quality standards until ICU discharge. Patients with <65% compliance were assigned to the low adherence group (LAG), patients with ≥65% to the high adherence group (HAG).Primary and secondary outcome measuresEconomic healthcare costs, clinical outcomes and patients’ characteristics.ResultsThe LAG consisted of 378 patients with a median negative economic results of −€3969, HAG of 205 (−€1030), respectively (p<0.001). Median duration of ventilation was 476 (248; 769) hours in the LAG and 389 (247; 608) hours in the HAG (p<0.001). Length of stay (LOS) in the LAG on ICU was 21 (12; 35) days and 16 (11; 25) days in the HAG (p<0.001). LOS in the hospital was 36 (22; 61) days in the LAG, and within the HAG, respectively, 26 (18; 48) days (p=0.001).ConclusionsHigh adherence to this single QI is associated with better clinical outcome and improved economic returns. Therefore, the results support the adherence to QI. However, the examined QI does not influence economic outcome as the decisive factor.

From drug-oriented curriculum to patient-oriented curriculum in Chile: Alumni satisfaction as a quality indicator for a pharmacy programme

Background: In 2005, a Health Care Reform in Chile established the role of pharmacists as contributors to achieving therapeutic goals. To fulfil the needs of the country in 2007 the pharmacy programme at Austral University of Chile started transiting from a drug-oriented to a patient-oriented curriculum. Objective: Monitoring this transition process using alumni satisfaction as a quality indicator. Methods: A questionnaire to assess alumni satisfaction with the pharmacy programme was designed and validated in its content and reliability. Subsequently, cross-sectional surveys over samples of graduates from both, drug-oriented and patient-oriented curriculum alumni were conducted. Satisfaction scores of both samples were statistically compared. Results: Cronbach´s alpha for all six dimensions of the final questionnaire was ≥ 0.70. The patient-oriented curriculum generated higher satisfaction scores (p < 0.001), noteworthy in dimensions ‘Design and organisation’, ‘Teachers’ and ‘Emotional bonding with the program/university’. In three out of 34 items the patient-oriented curriculum was less satisfactory than the drug-oriented one. Conclusions: Alumni satisfaction assessment is a useful source of feedback for quality assurance and continuous improvement of programmes. Considering this indicator, the transition of the pharmacy programme at Austral University of Chile to a patient-oriented curriculum was essentially successful.

URBAN RAIL TRANSIT PASSENGER SERVICE QUALITY EVALUATION BASED ON THE KANO–ENTROPY–TOPSIS MODEL: THE CHINA CASE

In order to evaluate the URTPSQ (Urban Rail Transit Passenger Service Quality) comprehensively, find the shortage of URTPSQ, find out the difference between the actual service situation and the passenger’s expectation and demand,and provide passengers with better travel services, a passenger-oriented KANO–Entropy–TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) method is proposed and applied in this paper. Firstly, a KANO model is applied to select the service quality indicators from the 24 URTPSQ evaluation sub-indicators, according to the selection results, the KANO service quality indicators of URTPSQ are constructed. Then the sensitivity of the KANO service quality indicators based on the KANO model are calculated and ranked, the PS (Passenger Satisfaction) of each KANO service quality indicator by using the Entropy–TOPSIS method is calculated and ranked. Based on the difference between the sensitivity degree rank and the satisfaction degree rank of each KANO service quality indicator, determine the service quality KANO indicators of the URTPSQ that need to be improved significantly. A case study is conducted by taking the Chengdu subway system in China as a background. The results show that the Chengdu subway operation enterprises should pay attention to the must-be demand first, then the one-dimensional demand, finally the attractive demand. The three indicators, including transfer on the same floor in the station, service quality of staffs of urban rail transit enterprises,and cleanness in the station and passenger coach, need to be improved urgently. For the managers and operators of urban rail transit system, the passengers’ must-be demand should be satisfied first if the KANO model is applied to evaluate the service. The indicators with highest sensitivity degree and lowest TOPSIS value should be improved based on the KANO–Entropy–TOPSIS model.

Review of the Kriging Technique Applications to Groundwater Quality

Kriging, a geostatistical technique, has been used for many years to evaluate groundwater quality. The best estimation data for unsampled points were determined by using this method depending on measured variables for an area. The groundwater contaminants assessment worldwide was found through many kriging methods. The present paper shows a review of the most known methods of kriging that were used in estimating and mapping the groundwater quality. Indicator kriging, simple kriging, cokriging, ordinary kriging, disjunctive kriging and lognormal kriging are the most used techniques. In addition, the concept of the disjunctive kriging method was explained in this work to be easily understood.

Nursing Home Satisfaction Surveys: Differences by Race, Age, and Gender

Nursing home satisfaction information has gained substantial traction as a quality indicator representing the consumers perspective. However, very little research has examined differences in satisfaction related to race, age and gender. As a quality metric, satisfaction measures are variously used for quality improvement, benchmarking, public reporting, and for adjustment to payments. As such, valid comparisons among facilities are important. To our knowledge, no adjustment to satisfaction scores are currently used for nursing homes. However, in many other settings this is a common practice. In this research, nursing home resident, family, and discharge satisfaction scores were examined from &gt;4,000 participants. The data were collected in 2020 and come from 420 facilities. Satisfaction information came from the CoreQ surveys, which include 23 individual questions four of which can be combined to produce an overall satisfaction score. These CoreQ nursing home surveys are endorsed by NQF. Generally lower overall satisfaction scores were found for family members compared to current residents or discharged residents. Minorities (Black, Asian, Hispanic) had lower overall satisfaction scores compared to whites; however, the differences were not significant at conventional levels. Participants of the lowest age (&lt;65 years) were significantly (p=&lt;.05) less satisfied than older participants (&gt;75 years) and males were significantly (p=&lt;.05) less satisfied than females. The findings indicate that some case-mix adjustment may be applicable for nursing home satisfaction scores.