Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil

Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

Evaluation Index System of Surgical Tourism Service Organizations in China: An Empirical Research

Background: Healthcare tourism is an emerging economy with the most potential in China's health industry before the COVID-19 pandemic. Surgical medical health tourism accounts for a large part of medical tourism services in China, which has higher requirements for quality and safety. By contrast, measurement tools and theoretical research are insufficient in China. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the original Donabedian’s quality model to evaluate surgical tourism services’ quality.Methods: Literature review and focus group interview were used to generate indicators for surgical tourism services’ quality. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through analytic hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. Validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. Reliability of the questionnaire was assessed by a pretest distributed within an international medical department of a public hospital in China.Results: Based on the Donabedian’s quality theory, the novel evaluation system of surgical tourism service institutions with 3 dimensions, 9 first-level items and 39 second-level items was constructed. The three dimensions consist of structure (0.315), process (0.287), and outcome (0.398), with each dimension set several indicators and each indicator given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p<0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could obtain a rating of two stars.Conclusions: The established evaluation system identified three different dimensions of surgical tourism services’ quality which fit for practical healthcare improvement in safety and quality. It can reflect the access criterion of surgical tourism institutions, provide references on better choices of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services to international standards.

The Completeness and Accuracy of Hepatoma Coding for Medical Procedure Based on ICD-9 CM at Public Hospital in Padang

Background: Hepatoma or hepatocellular carcinoma (KHS) is a primary malignant tumor of the liver originating from hepatocytes and the 3rd cause of death from cancer in the world. The history of a hepatoma patient can be seen based on the patient's medical record. The filling of medical record is done by doctors, nurses and medical record personel. However, in medical record filling, incompleteness is often found and cause inaccurate information. Accuracy coding important for financial of hospital.Methods: Type of research is quantitative descriptive, which is to determine the completeness and accuracy of the medical records for hepatoma cases and procedure code using criteria for document quantitative analysis in a public hospital, Padang. The study design used a retrospective analytical approach. The variables in the study were completeness of discharge summary and accuracy of hepatoma procedure based on ICD-9 CM. The population in this study were inpatient medical record documents for Hepatoma cases at a public hospital, Padang from June to August 2019, which were 45 medical record documents (discharge summary form) of hepatoma inpatients.Results: From 45 hepatoma patient medical record documents, filling of item name, medical record number, date of admission, indication of the patient being treated, history, physical examination, diagnostic examination, procedures, medications given, medicines used at home, PPBS doctor's signature, DPJP doctor's hand is complete 100% . Highest incompleteness of filling was found at code ICD (47%) and address item (43%). From 45 discharge summary , accuracy procedure code at hepatome case shows 100 % accurate in ultrasonoggrafi abdomen and ultrasonografi thorax. While that EKG 98% accurate and 95 % rontgen thorax.Conclusions: In general, item data of discahrege summary for hepatoma medical record are completenes; highest incompleteness of filling was found at code ICD (47%) and address item (43%); Accuracy of code procedure more than 90% in each code procedure.

The Economic Effects on Acute Care Surgery in a New York City Public Hospital During the COVID Pandemic

Background Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the start of the COVID-19 pandemic, as well as their effect on the economy. Methods This is a retrospective analysis of patients who underwent cholecystectomies and appendectomies during March–May 2019 compared to the same time period in 2020 using Chi-square and t-tests. Results There were 345 patients who presented with appendicitis or cholecystitis to Elmhurst Hospital Center during the March–May 2019 and 2020 time period. There were three times as many total operations, or about 75%, in 2019 (261) compared to 2020 (84). There was a decrease in the number of admissions from 2019 to 2020 for both acute cholecystitis (149 vs 43, respectively) and acute appendicitis (112 vs 41, respectively). The largest decrease in the number of admissions in 2020 compared to 2019 was observed in April 2020 (98 vs 9, P < .01) followed by May [69 vs 20, P < .01], and March [94 vs 55, P < .01]. Corresponding to the decrease in operative patterns was a noticeable six-time reduction in revenue for the procedures in 2019 ($187,283) compared to 2020 ($30,415). Conclusion We observed almost a triple reduction in the number of cholecystitis and appendicitis procedures performed during the 2020 pandemic surge as compared to the 2019 pre-pandemic data. Elmhurst hospital also experienced four times the loss of revenue during the same time period.

Actions of a regulatory nurse in the management of surgical waiting lists

ABSTRACT Objectives: to describe the actions of the regulatory nurse in the management of waiting lines for elective surgeries in a public hospital. Methods: this is an experience report about the actions of the regulatory nurse in the management of waiting lines for elective surgeries. Results: the results of this initiative were: diminution in waiting times; elimination of discrepancies that led to access inequality; promotion of safer treatments; actions of the nurse as a manager, conducting and mediating situations between services; autonomy from the high management of the hospital with regard to the manager of waiting lists; and effective communication due to a constant feedback with the medical teams. Final Considerations: the management of the surgical waiting lists must be continuous and systematic, and it must be broader, to include teams that are not involved yet. This initiative can be replicated and improved in other health organizations.

Managerial Innovations and Organizational Resilience During the COVID-19 Crisis

Developing the resilience of hospitals in this period of crisis is no longer a choice but rather has become a matter of course for survival. The use of this concept to understand how organizations can overcome the current crisis seems relevant insofar as the research will first identify the human and organizational constraints that are a source of vulnerability for public hospitals and then understand the main practices undertaken by the university hospital to deal with the COVID-19 crisis in terms of the HR function, and finally see to what extent these practices can contribute to the resilience of the public hospital.