بررسی تأثیر بازخورد بر کاهش اقامت غیرضروری بیماران در بخش اورژانس بیمارستان شهید بهشتی کاشان
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانی
احسان مقدسی
1
,
سیمین طهماسبی
2
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1 - كارشناسي ارشد مديريت خدمات بهداشتي درماني، واحد شهرکرد، دانشگاه آزاد اسلامي، شهركرد، ايران
2 - استاديار گروه پرستاري، واحد شهرکرد، دانشگاه آزاد اسلامي، شهركرد، ايران
کلید واژه: اورژانس, اقامت غير مقتضي, بازخورد, بیمارستان, بیمار,
چکیده مقاله :
مقدمه: اقامت یا پذیرش غیرضروری یکی از چالش‌های نظام سلامت است که منجر به هدررفت منابع و کاهش کارایی بیمارستان‌ها می‌شود. هدف این پژوهش، بررسی تأثیر بازخورد بر کاهش اقامت غیرضروری بیماران در بخش اورژانس بیمارستان شهید بهشتی کاشان است.
مواد و روش‌ها: پژوهش حاضر به‌صورت نیمه‌تجربی در بیمارستان شهید بهشتی کاشان در سال‌های 1399-1400 انجام شد. تمامی بیمارانی که در سه ماهه اردیبهشت، خرداد و تیر، بیش از 24 ساعت در بخش اورژانس این بیمارستان بستری شده بودند، به‌صورت سرشماری در مطالعه گنجانده شدند. این بیماران شامل 320 نفر در اردیبهشت، 244 نفر در خرداد و 319 نفر در تیرماه بودند. بیماران براساس معیارهای ورود و پروتکل ارزیابی اقامت (AEP) انتخاب شدند. تحلیل داده‌ها با استفاده از آزمون مقایسه نسبت‌ها، ضریب همبستگی و آزمون کای‌دو (Chi-square) انجام گرفت(p<0.05) .
یافته‌ها: نتایج نشان داد متغیرهای جنسیت، وضعیت تأهل، نوع بستری، روز بستری، هزینه، نوع پذیرش و نحوه ارجاع تأثیر معناداری بر اقامت مقتضی یا غیرضروری نداشتند (05/0<p).در اردیبهشت، 31/25 درصد از اقامت‌ها غیر مقتضی بود پس ازبازخورد، این میزان در خرداد به 25/4درصد کاهش یافت (کاهش 5/85%). ادامه بازخورد در تیرماه، میزان اقامت غیر مقتضی را به 17/55درصد رساند (کاهش 7.85% نسبت به خرداد و کاهش کلی 13.7% نسبت به اردیبهشت)). تنها کاهش مربوط به عوامل بیمارستانی (در کنترل پژوهشگر) از نظر آماری معنادار بود، در حالی که تغییرات در سایر عوامل مانند پزشک، بیمار، خانواده، محیط و جامعه معنادار نبودند.
نتیجه گیری: بازخورد مستمر، منجر به کاهش معنادار اقامت غیرضروری ناشی از عوامل درون‌سازمانی شد. با این حال، مداخلات بیشتری برای اثرگذاری بر سایر عوامل خارج از کنترل بیمارستان ضروری است.
Background Inappropriate admission or prolonged hospital stay is a challenge that leads to waste of healthcare resources and decreased hospital efficiency. This study aimed to evaluate the impact of feedback on reducing inappropriate stays in the emergency department of Shahid Beheshti Hospital in Kashan
Materials and Methods: This quasi-experimental study was conducted at Shahid Beheshti Hospital in Kashan during 2020–2021. All patients who stayed in the emergency department for more than 24 hours during the months of Ordibehesht, Khordad, and Tir were included through a census method (320 in Ordibehesht, 244 in Khordad, and 319 in Tir). Patients were selected based on the Admission Evaluation Protocol (AEP) and inclusion criteria. Data were analyzed using proportion comparison tests, correlation coefficients, and the Chi-square test (p<0.05)
Findings: The results showed that gender, marital status, type and day of hospitalization, costs, type of admission, and referral method had no statistically significant effect on appropriate or inappropriate hospitalization (p>0.05). In Ordibehesht, 31.25% of hospitalizations were inappropriate. After providing feedback, this decreased to 25.4% in Khordad (a 5.85% reduction). Continued feedback in Tir further reduced the rate to 17.55% (a 7.85% decrease from Khordad and 13.7% overall reduction from Ordibehesht). The hospital-related factor, which was under the researchers' control, showed a statistically significant reduction, while changes in physician, patient/family, environment, and community-related factors were not significant.
Conclusion: Continuous feedback significantly reduced inappropriate stays related to hospital factors. However, addressing other external factors requires additional interventions.
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