تحلیل شاخص‌های عملکردی بخش اورژانس بیمارستان‌های آموزشی دانشگاه علوم پزشکی کرمانشاه قبل و بعد از اجرای طرح تحول نظام سلامت
محورهای موضوعی : -مدارک پزشکی
مژگان چشمه کبودی
1
,
طیبه احمدی
2
,
روژیا نیک بزم
3
,
روح اله محمدی
4
,
شیرین زردویی گل عنبری
5
,
علی محمدی
6
1 - کارشناس ارشد، مرکز ثبت بیماری‌ها و پیامدهای سلامت، دانشگاه علوم پزشکی ارومیه، ارومیه، ایران
2 - دانشجوی کارشناسی ارشد گروه فناوری اطلاعات سلامت، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
3 - دانشجوی دکتری، گروه مهندسی کامپیوتر و فناوری اطلاعات، دانشکده برق و کامپیوتر، دانشگاه رازی، کرمانشاه، ایران
4 - کارشناس ارشد، بخش مراقبت‌های ویژه، بیمارستان امام رضا(ع)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران
5 - کارشناس ارشد، بخش آمار و فناوری اطلاعات سلامت، معاونت درمان، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران
6 - استادیار، گروه فناوری اطلاعات سلامت، دانشکده پیراپزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران
کلید واژه: طرح تحول نظام سلامت, شاخص عملکردی, بیمارستان, اورژانس,
چکیده مقاله :
مقدمه: تحلیل شاخص‌های عملکردی اورژانس معیاری برای درک عملکرد ارائه خدمات این بخش هست. لذا هدف این مطالعه تحلیل شاخص‌های عملکردی بخش اورژانس بیمارستان‌های آموزشی شهر کرمانشاه بود. روش پژوهش: پژوهش توصیفی مقایسه‌ای بود و برای هفت بیمارستان آموزشی شهر کرمانشاه در سال 1397 انجام شد. داده‌ها با استفاده از چک‌لیست که بر اساس شاخص‌های عملکردی بخش اورژانس تهیه و روایی آن تأیید شد، جمع‌آوری شدند. داده‌ها از واحد آمار و فناوری اطلاعات معاونت درمان جمع‌آوری، با نرم‌افزار SPSS20 تحلیل و در قالب جداول توصیفی تحلیلی ارائه شدند. یافته‌ها: نتایج برای نه شاخص عملکردی اورژانس نشان داد که تعداد مراجعین به تمام بیمارستان‌ها افزایش یافته است. درصد بیماران تعیین تکلیف شده ظرف مدت شش ساعت در پنج بیمارستان و خارج شده ظرف مدت 12 ساعت در چهار بیمارستان افزایش، ترک اورژانس با رضایت شخصی در چهار بیمارستان کاهش و احیاء ناموفق در شش بیمارستان افزایش یافته است. میانگین زمان تریاژ سطح چهار در بیش‌تر مراکز افزایش یافته بود ولی اختلاف زمان تریاژ سطح پنج بیش‌تر بود و کم‌ترین اختلاف در تریاژ سطح یک بود. نتیجه‌گیری: اجرای طرح تحول نظام سلامت در مراکز عمومی و تخصصی تأثیر متفاوتی در شاخص‌های عملکردی اورژانس داشت. افزایش متخصص و متخصص طب اورژانس در مراکز عمومی و روان‌پزشکی تأثیری نداشته ولی در مراکز تخصصی باعث بهبود عملکرد شده است. هم‌چنین ایجاد سامانه الکترونیکی جهت ثبت داده‌ها، تحلیل بهتری از عملکرد میانگین تریاژ خواهد داشت.
Introduction: Analysis of the Emergency performance Indices is a criterion for understanding services that performed in this department. The aim of this study was to analyze the performance Indices of the Emergency Department of educational hospitals affiliated with Kermanshah University of Medical Sciences. Methods: The descriptive-comparative study was conducted in seven educational hospitals in the Kermanshah University of Medical Sciences in 2018. The data were collected from information technology and statistic unit from deputy of clinical affairs, using a checklist based on the performance Indices of the emergency department and its validity was determined. Data were analyzed by SPSS20 software and presented in descriptive-analytic tables. Results: Results showed that the number of patients encounter to all hospitals increased. Percentage of patients who were decided upon within 6 hours in five hospitals, left the emergency department within 12 hours in four hospitals and discharged against medical advice have decreased. Unsuccessful resuscitation increased in six hospitals. The average duration of triage in level four was increased in most centers, but difference in the duration of triage in level five was greater. And so, lowest difference in duration of triage was in level one. Conclusion: Implementation of Health Sector Evolution Plan in general and specialized centers had different effect on emergency performance Indices. The increase in specialist and emergency medicine specialists in psychiatric and general centers has not been effective, but has improved performance in specialized centers. Developing an electronic system for recording data will also provide a better analysis of the performances.
1- Care Quality Commission. 2016 Emergency Department Survey Statistical release [cited 2019 20th of May]. Available from: http://allcatsrgrey.org.uk/wp/wpfb-file/20171017_ed16_statistical_release-pdf/.
2- Smeltzer CH, Curtis L. An analysis of emergency department time: laying the groundwork for efficiency standards. QRB Quality review bulletin, 1987; 13(7): 240-2
3- Pascasie K, Mtshali NG. A descriptive analysis of emergency department overcrowding in a selected hospital in Kigali, Rwanda. African Journal of Emergency Medicine, 2014; 4(4): 178-83
4- Phipps L. Stress among doctors and nurses in the emergency department of a general hospital. CMAJ: Canadian Medical Association Journal, 1988; 139(5): 375
5- Majidi A, Mahmoodi S, Adineh VH. An Epidemiologic Study of Emergency Department Visits before and after Executing Health Sector Evolution Plan; a Brief Report. Iranian Journal of Emergency Medicine, 2017; 4(3): 130-4
6- Hashemi B, Baratloo A, Rahmati F, Forouzanfar MM, Motamedi M, Safari S. Emergency department performance indexes before and after establishment of emergency medicine. Emergency, 2013; 1(1): 20
7- Green NA, Durani Y, Brecher D, DePiero A, Loiselle J, Attia M. Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage. Pediatric emergency care, 2012; 28(8): 753-7
8- Care ADoHaA. Emergency triage education / Australian Government Department of Health and Ageing. book; 2007
9- MOUSAVI RSA, DORAHAKI M, EBRAHIMI S. Comparison of performance indices of emergency departments before and after implementation of specialist residency program under the health sector evolution plan in the hospitals of Bushehr university of medical sciences, Iran. 2017
10- Mitra Sasani, Ghahraman Mahmoodi. Evaluating the Performance and Quality of Services in the Emergency Departments After Implementation of the Health Reform Plan From the Perspective of Staff of Selected Hospitals of Tehran University of Medical Sciences. Hakim Health Systems Research Journal, 2019; 21(4): 282-9
11- Emamgholipour S, arJaafaripooyan E, Mohammadshahi M, Yazani EM. The effect of Health Sector Evolution Plan on the performance indices of emergency department in hospitals of Tehran & Iran universities of medical sciences: interrupted time series analysis. Iranian Journal of Emergency Medicine; 2016: 5:9
12- Rahi F, Ale-Yasin A, Safdari S, Yaghoobi M, editors. Audit time off Patient before and after the intervention in Emergency Medicine Department of Amin Hospital, Isfahan in 2011. The First International & 4th National Congress on health Education & Promotion; 2011.
13- YOUSEFZADEH CS, MOHTASHAM AZ, Haghdoost Z, Mohseni M, Asadi P, KAZEMNEZHAD LE. Patients discharged before and after presence of medical emergency specialists; 2014
14- Jafari SM, Seyedin S, Aghlmand S, Seyed M. Performance indicators of emergency departments following the implementation of specialist residency program under the health sector evolution plan in public hospitals of West Azerbaijan province. Journal of Health Administration (JHA), 2017; 20(67)
15- Kariman H, Fattahi F, Rezaee M, Amini A. Effects of Executing Health Sector Evolution Plan on Emergency Department Performance Indices: A 5-Year Survey. Crescent Journal of Medical and Biological Sciences, 2018; 5(4): 371-6
_||_
1- Care Quality Commission. 2016 Emergency Department Survey Statistical release [cited 2019 20th of May]. Available from: http://allcatsrgrey.org.uk/wp/wpfb-file/20171017_ed16_statistical_release-pdf/.
2- Smeltzer CH, Curtis L. An analysis of emergency department time: laying the groundwork for efficiency standards. QRB Quality review bulletin, 1987; 13(7): 240-2
3- Pascasie K, Mtshali NG. A descriptive analysis of emergency department overcrowding in a selected hospital in Kigali, Rwanda. African Journal of Emergency Medicine, 2014; 4(4): 178-83
4- Phipps L. Stress among doctors and nurses in the emergency department of a general hospital. CMAJ: Canadian Medical Association Journal, 1988; 139(5): 375
5- Majidi A, Mahmoodi S, Adineh VH. An Epidemiologic Study of Emergency Department Visits before and after Executing Health Sector Evolution Plan; a Brief Report. Iranian Journal of Emergency Medicine, 2017; 4(3): 130-4
6- Hashemi B, Baratloo A, Rahmati F, Forouzanfar MM, Motamedi M, Safari S. Emergency department performance indexes before and after establishment of emergency medicine. Emergency, 2013; 1(1): 20
7- Green NA, Durani Y, Brecher D, DePiero A, Loiselle J, Attia M. Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage. Pediatric emergency care, 2012; 28(8): 753-7
8- Care ADoHaA. Emergency triage education / Australian Government Department of Health and Ageing. book; 2007
9- MOUSAVI RSA, DORAHAKI M, EBRAHIMI S. Comparison of performance indices of emergency departments before and after implementation of specialist residency program under the health sector evolution plan in the hospitals of Bushehr university of medical sciences, Iran. 2017
10- Mitra Sasani, Ghahraman Mahmoodi. Evaluating the Performance and Quality of Services in the Emergency Departments After Implementation of the Health Reform Plan From the Perspective of Staff of Selected Hospitals of Tehran University of Medical Sciences. Hakim Health Systems Research Journal, 2019; 21(4): 282-9
11- Emamgholipour S, arJaafaripooyan E, Mohammadshahi M, Yazani EM. The effect of Health Sector Evolution Plan on the performance indices of emergency department in hospitals of Tehran & Iran universities of medical sciences: interrupted time series analysis. Iranian Journal of Emergency Medicine; 2016: 5:9
12- Rahi F, Ale-Yasin A, Safdari S, Yaghoobi M, editors. Audit time off Patient before and after the intervention in Emergency Medicine Department of Amin Hospital, Isfahan in 2011. The First International & 4th National Congress on health Education & Promotion; 2011.
13- YOUSEFZADEH CS, MOHTASHAM AZ, Haghdoost Z, Mohseni M, Asadi P, KAZEMNEZHAD LE. Patients discharged before and after presence of medical emergency specialists; 2014
14- Jafari SM, Seyedin S, Aghlmand S, Seyed M. Performance indicators of emergency departments following the implementation of specialist residency program under the health sector evolution plan in public hospitals of West Azerbaijan province. Journal of Health Administration (JHA), 2017; 20(67)
15- Kariman H, Fattahi F, Rezaee M, Amini A. Effects of Executing Health Sector Evolution Plan on Emergency Department Performance Indices: A 5-Year Survey. Crescent Journal of Medical and Biological Sciences, 2018; 5(4): 371-6