Hospital Benchmarking Research Articles

Systematic review and meta-analysis of workload among medical records coders in China

HighlightsThis systematic review and meta-analysis uncovered that in China, there’s a shortage of medical records coding staff, coupled with heavy coding workloads.The insights gleaned from analyzing the allocation of medical records to full-time coders in China offer valuable guidance and benchmarks for hospitals in allocating these tasks.Ensuring accurate coding is pivotal for reliable data collection and the effective implementation of Diagnosis-Related Groups (DRGs) and Diagnosis Intervention Package (DIP) systems nationwide.

A time-motion study on impact of spatial separation for empiric airborne precautions in emergency department length of stay.

To evaluate the impact of spatial separation on patient flow in the emergency department. This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented. The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381-698) versus 390 min (285-595) in critical zone and 477 min (312-739) versus 393 min (264-595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h. The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay. The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery. STROBE guidelines. None. The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113-11727). The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).

Opioid Administration Practice Patterns in Patients With Acute Respiratory Failure Who Undergo Invasive Mechanical Ventilation.

The opioid crisis is impacting people across the country and deserves attention to be able to curb the rise in opioid-related deaths. To evaluate practice patterns in opioid infusion administration and dosing for patients with acute respiratory failure receiving invasive mechanical ventilation. Retrospective cohort study. Patients from 21 hospitals in Kaiser Permanente Northern California and 96 hospitals in Philips electronic ICU Research Institute. We assessed whether patients received opioid infusion and the dose of said opioid infusion. We identified patients with a diagnosis of acute respiratory failure who were initiated on invasive mechanical ventilation. From each patient, we determined if opioid infusions were administered and, among those who received an opioid infusion, the median daily dose of fentanyl infusion. We used hierarchical regression models to quantify variation in opioid infusion use and the median daily dose of fentanyl equivalents across hospitals. We included 13,140 patients in the KPNC cohort and 52,033 patients in the eRI cohort. A total of 7,023 (53.4%) and 16,311 (31.1%) patients received an opioid infusion in the first 21 days of mechanical ventilation in the KPNC and eRI cohorts, respectively. After accounting for patient- and hospital-level fixed effects, the hospital that a patient was admitted to explained 7% (95% CI, 3-11%) and 39% (95% CI, 28-49%) of the variation in opioid infusion use in the KPNC and eRI cohorts, respectively. Among patients who received an opioid infusion, the median daily fentanyl equivalent dose was 692 µg (interquartile range [IQR], 129-1341 µg) in the KPNC cohort and 200 µg (IQR, 0-1050 µg) in the eRI cohort. Hospital explained 4% (95% CI, 1-7%) and 20% (95% CI, 15-26%) of the variation in median daily fentanyl equivalent dose in the KPNC and eRI cohorts, respectively. In the context of efforts to limit healthcare-associated opioid exposure, our findings highlight the considerable opioid exposure that accompanies mechanical ventilation and suggest potential under and over-treatment with analgesia. Our results facilitate benchmarking of hospitals' analgesia practices against risk-adjusted averages and can be used to inform usual care control arms of analgesia and sedation clinical trials.

Development and Validation of the Hospital Medicine Safety Sepsis Initiative Mortality Model

When comparing outcomes after sepsis, it is essential to account for patient case mix to make fair comparisons. We developed a model to assess risk-adjusted 30-day mortality in the Michigan Hospital Medicine Safety sepsis initiative (HMS-Sepsis). Can HMS-Sepsis registry data adequately predict risk of 30-day mortality? Do performance assessments using adjusted vsunadjusted data differ? Retrospective cohort of community-onset sepsis hospitalizations in the HMS-Sepsis registry (April 2022-September 2023), with split derivation (70%) and validation (30%) cohorts. We fit a risk-adjustment model (HMS-Sepsis mortality model) incorporating acute physiologic, demographic, and baseline health data and assessed model performance using concordance (C) statistics, Brier scores, and comparisons of predicted vsobserved mortality by deciles of risk. We compared hospital performance (first quintile, middle quintiles, fifth quintile) using observed vsadjusted mortality to understand the extent to which risk adjustment impacted hospital performance assessment. Among 17,514 hospitalizations from 66 hospitals during the study period, 12,260 hospitalizations (70%) were used for model derivation and 5,254 hospitalizations (30%) were used for model validation. Thirty-day mortality for the total cohort was 19.4%. The final model included 13 physiologic variables, two physiologic interactions, and 16 demographic and chronic health variables. The most significant variables were age, metastatic solid tumor, temperature, altered mental status, and platelet count. The model C statistic was 0.82 for the derivation cohort, 0.81 for the validation cohort, and≥ 0.78 for all subgroups assessed. Overall calibration error was 0.0%, and mean calibration error across deciles of risk was 1.5%. Standardized mortality ratios yielded different assessments than observed mortality for 33.9%of hospitals. The HMS-Sepsis mortality model showed strong discrimination and adequate calibration and reclassified one-third of hospitals to a different performance category from unadjusted mortality. Based on its strong performance, the HMS-Sepsis mortality model may aid in fair hospital benchmarking, assessment of temporal changes, and observational causal inference analysis.

Healthcare-associated infections and antimicrobial use in acute care hospitals: a point prevalence survey in Lombardy, Italy, in 2022

BackgroundHealthcare-Associated Infections (HAIs) are a global public health issue, representing a significant burden of disease that leads to prolonged hospital stays, inappropriate use of antimicrobial drugs, intricately linked to the development of resistant microorganisms, and higher costs for healthcare systems. The study aimed to measure the prevalence of HAIs, the use of antimicrobials, and assess healthcare- and patient-related risk factors, to help identify key intervention points for effectively reducing the burden of HAIs.MethodsA total of 28 acute care hospitals in the Lombardy region, Northern Italy, participated in the third European Point Prevalence Survey (PPS-3) coordinated by ECDC for the surveillance of HAIs in acute care hospitals (Protocol 6.0).ResultsHAIs were detected in 1,259 (10.1%, 95% CI 9.6–10.7%) out of 12,412 enrolled patients. 1,385 HAIs were reported (1.1 HAIs per patient on average). The most common types of HAIs were bloodstream infections (262 cases, 18.9%), urinary tract infections (237, 17.1%), SARS-CoV-2 infections (236, 17.0%), pneumonia and lower respiratory tract infections (231, 16.7%), and surgical site infections (152, 11.0%). Excluding SARS-CoV-2 infections, the overall prevalence of HAIs was 8.4% (95% CI 7.9–8.9%). HAIs were significantly more frequent in patients hospitalized in smaller hospitals and in intensive care units (ICUs), among males, advanced age, severe clinical condition and in patients using invasive medical devices. Overall, 5,225 patients (42.1%, 95% CI 41.3–43.0%) received systemic antimicrobial therapy. According to the WHO’s AWaRe classification, the Access group accounted for 32.7% of total antibiotic consumption, while Watch and Reserve classes accounted for 57.0% and 5.9% respectively. From a microbiological perspective, investigations were conducted on only 64% of the HAIs, showing, however, a significant pattern of antibiotic resistance.ConclusionsThe PPS-3 in Lombardy, involving data collection on HAIs and antimicrobial use in acute care hospitals, highlights the crucial need for a structured framework serving both as a valuable benchmark for individual hospitals and as a foundation to effectively channel interventions to the most critical areas, prioritizing future regional health policies to reduce the burden of HAIs.

Calculation and Feedback of Risk-Adjusted Antibiotic Days as a Process Measure in a Statewide Trauma Collaborative.

Optimization of antibiotic stewardship requires determining appropriate antibiotic treatment and duration of use. Our current method of identifying infectious complications alone does not attempt to measure the resources actually utilized to treat infections in patients. We sought to develop a method accounting for treatment of infections and length of antibiotic administration to allow benchmarking of trauma hospitals with regard to days of antibiotic use. Using trauma quality collaborative data from 35 American College of Surgeons (ACS)-verified level I and level II trauma centers between November 1, 2020, and January 31, 2023, a two-part model was created to account for (1) the odds of any antibiotic use, using logistic regression; and (2) the duration of usage, using negative binomial distribution. We adjusted for injury severity, presence/type of infection (eg, ventilator-acquired pneumonia), infectious complications, and comorbid conditions. We performed observed-to-expected adjustments to calculate each center's risk-adjusted antibiotic days, bootstrapped Observed/Expected (O/E) ratios to create confidence intervals, and flagged potential high or low outliers as hospitals whose confidence intervals lay above or below the overall mean. The mean antibiotic treatment days was 1.98°days with a total of 88,403 treatment days. A wide variation existed in risk-adjusted antibiotic treatment days (.76°days to 2.69°days). Several hospitals were identified as low (9 centers) or high (6 centers) outliers. There exists a wide variation in the duration of risk-adjusted antibiotic use amongst trauma centers. Further study is needed to address the underlying cause of variation and for improved antibiotic stewardship.

The National Cancer Database Conforms to the Standardized Framework for Registry and Data Quality

BackgroundStandardization of procedures for data abstraction by cancer registries is fundamental for cancer surveillance, clinical and policy decision-making, hospital benchmarking, and research efforts. The objective of the current study was to evaluate adherence to the four components (completeness, comparability, timeliness, and validity) defined by Bray and Parkin that determine registries’ ability to carry out these activities to the hospital-based National Cancer Database (NCDB).MethodsTbis study used data from U.S. Cancer Statistics, the official federal cancer statistics and joint effort between the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), which includes data from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) to evaluate NCDB completeness between 2016 and 2020. The study evaluated comparability of case identification and coding procedures. It used Commission on Cancer (CoC) standards from 2022 to assess timeliness and validity.ResultsCompleteness was demonstrated with a total of 6,828,507 cases identified within the NCDB, representing 73.7% of all cancer cases nationwide. Comparability was followed using standardized and international guidelines on coding and classification procedures. For timeliness, hospital compliance with timely data submission was 92.7%. Validity criteria for re-abstracting, recording, and reliability procedures across hospitals demonstrated 94.2% compliance. Additionally, data validity was shown by a 99.1% compliance with histologic verification standards, a 93.6% assessment of pathologic synoptic reporting, and a 99.1% internal consistency of staff credentials.ConclusionThe NCDB is characterized by a high level of case completeness and comparability with uniform standards for data collection, and by hospitals with high compliance, timely data submission, and high rates of compliance with validity standards for registry and data quality evaluation.

Enhancing hospital benchmarking: A multidimensional approach to quality assessment in Portugal

The healthcare policy reforms implemented in Portugal in recent years significantly impacted the quality of health care provided to Portuguese citizens. Since public hospitals play a pivotal role as secondary care providers within the National Health Service (NHS), it is essential to assess their quality. However, a generalized assessment of this multidimensional concept is insufficient to differentiate hospitals across different quality dimensions, limiting the efficiency of benchmarking processes. The conjoint use of the Electre Tri-nC method with the Multiple Criteria Hierarchy Process (MCHP) allowed us to assess quality in Portuguese public hospitals by encompassing dimension-based analysis and a holistic perspective. Electre Tri-nC is a multiple criteria sorting method that categorizes each alternative (in this case, a public hospital in Portugal) into pre-defined and ordered categories representing quality levels. The hospitals are assessed based on four non-elementary criteria (Timeliness, Effectiveness, Safety and Efficiency) structured hierarchically in logical subsets of elementary criteria, allowing MCHP to evaluate each hospital based on specific criteria subsets or the comprehensive level. The sample size is 25 hospitals, and the analysis period includes the years from 2019 to 2022. The results evidence a general downward trend in quality, culminating in poor quality levels in most public hospitals in 2022, particularly in the Effectiveness dimension. A robustness analysis was conducted to examine the resilience and reliability of the model. By establishing a framework for assessing quality assessment across different critical dimensions, this work provides an enhanced hospital benchmarking process for healthcare policymakers. This process can serve as a reference for implementing new hospital reforms based on replicating the successful practices adopted by the healthcare facilities that demonstrate superior quality results in specific dimensions or even allocating resources more efficiently across the entire network by identifying dimensions in which hospitals are performing poorly.

Identifying Age-Specific Risk Factors for Poor Outcomes After Trauma With Machine Learning

IntroductionRisk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent. MethodsA cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated using three cohorts: (1) patients of all ages, (2) younger patients, and (3) older patients. Older patients were defined as aged 55 y or more to maintain consistency with prior trauma literature. Complications assessed included acute renal failure, acute respiratory distress syndrome, cardiac arrest, unplanned intubation, unplanned intensive care unit admission, and unplanned return to the operating room, as defined by the trauma quality improvement program. Mean decrease in model accuracy (MDA), if each variable was removed and scaled to a Z-score, was calculated. MDA change ≥4 standard deviations between age cohorts was considered significant. ResultsOf 5489 patients, 25% were older. Poor outcomes occurred in 12% of younger and 33% of older patients. Head injury was the most important predictor of poor outcome in all cohorts. In the full cohort, age was the most important predictor of poor outcomes after head injury. Within age cohorts, the most important predictors of poor outcomes, after head injury, were surgery requirement in younger patients and arrival Glasgow Coma Scale in older patients. Compared to younger patients, head injury and arrival Glasgow Coma Scale had the greatest increase in importance for older patients, while systolic blood pressure had the greatest decrease in importance. ConclusionsSupervised machine learning identified differences in risk factors and their relative associations with poor outcomes based on age. Age-specific models may improve hospital benchmarking and identify quality improvement targets for older trauma patients.

Sentiment analysis of U.S. News & World Report Best Children's Hospital urology rankings: A difference in positivity between the public and academic worlds

Initiated in 2009, the U.S. News & World Report (USNWR) pediatric urology rankings aim to guide patients and families towards high-quality urologic care. Despite this, the pediatric urology community remains divided, with significant debate over the rankings' accuracy, utility, and potential for misleading information. While some professionals argue for a collective opt-out from these rankings, citing these concerns, others highlight their positive impact on patient care, hospital benchmarking, and financial support. Recognizing the lack of formal evaluation on how these rankings are viewed beyond the pediatric urology community, this research endeavors to fill the gap through sentiment analysis of public news articles and academic publications. We captured news articles from Google News and academic papers from Ovid Medline and Embase, focusing specifically on content related to the USNWR pediatric urology rankings from 2009 to 2023. Sentiment analysis was conducted using the Valence Aware Dictionary and Sentiment Reasoner (VADER) package on both news and academic texts, aiming to capture the overall sentiment through a compound score derived from the presence of sentiment-laden words. Sensitivity analysis was performed using TextBlob Pattern Analyzer tool. The analysis revealed a significant divergence in sentiment between news articles and academic literature. News articles exhibited a predominantly positive sentiment, with an average compound score of 0.681, suggesting a general approval or celebration of the rankings in the public sphere. Conversely, academic literature showed a more moderate sentiment, with an average score of 0.534, indicating a nuanced perspective that includes both positive views and critical reflections on the rankings. Sensitivity analysis confirmed this observation (Figure). This difference may reflect the distinct nature of news media and academic discourse. While news outlets may prioritize celebratory narratives that align with public interest and institutional pride, academic discussions tend to offer a balanced view that critically assesses both the merits and limitations of the rankings. This discrepancy underscores the complexity of interpreting and acting upon the rankings within the pediatric urology community. While the USNWR pediatric urology rankings are generally received positively by the public, as reflected in news media, the academic community presents a more reserved sentiment. These findings suggest the need for ongoing dialogue and research to understand the implications of these rankings fully. It also calls for a strategic approach to address the concerns and perceptions of healthcare professionals, aiming to leverage the rankings in a way that truly benefits patient care and informed decision-making.

A review on hospital food waste quantification, management and assessment strategies in the eastern Mediterranean region

BackgroundHospital food wastage has been identified as a significant issue within the foodservice sector. Numerous studies have shed the light on the amount of food waste in hospitals, along with its financial and environmental implications. Consequently, reducing food waste in hospitals has become a priority for the foodservice management sector in the Eastern Mediterranean Region (EMR). AimsThis review aims to examine studies on food waste in the hospitals of the EMR countries, and highlight research gaps in quantification, management, and assessment strategies in this region. MethodsPubMed and Google Scholar databases were searched between January 6 and September 1, 2023, to identify relevant articles published up to 2023 in the EMR. ResultsSix studies were included in this review. Among EMR countries, only Iran, Saudi Arabia, and Qatar have assessed food waste at hospitals. The average food waste in the EMR represents 25.4 % of total food served. Factors contributing to food waste include clinical issues, food preferences, meal timing, and ward sections. Patient's plate waste reduce dietary intake, affects patient's nutritional status and predispose to malnutrition. While some strategies to reduce plate waste have been proposed in many countries, there is a notable lack of food and food-related waste management policies and programs in hospitals food services in the EMR. ConclusionThis review summarizes the hospital's food-related waste assessment, quantifications, and management used by hospitals in the EMR. This review is a benchmark for the EMR's hospitals to work on adopting proactive measures as a general strategy to move toward food and food-related waste reduction.

Improving Access to Specialty Pediatric Care: Innovative Referral and eConsult Technology in a Specialized Acute Care Hospital.

Background: The COVID-19 pandemic has exacerbated wait times for pediatric specialty care. Transformative technologies such as electronic referral (eReferral-automation of patient information) and electronic consultations (eConsult-asynchronous request for specialized advice by primary care providers) have the potential to increase timely access to specialist care. The objective of this study was to present an overview of the current state and characteristics of referrals directed to a pediatric ambulatory medical surgery center, with an emphasis on the innovative use of an eConsult system and to indicate key considerations for system improvement. Methods: This cross-sectional study was conducted at a specialized pediatric acute care hospital in Ottawa, Ontario. Secondary data were obtained over a 2-year period during the COVID-19 pandemic (2019-2022). To gain insights and identify areas of improvement related to the factors pertaining to referrals and eConsults at the process and system levels, quality improvement (QI) methodologies were employed. Descriptive statistics provide a summary of the trends and characteristics of referrals and the utilization of eConsult. Results: Among the 113,790 referrals received, 31,430 were denied. Most common reasons for referral denial were other/null (e.g., unspecified) (29.3%), inappropriate referrals (12.6%), and duplicate referrals (12.4%). Four clinics (e.g., endocrinology, cardiology, neurology, and neurosurgery) reported a total of 277 eConsults, with endocrinology accounting for 95.0% of all eConsults. QI findings revealed the need for standardized workflows among specialties and ensuring that eConsult options are accessible and integrated within the electronic medical record (EMR). Conclusions: Refining the pediatric referral management process and optimizing eConsult through existing clinical systems have the potential to improve the timeliness and quality of specialty care. The results inform future research initiatives targeting improved access to pediatric specialty care and serve as a benchmark for hospitals utilizing EMRs and eConsult.

Device-Associated Nosocomial Infections in Intensive Care Units at Al-Ahsa Hospitals, Saudi Arabia.

Introduction Patients admitted to intensive care units (ICU), especially those with devices used to support their condition, are at a higher risk of getting healthcare-associated infections (HAIs). The aim of the present study was to analyze the surveillance data and assess the device-associated infection (DAI) rates such as central line-associated blood-stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP) and ventilator-associated event (VAE) in ICUs of the Ministry of Health (MoH) hospitals in Al-Ahsa region. Methodology The study was conducted retrospectively using the surveillance data of governmental hospitals' intensive care units in the Al-Ahsa region. The surveillance data was collected from 10 ICUs at six MoH hospitals in the Al-Ahsa region during the year 2022. The data from the participating hospitals was entered into the Health Electronic Surveillance Network (HESN) plus program by trained infection prevention control practitioners of the respective hospitals. Results An overall CLABSI rate of 4.29 per 1000 central line days was reported during the study period. The CAUTI rate was 0.55 with a range from 0 to 1.29 cases per 1000 urinary catheter days. VAP rate ranged from 0.33 to 2.21 cases per 1000 ventilator days (average of 1.17). The study reported VAE only for the adult medical-surgical ICU (3.36 per 1000 ventilator days). Conclusion The present study revealed that the most common DAIs in the Al-Ahsa region are CLABSI and CAUTI. DAI rates generated from this study may be used as benchmarks for regional hospitals. An educational program regarding the prevention and control of DAIs targeting all healthcare workers, especially ICU staff, has to be done in the Al-Ahsa region.

Strategic Management and Planning for Health Care Organizations in Georgia

Background: In order to better adapt to the constantly changing global environment, the main priority of the healthcare system is the stable functioning of the hospital sector, for which it is necessary to execute efficient strategic management processes. The purpose of the research is to study the barriers to effective implementation of strategic plans in hospitals in Tbilisi (Georgia). Methods: As part of the quantitative research, a survey of 23 top managers of 10 large hospitals was conducted. Research results: None of the hospitals employed external consultants for strategic planning. A small number of hospitals attended strategic planning training (13%), only one hospital had a strategic planning committee (4.3%), the majority of hospitals (87%) had a documented strategic plan; Strategic planning was primarily engaged by the management board (69.6%), with doctors participating to a lesser extent (30.4%). Only one-third (34.8%) of hospitals develop their budget according to the strategic plan. Resources (43.5%) and allocation of budget funds (47.8%) are not done in accordance with the goals of the strategic plan. The majority of hospitals are less likely to compare the results of the evaluation of goal achievement indicators with those of other hospitals (52.2%), Only a few of them report the values of actions taken to accomplish the strategic plan's goals to the hospital (43.5%), Most of the hospitals rarely do benchmarking of other hospitals' goal-achieving measures (78.3%). Discussion, Conclusion: Only a small number of hospitals have a strategic management process that as a consequence affects their success in the healthcare market. Due to inappropriate competence, physicians’ strategic planning skills are low. It is reasonable for the state to impose a requirement that the hospitals must produce a written strategic plan and employ a strategic management manager. It is essential to provide educational training on hospital strategic management processes.

Validity of16 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals.

The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitablePSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.

STRATEGIC MANAGEMENT PROCESS INHOSPITALS

The purpose of the research is to study the strategic management process in Georgia's hospitals. As part of the quanƟ taƟ ve research, a survey of managers of hospitals was conducted using a pre-structured ques-Ɵ onnaire. A relaƟ vely small number of hospitals aƩ ended strategic planning lectures and pieces of training (13%), Only one hospital had a strategic planning commiƩ ee (4.3%), 87% of hospitals had a documented strategic plan; Strategic planning was primarily engaged by the management board (69.6%), with doctors parƟ cipaƟ ng to a lesser extent (30.4%). Only 34.8% of hospitals develop their budget according to the strategic plan. Resources (43.5%), allocaƟ on of budget funds (47.8%) and idenƟ fi caƟ on of addiƟ onal fi nancial resources (47.8%) are not made in accordance with the goals of the strategic plan. Most hospitals are less likely to compare the evaluaƟ on results of goal achievement indicators with other hospitals (52.2%), and 43.5% report the values of acƟ ons taken to accom-plish the strategic plan's goals to the hospital. Most of the hospitals rarely do benchmarking of other hospitals' goal-achieving measures (78.3%).Small number of clinics have a strategic management process that, as a consequence, aff ects their success in the healthcare market. Hospitals develop a strategy plan, but its implementaƟ on is poorly monitored and not based on scienƟ fi c methods. It is reasonable for the state to impose a legal requirement that hospitals produce a wriƩ en strategic plan. Providing educaƟ onal training on the strategic management process in hospitals is essenƟ al.

National Healthcare-Associated Infections Report 2022 – Saudi Arabia

BackgroundSurveillance data are very essential for the effective use of available resources, the prioritization of infection control practices, and setting goals for intervention. The aim was to present the current rates of healthcare-associated infections (HAIs) and device utilization ratios (DUR) among the Saudi Ministry of health (MOH) hospitals. MethodsMOH analyzed the surveillance data collected from 106 MOH hospitals enrolled in the health electronic surveillance network (HESN) between January 2022 and December 2022. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control. ResultsMore than one million device-days of surveillance were analyzed. The rate of central line associated bloodstream infection (CLABSI) was 2.57 per 1000 central lines days. The rate of catheter-associated urinary tract infection (CAUTI) was 1.08 per 1000 urinary catheter days. The rate of ventilator-associated events (VAE) was 4.21 per 1000 ventilator days. The average rate of pediatric/neonatal ventilator-associated pneumonia (VAP) was 1.53 per 1000 ventilator days. The average DURs were 0.33 for central line, 0.61 for urinary catheter, 0.44 for ventilator in adult patients, and 0.26 in ventilator in pediatric/neonatal patients. In 238632 months of surveillance, the rate of dialysis events (DE) was 0.97 per 100 patient-months. In 86324 surgeries monitored, the rate of surgical site infection (SSI) was 0.87 per 100 surgeries surveyed. ConclusionsThe current report can serve as a national benchmark for MOH hospitals and a regional benchmark for similar hospitals in the region.

Impact of COVID-19 situation on non COVID cardiological admissions

Abstract Funding Acknowledgements Type of funding sources: None. Background The COVID-19 outbreak led to a redistribution of resources in order to provide care to coronavirus patients, taking those resources from other areas such as cardiology, specially from ambulatory patients. Moreover, the fear to the contagious disease, made people to avoid seeking hospital aid. This two factors may have had impact on hospital parameters such as length of stay, readmissions or mortality, with short and mid term effect. Scope: To demonstrate that the factors exposed in the introduction had led to more complex admissions, higher mortality rates, more readmissions and longer stays. Methods we performed a descriptive study comparing hospital parameters from a secondary hospital in Spain using to different periods: a pre-COVID period (01/2019 to 02/2020) and a COVID period (03/2020-01/2022). Only non-COVID cardiological patients where analyzed. Data where extracted form the hospital database and benchmarking tool "Iasist". Results Despite the fact that %readmissions, length of stay (specially form patients awaiting surgery) and complications increased after the outbreak, there was not an increase in mortality . As additional finding, we observed a decrease in admissions complexity according to coding weight parameters. Conclusions Non COVID cardiological admissions have varied since the outbreak, some of those variations where expected such as increase in complications or readmissions, but there was no deleterious impact on mortality.

Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018

BackgroundAntimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals.MethodsAcute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd).ResultsNine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409–554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd).ConclusionsThis study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.

Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey.

Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established. To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment. A nationwide cross-sectional hospital performance survey conducted from January to March 2021. At 30 tertiary cancer hospitals in China. A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included. Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire. Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined. The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained. This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.