Hospital Services Research Articles

Assessment of Healthcare Service Quality and Patient Satisfaction Using the SERVQUAL Questionnaire in Khuzestan Province During 2022 - 2023

Background: Hospital service quality is the primary predictor of a hospital's success, and any decrease in patient satisfaction is a cause for concern for the organization. Objectives: This study aimed to evaluate the service quality of Golestan Hospital in Ahvaz, Iran, based on patient satisfaction measured using the SERVQUAL questionnaire. Methods: This cross-sectional study was conducted in 2022 - 2023. Patients over 18 years old who visited the emergency department at Golestan Hospital were evaluated, with the exception of those with mental or multiple chronic disorders. Data collection tools included demographic and SERVQUAL Questionnaires. The data were analyzed using SPSS software, with a significance level set at less than 0.05. Results: A total of 200 subjects participated in the study, comprising 124 females (62%) and 76 males (38%). The results of the SERVQUAL Questionnaire indicated that the highest score was in the tangibility dimension (4.35), while the lowest score was in the assurance dimension (1.38). Negative gaps between perception and expectation were observed in the responsiveness (-0.99) and empathy (-1.22) dimensions. The mean total scores for expectation and perception were 99.55 ± 5.06 and 92.85 ± 5.5, respectively, with the highest scores observed for reliability. No significant association was found between expectation and perception (P-value > 0.05). However, the reliability of the gap and expectation in males was significantly higher (P-value < 0.05). A direct correlation was found between age and tangibility, Assurance, and total score of gaps (P-value < 0.05). Conversely, a reverse correlation was observed between age and tangibility and the total score in perception (P-value < 0.05). Post-hoc analysis revealed that the Assurance and total score of gaps and expectations were significantly higher in married patients compared to single patients (P-value < 0.05). Conclusions: This study revealed a negative gap between patients' expectations and perceptions, highlighting the need for adjustments and improvements in hospital service quality by addressing all five dimensions of service quality.

Adjusting the risk-adjustment: Accounting for variation between organisations in the responsiveness of their expenditure to need

There is concern that basing healthcare budgets on risk adjustment estimates derived from historical utilisation data may reinforce patterns of unmet need. We propose a method to avoid this, based on a measure of how closely local health organisations align resources to the needs of their populations. We refer to this measure as the ‘responsiveness of expenditure to need’ and estimate it using national person-level data on use of acute hospital and secondary mental health services in England. We find large variation in responsiveness in both services and show that higher expenditure responsiveness in mental health is associated with fewer suicides. We then re-estimate the national risk-adjustment model removing the data from the organisations with the lowest expenditure responsiveness to need. As expected, higher need individuals are estimated to have higher expenditure needs when less responsive organisations are removed from the estimation of the risk-adjustment. Removal of organisations with below-average responsiveness results in the neediest deciles of individuals having an extra £163 (7%) annual need for acute hospital care and an additional £79 (27%) annual need for mental health services. The application of this approach to risk adjustment would result in more resources being directed towards organisations serving higher-need populations.

Perceived outcomes of medical teaching institute reforms: insights from management, faculty, and administration in Pakistani tertiary health care

ObjectiveThe study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan.MethodologyA cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques.ResultsThe study showed that institutional staff members’ knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures.ConclusionDespite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.

Mapping Segregation Patterns of Hospital Care among Patients with Limited English Proficiency.

Individuals with limited English proficiency (LEP) are disproportionately more likely to experience suboptimal care outcomes compared to English-proficient individuals, attributed to multi-level social determinants of health, including the quality of the hospital where LEP patients are more likely to receive care. Evidence demonstrates that racial minority patients are more often admitted to lower-quality hospitals serving high proportions of minority patients, despite living closer to higher-quality hospitals. Less is known about where individuals with LEP reside, where they seek hospital care, and the quality of care in these hospitals. Using Geographic Information Systems (GIS) methods, we developed a density map characterizing residential patterns of the LEP population across zip code tabulation areas in New Jersey and designated hospitals as high, middle, or low-LEP volume. We described differences in 30-day hospital wide readmission rates for hospitals across varying LEP volume status using Centers for Medicare and Medicaid Services Hospital Care Compare Data. Most hospitals in ZCTAs with higher LEP populations serve a high proportion of LEP patients (i.e. their patients' demographics are reflective of the community in which they are located). However, our results also show instances in which LEP patients may be forgoing receiving care at closer hospitals to instead receive care at further-distanced, high-LEP volume hospitals. significant. High-LEP volume hospitals have higher 30-day hospital wide readmission rates (20.1%) compared to middle (15%) and low (11.3%)-LEP volume hospitals (p < .001), indicating lower quality of care within high-LEP volume hospitals.

Physical and internet medical system: Service quality and management mode analysis

In an era of social progress and policy changes, some hospitals have diversified their services by incorporating internet hospitals. However, since the development of internet hospitals has been delayed and their management model remains ambiguous, this paper employs game theory to establish an internet medical system. By categorizing patients based on their severity and their acceptance of telemedicine, and by devising the centralized and decentralized management models, the paper assesses the quality of service and management practices of internet hospitals. The findings reveal that under decentralized management, internet hospitals can enhance the quality of service in physical hospitals. Nevertheless, the disparity in quality of physical hospitals in the two medical systems under the centralized management mode requires clarification. In addition, the paper delves into hospital revenue and patient utility, indicating that while the establishment of internet hospitals may not consistently increase healthcare system revenue, it can significantly improve patient utility, especially in remote areas. These results provide valuable insights into the management and expansion of internet hospitals.

Teaching Hospital Governance Model for Service Quality Performance: Case Study of Indonesian Central General Hospital

This study aims to investigate the effect of teaching hospital management practices on the quality performance of health services by involving elements such as hospital accreditation standards, quality management, and JCI Academic Hospital-specific standards that are indirectly connected. This study chose a survey-based quantitative approach to clinical professional students in vertical teaching hospitals under the direct management of the Ministry of Health of the Republic of Indonesia. Six proposed hypotheses were tested by Partial Least Square-Structural Equation Modeling (PLS-SEM) analysis. The test results showed a positive influence between hospital teaching governance and hospital accreditation compliance, quality assurance and JCI Academic Hospital standards. Third, compliance with teaching hospital standards was also found to have a significant positive effect on the performance of teaching hospital service quality. Understanding the role of governance in encouraging the performance of teaching hospital service quality can help develop effective managerial strategies in achieving complete service quality for patients and clinical profession participants. This research resulted in contributions to existing practices and literature as governance modeling in dual quality standards charged to teaching hospitals.

Emotional intelligence and demographic factors: Moderating effects in service recovery strategy

This study highlights the role of emotional intelligence, gender, income, and residence area on the relationship between brand image, service recovery strategy, and satisfaction. The multistage with purposive sampling method has recruited 600 samples of private hospital services in Thailand. Self-administered online questionnaires via Google Forms were used to collect the data online. Confirmatory factor analysis and multigroup SEM have been used for hypothesis testing. The research explores emotional intelligence (EI), with lower emotional intelligence associated with more negative perceptions of social brand image. Lower income affects the symbolic and social image, influencing satisfaction with a service recovery strategy. The upcountry areas viewed experiential images more positively compared to those from urban regions. Gender did not significantly moderate these relationships. The study also highlights thatfactors do not substantially impact service recovery satisfaction but are still vital for effective communication and brand attachment. The results underscore the intricate dynamics of the various factors that shape consumer attitudes and behaviours toward service recovery strategy.

Travelers With Disabilities: How Online Information Search Reduces Uncertainty About Service Accessibility in Hospitality and Tourism

Despite the significant number of travelers with disabilities and their substantial contribution to the tourism and hospitality industry, there has been a lack of research exploring the necessary services required by travelers with disabilities during their travels. Therefore, this study aims to identify accessibility issues encountered by travelers with disabilities during their travels and to examine the impact of these issues on their behavior in reducing uncertainty within the online travel community. To achieve the research objectives, the present study performed an integrated approach that combines text analytics and robust regression analysis. The findings of this study provide guidelines for tourism and hospitality management to reduce the perceived uncertainty experienced by travelers with disabilities, thereby promoting the accessibility of tourism and hospitality services.

A surgical preadmission pharmacist service in a tertiary paediatric hospital: a pilot study

AbstractBackgroundPharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.AimTo evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.MethodA retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non‐identifiable patient data.ResultsIn total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p &lt; 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.ConclusionImplementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow.

Predictors of high hospital admission and criminal reoffending in adults experiencing homelessness: a retrospective cohort study

ObjectivesTo examine the costs and predictors of high hospital use and criminal reoffending in adults experiencing homelessness. ApproachRetrospective cohort study of 2,140 adults who attended homeless hostel clinics in New South Wales, Australia using linked clinic, health, criminal offence, and mortality data from 1 July 2008 to 30 June 2021. Multivariable logistic regression examined predictors of high all-cause hospital use (≥4 emergency department presentations in 12 months) and predictors of recidivism. ResultsThere were 27,466 hospitalisations at a total cost of AUD$548.2 million. Twenty-seven percent of the cohort had high hospital use. Factors associated with high use were age ≥45 years, female (AOR: 1.52; 95%CI 1.05-2.22), presence of a mental disorder, substance use disorder (AOR: 1.36; 95%CI: 1.03-1.82), or being homeless for &gt;1 year (AOR: 1.31; 95%CI: 1.06-1.62). There were 1,646 (76.9%) adults who had contact with the criminal justice system. Most (75.3%) reoffended within 24 months after index offence, and reoffenders were more likely to be younger, have a personality disorder (AOR: 1.31; 95% CI: 1.04-1.67), substance use disorder (AOR: 1.60; 95%CI 1.14-2.23), and had a previous charge dismissed on mental health grounds (AOR: 1.79; 95% CI: 1.31-2.46). Reoffenders more likely to have a principal theft-related offence (AOR: 1.85; 95%CI: 1.29-2.66). Total court finalisation costs were AUD$11.3 million. ConclusionsThe high use of hospital and criminal justice services lends support to strategies to develop models of supported housing with a focus on integrated care, mental health support, improved referral pathways, and better coordination with community-based support agencies.

Combining cohorts of prospectively collected and linked data to improve health after release from prison

BackgroundWhile people who experience incarceration have remarkably poor health profiles, undertaking research to inform evidence-based responses is complicated by difficulties of recruiting people in prison; high rates of socioeconomic marginalisation, study attrition; and legislative and financial barriers to linked data research. There are many advantages to pooling data from multiple studies involving people who experience incarceration, including greater statistical power and geographic and participant heterogeneity. However, there are also challenges that need to be addressed. MethodsWe combined four prospective cohort studies of adults released from prisons in four Australian states. Pre-release interviews, and validated screening assessments, were linked to primary care, medicine dispensing, hospital, alcohol and other drug treatment services, ambulatory mental health, ambulance, corrective services, and death records. Data were harmonised by team members reviewing variable definitions and categories within subject domains. ResultsThe combined cohort consists of 4,232 adults, including 1,544 Indigenous people and 905 women, with a median age of 31 years. Data linkage will enable a median of 9.3 years of prospective follow-up after release from incarceration. Differences in data structures, coding systems between and within datasets, changes over time, and grouping of records belonging to the same event were also addressed. ConclusionThis combined multi-site cohort study is an example of a complex, policy-oriented data linkage project. It was developed to underpin evidence-based, culturally appropriate interventions, health policy and service development for people who were incarcerated. This presentation will discuss the processes and pitfalls experienced while building a multi-sectoral, multi-jurisdictional data linkage project.

Potentially burdensome care at the end-of-life for people who had a death from cancer: A retrospective population-level cohort study

ObjectivesTo examine factors associated with indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. ApproachA population-based retrospective cohort study of people aged ≥20 years with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, derived by summing 4 indicators: &gt;1 ED presentation; &gt;1 hospital admission; ≥1 ICU admission within 30 days of death; died in acute care (scored as 0, 1 ≥2). ResultsOf the 80,005 cancer-related deaths, 69.1% had none, 20.0% had 1 indicator, and 10.9% had ≥2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥55 years), females, people with 1 or ≥2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Conclusions and implicationsThis study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.

Improving Electronic Health Record (EHR) data linkages for identifying Aged Care Residents through publicly available data

IntroductionAccurate identification of Aged Care residents accessing hospital services is challenging due to multiple hospital Electronic Health Record (EHR) systems and entry points resulting in inconsistent addresses and coding. Improving accuracy and completeness of addresses is crucial for cohort identification and data linkage. ObjectiveDevelop methods to validate cross-sectoral data linkages to improve identification of aged care residents within EHR systems. ApproachAmong individuals aged ≥65 years (or ≥50 identifying as Aboriginal or Torres Strait Islander) between January 2013 to December 2023 within our Data Platform, we first used data items mandated by the Department of Health to identify aged care residency. Data quality was enhanced using a residential address index derived from Australian Geocoded National Address File (G-NAF). We evaluated sensitivity, specificity, and Positive Predictive Values (PPVs) of recorded addresses against the Australian Institute of Health and Welfare (AIHW) aged care services list. ResultsAmong 409,677 addresses extracted, 55.4% (raw) had sufficient data for validation. This increased to 89.9% (enhanced) with G-NAF. Among 79,028 admitted and 88,876 emergency patients, 22.7% and 18.4% respectively were aged care residents. We compared performance of raw vs enhanced comparisons were: sensitivity (admission: 34.1% vs 73.8%), (emergency: 42.6% vs 66.2%); specificity (admission: 96.2% vs 90.9%), emergency (96.8% vs 95.2%); Positive Predictive Value (admission: 61.3% vs 58.8%), (emergency: 64.2% vs 65.3%). Conclusions and ImplicationsOur approach significantly increased sensitivity without sacrificing specificity, enhancing Aged Care resident identification in EHR data. It also improved linkage with external datasets and Statistical Area Level 1 (SA1) mapping.

ThP5.9 - Evaluation of cholecystectomy service in a general NHS hospital

Abstract Background Cholecystectomy is commonly performed for biliary pathologies, as elective, emergency, or at prioritised basis (Hot Gall bladder service). Aim Evaluating local performance of cholecystectomy, outcomes and areas for improvement. Results Over a 4-week period, 38 cholecystectomies were performed, all laparoscopically. Almost half had cholecystitis or cholangitis requiring at least 1 admission with 5 patients required more than 1 admission in 12 months prior to surgery. 50% of cholecystectomies were done in 6 months, while the longest waiting time was 13 months. 50% of procedures were done electively, whereas the rest in emergency and hot gall bladder lists. Indications included acute cholecystitis (13), biliary colic (11), chronic cholecystitis (6), biliary pancreatitis (4), GB polyps (3) and CBD stones (1). Only 2 had subtotal cholecystectomy, and Nassar operative difficulty was graded as one in 18, two in 15, three in 4 and four in 1 of the cases. Critical view of safety was obtained in 85% and biliary anatomy was unusual in 12 cases. Operative cholangiogram and CBD exploration were performed in 5 and 8 cases respectively. Complications included bile spillage (12/38), and bleeding (7/38). 30-day follow up showed 16 patients were discharged in 24 hours and only 3 readmitted. The incidence of complications was 37%, 11 cases had SSI and 3 had pulmonary complications). No bile leak or CBD injury. All specimens were sent for examination showing benign histology. Recommendation Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions, with no significant added complications. Selective gall bladder histological examination may reduce costs with no recognised risks.

Enhancing Transitions of Care: A Cross-Sectional Observational Study on the Role of Clinical Pharmacists in Transition Management in a Latin American Hospital.

Background The seamless management of transitions of care (TOC) is necessary for patient safety, as it directly correlates with a heightened risk of medication errors and adverse effects. Clinical pharmacists emerge as key stakeholders in optimizing medication management during TOC, specifically during hospital admission and discharge, through the implementation of innovative programs that contribute significantly to the mitigation of medication errors and improve patient satisfaction. Aim This study aims to assess the benefits of pharmacist-led interventions in a Costa Rican private hospital's TOC program for polymedicated and high-risk patients during admission and discharge by identifying and addressing medication errors. Methods A cross-sectional observational study was conducted at Clínica Biblica Hospital in San José, Costa Rica, from February 2022 to May 2023 and focused on polymedicated patients with chronic therapy and high-risk medications. The TOC Medication Program was specifically implemented to focus on medication reconciliation during the admission and discharge processes. A clinical pharmacist documented interventions based on discrepancies found within each patient's medication and assessed the economic impact of interventions on healthcare personnel during discharge by projecting potential complications in the absence of such interventions, a process that was validated by an internist physician. Results During the medication reconciliation at admission, medication discrepancies, mostly intentional omissions, were successfully addressed by clinical pharmacist interventions with a 90.2% acceptance rate during the admission process. At discharge, 18.9% of medications were high-risk, and nearly 40% of discharges were linked to drug-related problems (DRPs), prompting pharmaceutical interventions. The economic analysis indicated potential savings of $21,010.20 during discharge, demonstrating the substantial impact of interventions in preventing emergency service visits, specialist consults, and hospital admissions. Conclusion Pharmacist-led TOC programs offer important clinical advantages by effectively preventing and rectifying medication discrepancies. These discrepancies, if left unaddressed, pose a potential threat to patient safety. Moreover, the implementation of such programs demonstrates promising economic benefits.

Mortality in people living with dementia who self-harmed: An Australian data linkage study.

This study aimed to examine mortality for people living with dementia/mild cognitive impairment who self-harmed. We conducted a retrospective cohort study in New South Wales, Australia, using data ranging from 2001 to 2015. From people who accessed hospital services in the study period, we identified 154,811 people living with dementia/mild cognitive impairment, 28,972 who self-harmed and 1511 who had a record of both dementia/mild cognitive impairment and self-harm. We examined rates, causes and predictors of death for people with dementia/mild cognitive impairment and/or self-harm diagnoses using flexible parametric survival analyses. We explored rates of repeat self-harm in people living with dementia who self-harmed. Circulatory disorders accounted for 32.0% of deaths in people with a living with dementia who self-harmed, followed by neoplasms (14.7%), and mental and behavioural disorders (9.6%). Death was more likely for someone who had self-harmed if they developed dementia/mild cognitive impairment. Predictors of death included male sex, greater physical comorbidity, a history of delirium, more previous emergency department presentations and fewer previous mental health ambulatory service days. Greater engagement with outpatient mental health services predicted a decreased likelihood of repeat self-harm. We found that mortality increases when people who self-harm develop dementia. We argue post-diagnosis support offers a potential opportunity to reduce mortality rates in people with both dementia and self-harm diagnoses.

Analysis of The Level of Patient Satisfaction with Pharmaceutical Services In Xyz Regional Hospital Bandung Indonesia

Abstract Hospitals are health facilities that provide various services, one of which is pharmaceutical services. Pharmaceutical services are an activity organized to maintain and improve the health of patients. Patient satisfaction is an important indicator in achieving conformity with expectations in health services in hospitals. The level of patient satisfaction can be seen from good service. The purpose of this study is to determine and evaluate the level of patient satisfaction with pharmaceutical services at the XYZ regional hospital in Bandung, West Java. In this study, the application used in SPSS to process data with the methods used, namely the Importance Performance Analysis (IPA) method and the Customer Satisfaction Index (CSI). This method is used to identify the level of importance of each service attribute and the priority of improvements that must be made by a hospital to determine the level of patient satisfaction. IPA analysis shows that the point included in quadrant I (high importance and low satisfaction) is R6, namely complete available drugs but in reality, the drugs are not available so this statement is considered important by patients because it has facts that are not yet appropriate and need to further improve their performance so that the service is more satisfying. Meanwhile, based on the results of the CSI analysis, it is known that the overall value of the respondent's satisfaction level for all attributes is 83.9%. So based on the satisfaction index patients are satisfied with pharmaceutical services at the XYZ Bandung Regional Hospital. Keyword: Patient Satisfaction, IPA, CSI, Hospital

Gender Differences in the Perception of Ethics and Civic Moral Disengagement in Medical Doctors

The present study aims to find the gender differences in the perception of doctors while making ethical decisions and their level of civic morality. A simple distinction between ethics and morality would be that ethics are in reference to an external source, they come from the work environment. A comparative research design has been used in this study for which a Purposive sampling strategy was selected. The participants of the study selected were 75 male and 75 female doctors aged 25-40 years, practicing in Jinnah Hospital and Services Hospital, Lahore. Ethics Position Questionnaire (EPQ) and Moral Disengagement Scale (MDS) were utilized to collect the data. To identify the differences among the variables Independent Sample T-test was administered on the collected data. The results of the study revealed that there is no significant difference in the perception of ethics and civic moral disengagement, this brought to the view that gender alone does not influence one’s ethics, pro-social reasoning, and behavior. The findings of this current research state that there are no differences among doctors working in two different locations, among genders, or between ethics and civic moral disengagement. This would be helpful to know because doctors constantly face questions regarding ethics and have to make fast, effective decisions that will affect their patient's life.

Achieving Robust Medical Coding in DRGs Systems: Innovative Actions Adopted in Greece.

The purpose of this study is to evaluate and illustrate the effectiveness of a specialized digital platform developed to improve the accuracy of medical coding during the full implementation of Greece's new DRG system, and to highlight innovative actions for achieving and/or improving accurate medical coding. Already grouped DRG cases recorded in the first DRG implementation year in the region of Crete were examined. A sample of 133,922 cases was analyzed and audited, through a process consisting of three stages: (i) digitalization, (ii) auditor training, and (iii) control and consultation. The results indicated that a significant proportion of DRG coding, with a length of stay exceeding one day, was reclassified into different DRG categories. This reclassification was primarily due to coding errors-such as the omission of secondary diagnoses, exclusion of necessary medical procedures, and the use of less specific codes-rather than mistakes in selecting the principal diagnosis. The study underscores the importance of medical coding control and consulting services. It demonstrates that targeted actions in these areas can significantly enhance the implementation of the DRG coding system. Accurate medical coding is crucial for transparent allocation of resources within hospitals, ensuring that hospital services and reimbursements are appropriately managed and allocated based on the true complexity and needs of patient cases.

The Effectiveness of the Surgical Correction of Vesicoureteral Reflux on Febrile Urinary Tract Infections after a Kidney Transplant: A Single-Center Retrospective Study.

Background/Objectives: Vesicoureteral reflux (VUR) is considered one of the major causes of post-renal transplant febrile urinary tract infections (UTI), leading to impaired renal function and the premature loss of the renal graft. We aimed to evaluate whether surgical VUR correction, such as open redo ureteric reimplantation, could be an option for treatment and provide better outcomes in post-transplant care for patients with UTI compared to their pre-VUR correction clinical state. Methods: Our study presents a retrospective analysis of 10 kidney transplant recipients with febrile UTI at the Renal Transplant Service of a Brazilian public hospital from 2010 to 2020. We selected patients who primarily underwent a surgical correction of post-transplant VUR, which was corrected by extravesical reimplantation without a stent in all patients by the same professional surgeon. Results: From 710 patients who received kidney transplants, 10 patients (1.4%) suffered from febrile UTI post-transplant and underwent surgical correction for VUR. Despite the study's limitations, such as its retrospective nature and limited sample size, the efficacy of open extravesical ureteral reimplantation in reducing post-operative febrile UTI in renal transplant patients was observed. Conclusions: As febrile UTI can contribute significantly to patient mortality after kidney transplantation and VUR emerges as a major cause of post-transplant febrile UTI, it is essential to treat it and consider the surgical outcome. This study emphasizes the timely detection and effective treatment of VUR via extravesical techniques to reduce febrile UTI occurrences post-transplant and it contributes insights into the role of surgical interventions in addressing VUR-related complications post-kidney transplantation.