Hospital Infrastructure Research Articles

Point prevalence probing of antimicrobial prescription patterns from a developing country

ABSTRACT Background Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. Research Design and Methods This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. Results In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. Conclusion Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

Best Practices for the Management of Patients with Non-Tuberculous Mycobacterial Pulmonary Disease According to a German Nationwide Analysis of Expert Centers.

Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic inflammatory lung disease caused by infection with non-tuberculous mycobacteria (NTM). International guidelines provide evidence-based recommendations on appropriate diagnosis and treatment strategies, but there is a need for sharing day-to-day best practice between treatment centers to optimize patient care. This is particularly valuable for rare diseases like NTM-PD. In this cross-sectional analysis of NTM-PD management in Germany, medical and administrative staff from seven treatment centers were interviewed to identify best practice in the diagnosis, treatment, and ongoing management of patients with NTM-PD, including related hospital infrastructure and administration processes. A prioritization led to a collection of best practices for the management of patients with NTM-PD in Germany, which is presented here. Selected current best practices included performance of regular sputum tests for diagnosis, use of medical reports, and regular follow-up visits as well as increased interaction between physicians across different specialties. Future best practices that may be implemented to overcome current barriers comprised disease awareness activities, patient empowerment, and new approaches to enhance physician interaction. Challenges related to their implementation are also discussed and will help to raise disease awareness. The presented best practices may guide and optimize patient management in other centers.

Quick Transition to One Day Length of Stay after Hip and Knee Arthroplasty Using a Digital Follow-Up Tool during COVID-19: A Retrospective Comparative Study.

The COVID-19 pandemic highlighted the need for efficient use of hospital infrastructure. The hypothesis was that a rapid shift to outpatient surgery after hip or knee arthroplasty could be implemented without compromising quality of care. The aim of this study was to assess the safety, pain management and patient-reported outcomes before and after the implementation of an accelerated discharge program using a digital follow-up tool. A retrospective cohort design was used to compare 97 patients who received primary total hip or knee arthroplasty during the pandemic (early discharge) to comparable 194 pre-pandemic patients (normal discharge). Both cohorts had the same inclusion criteria and were closely monitored using the digital follow-up tool. The accelerated discharge program reduced length of stay from a median of 3 days (before the pandemic) to a median of 1 day (during the pandemic) (p < 0.001). The complication rate of 2% was the same for both groups (p > 0.05). Patient-reported outcomes for matched samples of hip (n = 100) and knee (n = 82) arthroplasty patients were similar before, at 6 weeks and 3 months after surgery for both groups (p > 0.05). There were no differences in pain and medication consumption for the first 6 weeks (p > 0.05). This study demonstrates that reducing length of stay from three to one night after total knee or hip arthroplasty, with the help of a digital follow-up tool, results in a stable rate of complications, readmission, and comparable clinical outcomes, while reducing the socio-economic burden on the health system.

Climate-related disaster impact on health care infrastructure in the USA

PurposeResearch on postdisaster health care accessibility and availability has largely focused on the short-term impacts of isolated disasters on specific health care services. We examined the distribution of health care facilities and climate-related weather disasters across counties in the United States across a 15-year period. MethodsLinking longitudinal data on disasters, health care, and demographic and socioeconomic characteristics, we created an annual panel dataset of counties in the United States from 2000 to 2014 (N = 3108). National Establishment Time Series data measured change in health care facilities, categorized into drug stores, hospitals, and ambulatory care. Using data from Spatial Hazards and Events Losses Database for the United States, we classified county-level disasters as moderate and severe. We used autoregressive linear models to estimate the per-capita number of health care establishments in 2014 associated with the total number of moderate and severe disasters (2000–2013), after adjustment for health care establishments, total population, and poverty in 2000. ResultsEach additional moderate disaster was associated with a significant increase in hospital infrastructure (0.14, 95% confidence interval [CI]: 0.02 to 0.25) while an increase in severe disasters was associated with a significant decrease in hospital infrastructure (−0.28, 95% CI: −0.45 to −0.12). Similar relationships were found with ambulatory care facilities (2.49, 95% CI: 0.89 to 4.09 and −5.78, 95% CI: −8.13 to −3.43, respectively). The association between disasters and drug store facilities was not statistically significant. ConclusionsGiven the increasing number and severity of climate-related disasters, the loss of health care facilities following severe disasters may lead to poor health outcomes, especially among vulnerable populations.

Disaster response readiness assessment of public hospitals in Addis Ababa City, Addis Ababa, Ethiopia.

Introduction: Due to its diverse geography, climate, and political instability, Ethiopia is one of the countries most affected by disasters. However, there is a lack of evidence-based assessments of disaster preparedness, especially in Addis Ababa, where most tertiary-level referral hospitals are located. This study aims to evaluate disaster readiness in public hospitals in Addis Ababa using WHO standards, focusing on hospital characteristics, disaster plans, infrastructure, and human resources availability. Ultimately, the findings are expected to provide actionable recommendations for improving disaster preparedness in public hospitals in the city. Methods: A cross-sectional study design was utilized using quantitative and qualitative methods to assess disaster response readiness among public hospitals in Addis Ababa, the capital city of Ethiopia. Results: This study assessed ten public referral hospitals in Addis Ababa. In the last two years, all but one of the ten public referral hospitals in Addis Ababa have experienced a disaster. Road traffic accidents are responsible for half of all disasters. While 50% of the hospitals have trauma-specific plans, there are no disaster-specific guidelines for the remaining hospital. Moreover, all facilities and ambulances lack communication networks to receive assistance during disasters. A total of 88.8% of emergency and disaster facility level representatives (n=18) stated that their emergency care areas need improvement to be able to manage patients during disasters more effectively. While seven hospitals (70%) have separate disaster medication and equipment storage, only three (43%) are regularly restocked. Furthermore, nearly half of the respondents (44%) reported that their hospital does not have a functional disaster management team, and 61% are unprepared to handle a disaster. Lastly, 33% of the respondents mentioned the Ministry of Health and hospital leaders' commitment as an enabling factor to improve future disaster response readiness. Conclusion: Public referral hospitals in Addis Ababa have significant gaps in disaster management preparedness and response. A comprehensive disaster response plan, including staff training, regular restocking of medication and equipment, and functional communication networks, should be implemented in every public referral hospital. It is imperative that all stakeholders work together, including local government authorities, emergency response teams, and community members, to ensure hospitals are well-equipped to deal with disasters.

Enablers and barriers to adopt the locally developed Masi mechanical ventilator amid COVID-19 pandemic in Peru

BackgroundLimited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021). MethodsWe conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent. ResultsMost of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information. ConclusionsThe perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

A review of the effect of nurse shortages on existing nurse workforces in South Africa and Ukraine

The object of this research is the nurse shortages on existing nurse workforces in South Africa and Ukraine. The healthcare system has taken strain since the inception of the war in Ukraine. The war caused damages to hospital, clinic and warehouse infrastructure, leading to limited medical resources and impacting the shortage of healthcare personnel, especially among the nursing professionals. A skilled, motivated and supported health workforce is essential to providing consistent and quality healthcare to patients. However, nurse shortages make it difficult for the existing nurses in a war-stricken country to provide the best possible care to their patients, which can be emotionally distressing for the nurses. Whereas in South Africa, economic turmoil and the recent COVID-19 pandemic placed an even more significant strain on South Africa’s overburdened and under-resourced healthcare system, eventually leading to a decline of healthcare workers on the frontline, thereby affecting the delivery of quality healthcare to patients. This paper will explore the expected effects of nurse shortages on the existing nurse workforce in these countries. It will provide recommendations for nurses to cope and regain their motivation to deliver quality healthcare to patients without compromising their own health and well-being. The researchers, therefore, conducted a qualitative study with Registered Nurses (RNs) and Operational Nurse Managers (ONMs) working in selected critical care units at a public hospital under investigation. The findings of the study revealed that the nurse shortage significantly impacted the well-being of existing nursing staff, both personally and professionally. Simple strategies to improve their well-being via the use of an Employee Assistance Program (EAP) were recommended by the researchers to address their mental health and well-being issues by providing support and advice in critical times of need, encouraging meditation &amp; physical fitness activities and encouraging nurses to make a conscious decision to achieve a balance between work and family life. Such strategies will benefit the Ukrainian health workforce in providing quality healthcare to their patients during the unpleasant circumstances caused by the ongoing war.

A Study on Sustainable Hospital Supply Chain Management towards Societal Advancement in the Post-Pandemic Era

Abstract— This study delves into the intricate relationships between Hospital Infrastructure Development (HID), Collaboration Information Flow (CIF), Forecasting and Planning Management (FPM), Technology Supply Chain Application (TSCA), Sustainable Hospital Supply Chain Management (SHSCM), and Sustainable Societal Advancement (SSA) within the healthcare sector of Bangladesh. Utilizing a structured questionnaire, data was collected from a diverse group of 22 respondents, including doctors, administrators, and patients. Frequencies Analysis, conducted using IBM SPSS, provided a comprehensive demographic overview, while the Alpha Cronbach test affirmed the reliability of the research instrument with a high value. The fitness index analysis, performed using IBM AMOS software, subsequent modifications based on the Modification Index (MI) results led to a model that closely met the criteria of CMIN, degrees of freedom (df), CMIN/df, incremental fit CFI IFI, and absolute fit RMSEA, underscoring the pivotal role of the aforementioned variables in enhancing SHSCM and contributing to SSA. The findings emphasize the significance of a robust healthcare supply chain in ensuring optimal healthcare delivery and broader societal benefits. This research offers valuable insights for healthcare administrators, policymakers, and stakeholders, providing a roadmap for building resilient, efficient, and sustainable healthcare systems in the post-pandemic era.Keywords—Sustainable Hospital Supply Chain Management (SHSCM), Sustainable Societal Advancement (SSA), IBM SPSS, IBM AMOS.

Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges, and Ways Forward

The neurosurgical workforce in the Caribbean and surrounding countries is largely unknown due to the diversity in cultural, linguistic, political, financial disparities, and colonial history between the countries. About 45 neurosurgeons serve 16 million people in the Caribbean Community and Common Market, a trade alliance including most Caribbean nations. We aimed to understand the current scope of neurosurgical workforce in this region while highlighting any system challenges and potential solutions for upscaling the workforce. We surveyed neurosurgeons within Caribbean countries and surrounding countries online using qualitative and quantitative methods via Qualtrics. Of the 38 countries within the Caribbean and surrounding countries, 26 (68%) were surveyed and of which 18 (69%) replied. In total, 172 regional neurosurgeons were identified, of which 61 (35%) replied-with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care-either expressed by full-time equivalent neurosurgeons or neurosurgical centers (see table). Most neurosurgical practices confirmed receiving or sending medical referrals. If so, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in the following: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education, and training (44%). To our knowledge, this is the first qualitative and quantitative study exploring the current status of the neurosurgical workforce within the Caribbean and surrounding countries. Identifying resources and challenges can contribute to improving regionalized neurosurgical care.

Role of oxygenation devices in alleviating the oxygen crisis in India.

There has been an unprecedented increase in global demand for medical oxygen equipment to solve the acute oxygen shortages caused by SARS-CoV-2 infection. The study aims to assess the value of improved access and use of Oxygen Concentrators (OCs) and cylinders during the COVID-19 pandemic in India. This evaluation is relevant to strengthening health systems in many resource-constrained Low- and Middle-Income Country (LMIC) settings. Using a Probability Proportional to Size (PPS) sampling method, primary surveys were conducted in 450 health facilities across 21 states in India. The primary outcomes measured were self-reported utility of oxygenation devices in meeting the oxygen demand in the short-run and long-run utility of devices compared to the pre-oxygen-devices-distribution-period. We perform bivariate and multivariate regression analyses. Around 53-54% of surveyed facilities reported that the distributed oxygenation devices helped meet oxygen demand in the short run and are expected to increase their long-run capacity to admit non-COVID patients with oxygen needs. The timely availability of technicians was associated with meeting oxygen demand using the additional oxygenation devices at the facilities. Facilities that increased the number of staff members who were able to administer oxygen devices were at higher odds of reducing the administrative load on their staff to organize oxygen support in the long run. Hospital infrastructure was also associated with long-run outcomes. We find that oxygenation devices such as cylinders and OCs were useful in addressing the oxygen demand during the COVID-19-related oxygen emergency. Overall production of oxygen to meet the demands and investments in training biomedical engineers/technicians to administer oxygen could help save lives.

Resilience of the critical infrastructure in hospitals : Categorization and quantification as abasis for optimization

Critical infrastructure (CRITIS) in hospitals has become the focus of resilience research due to the impact of the COVID-19 pandemic and also the events in Ukraine. This foundational research examines overall contexts, categorizing and quantifying them. Previous research examined limited scale damage situations with little CRITIS involvement: Worst case studies are missing. The vulnerabilities of the CRITIS of one or more countries will likewise be aprime target for attack in current and future conflicts or criminal extortion, this is especially true in the healthcare sector. Therefore, detailed research with ablack swan scenario is necessary in this field. The aim of the study was to create and validate acategorized and weighted model for the self-assessment of the resilience of critical infrastructure in German hospitals at different levels of care before the exemplary scenario of aprolonged supraregional power blackout. Using an explorative design, experts from 8hospitals of different care levels performed an expert-based qualitative system analysis to develop, weight and test the model. The resilience index was then calculated using adapted interdependence analyses in aVester influence matrix. A total of 7 categories and 24subcategories of hospital CRITIS were identified. There are several key elements: rank1 of active elements is the emergency power system (E1), and for passive elements, it is the nursing staff (P2). This means that the emergency power system has the greatest impact on all other areas and the nursing staff are most dependent on all others for their work. The most critical elements, because they are most intertwined in the overall system, are the situation center/command staff (Z1) and technical staff (P3), on which the entire system depends. From the weighted individual elements of CRITIS, an overall resilience for ahospital can be calculated (resilience index). The developed model can be used by hospital crisis experts as part of aself-assessment to provide abasis for risk management, financial planning, technical planning, personnel planning or crisis and disaster management. The categorization and quantification of critical infrastructure (CRITIS) in hospitals with the aim of resilience documentation and optimization is possible. The model that has been developed allows rapid adaptation to changing initial situations and increases in resilience that can be realized in the short and medium term. Emergency and crisis preparedness is adynamic process, which has been combined here with the further development of critical infrastructure. Consequently, there can be no final state to be achieved but only acertain best possible framework within which the hospital as abusiness enterprise can operate. The classification of the categories in the model must also be constantly further developed and adapted to the current status. Once the explorative and qualitative basic research has been completed, it is necessary in afurther step to subject the model, which has been validated by experts, to abroader review. Ideally, this will be done using quantitative methods and asignificantly larger sample.

Predictors of Mortality and Functional recovery after severe traumatic brain injury: protocol for a prospective cohort study

Introduction: traumatic brain injury is a global public health problem due to its severity and high rates of morbimortality worldwide. Identifying predictors associated with increased mortality and unfavorable functional outcomes after the traumatic brain injury event is crucial for minimizing morbidity and mortality rates. Therefore, this study aims to establish a protocol to investigate the predictors of mortality and functional recovery after severe traumatic brain injury in Brazil. Methods: The study will include all patients admitted for severe traumatic brain injury (Glasgow Coma Scale ≤ 8) at the State Hospital of Urgency and Emergency, which is the referral trauma hospital of Espirito Santo. The outcomes of interest are hospital mortality and functional recovery 24 months after hospital discharge. Subjects will be followed up at seventy-two hours, three months, six months, twelve months, and twenty-four months after the trauma. Morbidity will be determined by assessing: 1) the level of motor and cognitive disability, 2) functional impairment and quality of life, and 3) aspects of rehabilitation treatment. Additionally, the traumatic brain injury load, estimated by the years of life lost, will be calculated. Discussion: the results of this study will help identify variables that can predict morbidity and mortality, as well as diagnostic and therapeutic targets for patients with severe traumatic brain injury. Furthermore, the findings will have practical implications for: 1) the development of public policies, 2) investments in hospital infrastructure 3) understanding the socioeconomic impact of functional loss in the individuals. Study registration: the study received approval from the Ethics Committee of the Federal University of Espirito Santo under protocol number 4.222.002 on August 18, 2020.

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Contribution of Tourism Objects in Banyumas Kota Lama to the Hotel Occupancy

This study aims to assess the impact of tourism attractions in the Kota Lama Banyumas area on hotel occupancy rates. This study employed a qualitative research methodology utilizing a descriptive approach. Qualitative research methods are employed to assess the state of tourism in the Banyumas Kota Lama area. This area lacks optimal and professional management of tourist attractions, leading to suboptimal economic benefits for the local community and low hotel occupancy rates in the vicinity of these destinations. The study findings indicate that the presence of tourist attractions in the Banyumas Kota Lama tourist destination has a significant impact on the local community's economy through increased hotel occupancy. The rise in tourist visits to Banyumas Kota Lama has led to an expansion of employment opportunities in the tourism sector. The hotel industry in the region will see a rise in occupancy due to the growing number of tourists. Hoteliers will directly benefit from the rise in visitor numbers, leading to an increase in their revenues. This can incentivize hoteliers to enhance their hospitality infrastructure and provide superior services in order to attract a larger number of tourists. Moreover, the growing tourist influx will positively affect Micro, Small, and Medium Enterprises (MSMEs) in the vicinity.

Physician Perceptions of the Clinical, Economic and Humanistic Burden of Disease and Unmet Needs in Myelofibrosis: Preliminary Findings from the MPN Landmark Survey in Indonesia.

A cross-sectional survey was designed and administered between November and December 2021 among practicing Haematologists-Medical Oncologists who are experienced in treating patients with MF. The objectives of the survey were to assess physician's understanding of the overall diagnosis of MF, the disease burden, current treatment practices and remaining unmet needs. Outcomes were analysed descriptively. The survey was completed by 30 respondents. The findings suggest that symptom burden is high and has a significant negative impact on quality-of-life. Treatment burden is also high which can result in high healthcare resource utilisation. Physicians expressed need for novel therapeutic options and improved access and coverage for such options. There is also a need to improve access and coverage for JAK V617F testing locally and local hospital infrastructures should be upgraded to ensure MF is accurately diagnosed. Patient may benefit from information on MPN, which may result in earlier presentation, diagnosis and treatment which can improve outcomes. The findings align with previous international research reporting that symptoms and treatment burden are high, and that novel therapeutic options are needed. Additional patient research might be required to better understand the patient experience of MF and how this can be improved.

Association between waiting time, service time and patient satisfaction in the out-patient department of a tertiary care hospital in Maharashtra

Background: Quality patient care is controlled by various factors - degree of fulfilment of patients' needs being one of them. Lesser waiting times, empathetic doctors and availability of medications yield more satisfied patients. Methods: A descriptive cross-sectional study was carried out among 80 patients attending the OPD of a tertiary care hospital from 9 am to 1 pm, Monday to Saturday from 8th February 2021 to 8th April 2021. Consenting patients were shadowed and observed until they completed their visit. Actual waiting time, consultation time and overall visit duration were calculated. An exit interview was conducted to assess satisfaction with waiting time, infrastructure and doctor-patient interaction. Results: The mean waiting time in one visit was 59.025±39.497 minutes. The mean consultation time with the doctor was 6.925±7.688 minutes. Statistical analysis showed that patients with lesser waiting time were significantly more satisfied with hospital services (p=0.004). Males were significantly more satisfied than females (p=0.02). Domains of dissatisfaction were waiting time at the registration desk, outside the OPD, seating arrangement, cleanliness and availability of medications. Doctor-patient interaction and consultation time were rated highly. Conclusions: The results showed that significant changes are required in the queueing system and hospital infrastructure. The positive response received in case of doctor-patient interaction is a step in the right direction. Regular surveys can help us rectify oversights in the present healthcare system.

Delivery of virtual acute cardiac care- a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background The increasing incidence of chronic conditions, along with the SARS CoV-2 pandemic, put unprecedented capacity restraints on hospital bed access. New models of care are required to meet the increasing clinical demand for hospital services. Digital health technologies to support virtual hospital in the home services may address this need by offering patient-centered, safe and efficient models of care that are not reliant on physical hospital infrastructure. Specific cardiac conditions are well suited to a virtual model of care. Purpose To describe and evaluate a novel virtual model of care for cardiac patients that delivers early supported discharge from the acute inpatient ward to home. Model of Care The cardiac hospital in the home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. This 48-hour model of care utilized wearable technology to monitor cardiac rhythm and vital signs in conjunction with daily virtual ward rounds to manage recognised post operative/ procedural complications. Escalation pathways for clinical deterioration were designed to support patient safety. Transitional care to discharge was a key element of this model. Quality, safety, efficiency and patient experience were evaluated. Key Results From March-November 2022, 260 patients were referred to cHITH with 191 (74%) patients accepted according to the risk-stratification criteria. This cohort included post cardiac surgery (CSUR) patients (54%); post interventional procedures (31%), post device implant (6%) and other (9%). The cHITH length of stay (LOS) was 1.9 ± 0.1 days reflecting 20% of the episode of acute care delivered in the virtual environment. Re-admission rates were 9.4% at 30-days, with 0% mortality. Patient satisfaction was &amp;gt;90% (net promoter score). The CSUR cohort (n=103) had a mean age of 62 ± 4 years; male 82%; isolated CABG 62%; 30-day re-admission rate 7.8%. Total post-operative LOS was 7.1 ± 2.4 days with 35% of post-operative care delivered in the virtual cHITH environment. A total of 258 bed days were realized. Conclusion This pilot virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.

Investigating How Budget Plan Contributes to Successful Implementation of Level Two Healthcare Infrastructure Projects in Kiminini Sub-County, Trans Nzoia County, Kenya

Healthcare is a critical pillar of long-term development. It is therefore up to nations and governments to ensure their healthcare systems are up to date to meet the growing needs of their populations. Developing healthcare infrastructure is critical to achieving this goal. The overall goal of this research was to investigate the influence of project planning on successful implementation of functional level two hospital infrastructure projects in Kiminini Sub-County. The specific objective was to investigate how cost and budget plan influences successful implementation of projects in Kiminini sub- County, Trans Nzoia County, Kenya. Kenya Health Policy 2014-2030 was the intervening variable. Explanatory research design that utilizes both qualitative and quantitative data collection methods was used. The target population included the County departments of health, public works, and finance, heads and staff of the sampled facilities, political and community representatives and contractors. Sample size was 100 respondents. Questionnaires and interview guides were used to collect primary data. Quantitative data was analysed using SPSS version 25. Qualitative data was analysed using content analysis method and presented in narrative form. According to study findings, while some projects were completed within budget, others failed to meet their objectives. Budget estimates and funding were planned though not all were implemented as planned due to delayed disbursement of funds and delay in approving the budgetary allocation for projects due to political differences. The study recommended better collaboration between County and National governments and County assembly, and political good will. The study concluded that planning, and cost and budget plan are crucial in implementation of successful projects. The study aimed at adding value to existing knowledge in the field of study and aiding in implementing successful healthcare infrastructure projects as envisioned in Kenya Vision 2030, and Kenya Health Policy 2014-2030.

Retrospective analysis of 261 autopsies of penetrating cardiac injuries with emphasis on sociodemographic factors

Penetrating cardiac injuries (PCIs) are highly lethal and several factors are related to its incidence and mortality. While most studies focus on characterizing patients who arrived at a medical facility alive and exploring the relationship between the degree of heart compromise and mortality, our study delved deeper into the topic. This study analyzed 261 autopsy reports from 2017 in Bogotá, Colombia, and characterized the factors surrounding PCI incidence and mortality while emphasizing the role of sociodemographic variables. Of these cases, 247 (94.6%) were males with a mean age of 29.19 ± 9.7 years. Weekends, holidays, and late hours had the highest incidence of PCIs. The victims' deaths occurred at the scene in 66 (25.3%) cases, and 65.1% of the victims died before receiving medical care. Upon admission, patients with vital signs were more likely to have been transported by taxi or a private vehicle. Two or more compromised cardiac chambers, increased time of transportation, trauma occurred in the city outskirts, and gunshot wounds were related to increased mortality. Our data is valuable for surgeons, health system managers, and policy analysts as we conducted a holistic assessment of the anatomical and sociodemographic factors that are closely associated with mortality following a PCI. Surgeons must recognize that PCIs can occur even when the entrance wound is outside the cardiac box. Reinforcing hospital infrastructure in the outskirts and improving the availability, accuracy, and response time of first responders may lead to improved patient mortality rates.

A Unified Approach to Sustainable Hospital Supply Chain Management in the Post-Pandemic Era

Sustainable Hospital Supply Chain Management (SHSCM) has become crucial in the post-pandemic era, balancing economic, environmental, and social dimensions of healthcare. This paper proposes an integrated approach to SHSCM, combining four core elements, particularly Hospital Infrastructure Development (HID), Collaboration and Information Flow (CIF), Forecasting and Planning Management (FPM), and Technology Supply Chain Application (TSCA). This approach addresses the complexities and challenges in healthcare supply chains, promoting resilience, efficiency, and sustainability. The authors present potential applications from two different healthcare systems scenarios to demonstrate the application and effectiveness of the proposed approach. The findings of this study suggest that the integration of HID, CIF, FPM, and TSCA provides a comprehensive and systematic way to enhance SHSCM, with implications for research and practice in this important field.