Hospital Management Research Articles

Optimalisasi Pengelolaan Simrs pada Unit Nurse Station Rawat Jalan di Rumah Sakit Mata Pekanbaru Eye Center Tahun 2024

This study aims to optimize the management of the Hospital Management Information System (SIMRS) in the nurse station unit of the outpatient department at Pekanbaru Eye Center Hospital. Observations revealed various technical and operational challenges, including limited IT staff, lack of user training, and inadequate SIMRS infrastructure and features. The research methodology involved a priority problem analysis using the USG method (Urgency, Seriousness, Growth) and Fish Bone Diagram to identify root causes. Proposed interventions include intensive training, development of relevant SIMRS features, technological infrastructure upgrades, standardized SOP preparation, and regular monitoring and evaluation. The findings suggest that these measures have the potential to significantly improve operational efficiency, data accuracy, and the quality of hospital services. The study’s implications are expected to assist hospitals in addressing digitalization challenges in the healthcare sector.

Effectiveness of training hospital management teams in tier three hospitals in Kiambu County and utilization of routine health information

Health information is essential for health decision-making at all levels of the health pyramid. This study investigated the effect of training HMTs in tier three hospitals in Kiambu County and utilization of routine health information. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results revealed a significant association between the training and the odds of good utilization (A.O. R=9.01, p=0.0001). Those who received training are 9 times more likely to utilize RHI. The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Effectiveness of socio-economic-demographic factors on utilization of routine health information among hospital management teams in tier-three hospitals in in Kiambu County, Kenya

This study investigated the effectiveness of socio-economic-demographic factors on utilization of routine health information among HMTs in tier-three hospitals in Kiambu County. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results indicate that there was no statistically significant difference regarding the socio-economic-demographic factors before and after the intervention, (Mann-Whitney U-test results (U = 28333, p = 0.7851). The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Revamping field practicum: insights for future health services management professionals

BackgroundThe effectiveness of Health Services Management curricula relies heavily on practical experiences that reflect the evolving needs of the healthcare sector. This study focuses on revising Field Practicum 4 for undergraduate students to better prepare them for leadership roles in healthcare.MethodsThis qualitative and cross-sectional case study was conducted during the 2022–2023 academic year at Zabol University of Medical Sciences. Data were collected through semi-structured, in-depth interviews and document analysis of the undergraduate curriculum. Purposeful sampling was used to select a diverse group of interviewees, including faculty members, healthcare managers, graduates, and current students, with a total of 38 interviews conducted until data saturation was reached. Thematic analysis was performed using MAXQDA software version 11. The CIPP (Context, Input, Process, Product) evaluation model was applied to systematically assess and enhance the practicum program.For the quantitative data analysis, SPSS version 23 was utilized.ResultsThe central finding from this study was the enhancement of productivity in Field Practicum 4. Thirteen core issues were identified and categorized into primary codes, including causal, contextual, intervening, focal, strategies, and outcomes. To achieve desirable outcomes through a fundamental revision strategy, it was decided that, in addition to students’ presence in hospitals (including the office of senior hospital managers and the quality improvement and accreditation unit), students should also be present in the deputyships and central units of Zabol University of Medical Sciences (treatment, resource development and management, food and drug administration, and the center for management of medical emergencies). Furthermore, students should engage with the county health insurance organization and a private insurance company to gain comprehensive familiarity with their operations. The level of consensus among the faculty members of the Health Services Management Department was at least 90%. The findings indicate that both students and internship supervisors generally rated the program positively (Mean > 4.5), although areas for improvement are highlighted, particularly in aspects of process and product.ConclusionsThe study concludes that revising Field Practicum 4 using the CIPP model provides a structured approach to enhancing practical training for Health Services Management students. Implementing these modifications in the apprenticeship syllabus is expected to improve the capabilities of graduates, better preparing them to meet the needs of healthcare system.

Improving Newborn Professional Billing at a Community Hospital.

In community hospital medicine programs, newborns often represent a large patient population with diverse clinical needs. Capturing the care provided through professional billing provides the foundation for division revenue; however, provider knowledge on how to optimally bill is often lacking. Our group underused Hospital Care current procedural terminology (CPT) evaluation and management (E/M) codes for newborns requiring increased monitoring, diagnostic interventions, or therapy. Our aim was to increase use of Level 2 and 3 Hospital Care CPT E/M codes for newborns from 1% to 15%. The process improvement project was conducted from October 2022 through October 2023 in the mother-baby unit of a community hospital with approximately 1800 births per year. Key drivers for underuse of Hospital Care CPT E/M codes were identified, and interventions were developed that included educational sessions, real-time guidance, and improved access to the billing codes. All newborn initial and subsequent care professional billing codes were included. We used retrospective chart review to determine whether clinical care and documentation supported the use of the codes. The proportion of Level 2 and 3 Hospital Care CPT E/M codes increased to 17%. This increase represented a 7% increase in work relative value units and an estimated increase in revenue of $37 805 per 10 000 billing encounters. Review of select charts demonstrated appropriate documentation to support use of the codes 72% of the time. Providing education and tools on professional billing for newborns improved appropriate billing code use and optimized revenue at 1 community hospital.

Factors affecting decision making among nurse managers working in government hospitals

BackgroundEffective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.MethodsNon experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.ResultsThe study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.ConclusionSelf-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

Performance of Muhammadiyah Hospital as Social Entrepreneurship Organization: The Role of Leadership Effectiveness

Background: Muhammadiyah is one of the largest religious organizations in Indonesia which owns and manages the largest non-profit hospitals for more than a hundred years. Muhammadiyah Hospital is a model of social entrepreneurship organization (SEO). Studies related to the performance of Muhammadiyah hospital organizations and their relationship with several other related variables have not been widely conducted and have focused more on Muhammadiyah's philanthropic activities and roles, Muhammadiyah's history in the field of health services, and the ethics of Muhammadiyah's health service. Therefore, this research aims to explore the relationship of variables Servant Leadership, Managerial Cognitive Capability, and Emotional Regulation to shape Organizational Performance (OP) with intermediate variable: Leadership Effectiveness in Muhammadiyah Hospitals. This research utilizes primary data which was collected through phone-call surveys with 443 top and middle management respondents at 111 Muhammadiyah Hospitals in Indonesia. The data was collected by trained and experienced Enumerators using structured questionnaire designed specifically for each type of respondents. Methods: The study utilizes Structural Equation Modelling (SEM) methods using Maximum Likelihood Estimation. The method is used to analyze the influence of variables Servant Leadership, Managerial Cognitive Capability, and Emotional Regulation: Improving and Worsening (IMP and WOR) on Organizational Performance (OP) with Leadership Effectiveness as a mediator. Results: The study results found that Servant Leadership, Managerial Cognitive Capability, and Emotional Regulation: Improving (IMP) have a positive effect on Leadership Effectiveness. The increasing Servant Leadership, Managerial Cognitive Capability, and Emotional Regulation: Improving (IMP) will increase Leadership Effectiveness. Meanwhile, Emotional Regulation: Worsening (WOR) has a negative effect on Leadership Effectiveness. Increasing Emotional Regulation: Worsening (WOR) will reduce Leadership Effectiveness. The analysis results show that Leadership Effectiveness variable directly affects Organization Performance positively, in terms of the effect of Leadership Effectiveness as a mediate variable. Conclusion:This research concludes that leadership effectiveness play an important role in the cognitive abilities of hospital directors in driving hospital performance and the hospital director's cognitive ability is the key to strengthen leadership effectiveness. Considering limitations of this research, future studies should employ a-mix method of quantitative and qualitative data collection technique to bring deeper analysis results, as well as include diverse leadership types other than servant leadership to explore their relationship with the organization performance.

All That I Studied Gave Me a Clearer Goal” Students’ Voice: Project-Based Learning in ESP Course

English as the main language held an enormous role in the Ecotourism and Hospitality sectors, moreover in preparing students for the working field. This study examines the use of a project-based learning (PBL) approach in an English for Specific Purposes (ESP) course, specifically in an English for Ecotourism and Hospitality Management class for Thai students. It focuses on students’ perceptions during and after the implementation of PBL. Data were collected through interviews, revealing that participants experienced happiness and enjoyment throughout the process. Additionally, they gained greater clarity about their future goals upon completing their projects. The findings suggest that PBL in ESP not only strengthens students’ knowledge and skills but also promotes their mental well-being. The study concludes with implications and recommendations for future research on PBL and ESP.

Decoding Success: The Role of E-Learning Readiness in Linking Technological Skills and Employability in Hospitality Management Graduates

Technological advancement alongside global epidemics stimulated the widescale implementation of e-learning. However, it is reported that e-learning is in the experimental phase and still requires fundamental improvements, particularly in disciplines that go beyond theoretical knowledge. The current study examines the nexus between e-learning readiness, psychological motivation, technological skills, and employability skills among hospitality management undergraduates. It also explores the moderating effects of student engagement on the linkages among these variables. To that end, this study adopted a quantitative approach and used a self-administered questionnaire survey to collect primary data. The sample included a total of 428 participants who were recruited from undergraduates of hospitality management programs in Egyptian universities using the convenience sampling technique. Data analysis included performing PLS-SEM using Smart PLS 3.0 software. The results confirm the positive effects of psychological motivation and technological skills on both e-learning readiness and the employability skills of hospitality management undergraduates. The study also underscores the mediated role of e-learning readiness in the linkages between study predictors and outcomes. Additionally, the findings highlight the moderating effect of student engagement in supporting e-learning readiness and eventually employability skills. This study adds to the hospitality management body of knowledge and provides valuable insights for education institutions and policymakers to optimize e-learning experiences.

Diabetic ketoacidosis treatment outcomes and its associated factors among adult patients with diabetes mellitus admitted to public hospitals in Nekemte Town, Ethiopia: a cross-sectional study

BackgroundDiabetic ketoacidosis (DKA) is a serious and acute complication of diabetes mellitus. In Ethiopia, the mortality associated with acute diabetes complications ranges from 9.8% to 12%. Despite this, there is limited information on the clinical outcomes of DKA in our study location. Therefore, this study aimed to assess the magnitude and associated factors of DKA treatment outcomes among adult patients with diabetes admitted to public hospitals in Nekemte Town, Ethiopia.ObjectiveTo assess the DKA treatment outcomes and their associated factors among adult patients with diabetes admitted to public hospitals in Nekemte Town.MethodsA 5-year cross-sectional study was conducted using a systematic random sampling technique among 201 patients from 1 July to 31 August 2023. DKA treatment outcomes were assessed at discharge. Pharmacists collected data by reviewing patient charts using Kobo Toolbox software. The data were then exported to SPSS Version 27 for analysis. Both bivariable and multivariable logistic regression analyses were performed. Variables with a P-value < 0.25 in the bivariable logistic regression were entered into the multivariable regression analysis to control for potential confounders. An adjusted odds ratio with a 95% confidence interval was used to identify predictors of treatment outcomes. A P-value < 0.05 was considered significant in the multivariable analysis.ResultComplete data was available for 201 patients admitted with DKA. The majority, 178 (88.6%), improved and were discharged. Independent predictors of DKA recovery were comorbidities [AOR: 3.45, 95% CI: 1.33, 9.72], admission Glasgow Coma Scale (GCS) score (<8) [AOR: 2.74, 95% CI: 1.02, 7.34], random blood glucose (RBS) (≥ 500) [AOR: 3.07 (95% CI: 1.12, 8.39)], and urine ketones (≥ +3) [AOR: 3.24, 95% CI: 1.18, 8.88].Conclusion and recommendationMost of the treated patients with DKA were discharged with improvement. Comorbidity, admission GCS, RBS, and urine ketones were independently associated with DKA recovery. In general, significant consideration should be given to DKA prevention, early detection, and appropriate hospital management.

Association of Burnout and Intention-To-Leave the Job With Objective Nursing Workload and Nursing Working Environment: A Cross-Sectional Study Among Intensive Care Nurses.

The objectives of this study were to determine the prevalence of burnout risk and intention-to-leave among intensive care unit (ICU) nurses and analyse the association of these with workload and work environment. A cross-sectional survey of nurses working in ICUs was conducted in France between 15 January 2024 and 15 April 2024 alongside a longitudinal assessment of workload during the same period. ICU nurse workload was assessed using the Nursing Activities Score (NAS). The risk of burnout was assessed using the Maslach Burnout Inventory scale and intention-to-leave the hospital was assessed with a binary question. A total of 1271 nurses working in 61 intensive care units completed the questionnaire and 14,134 NAS per patient and 1885 NAS per nurse were included in the study. The median overall of burnout by hospital site was 64.7% [P25: 53.3-P75: 72.7] for the broad definition and a median of 20.7% [13.3-27.3] of ICU nurses reported an intent-to-leave their job. The median overall NAS score per nurse was 135.9% [121.4-156.9] and the prevalence of NAS scores exceeding 100% per nurse was 73.9% [62.8-80.3]. A significant association was found between nurses working in an ICU with a better work environment and all dimensions of burnout as well as the intention-to-leave the job. A prevalence in the hospital site of NAS scores exceeding 100% per nurse below the median was associated with a lower burnout (OR = 0.69, 95% CI: 0.50-0.88 for broad definition) and intention-to-leave the job (OR = 0.68, 95% CI: 0.50-0.92). This study found significant associations between burnout and the intention to leave the job for nurses in ICUs, mainly due to a better work environment and, to a lesser extent, a lower workload for nurses. In an era of nurse shortages and absenteeism, it is crucial for institutions to retain their nursing staff. Our results should encourage hospital managers to take action to improve the ICU work environment and keep ICU workloads manageable to decrease burnout and the intention-to-leave the job among ICU nurses. This article follows the STROBE guidelines for the reporting of cross-sectional studies. No patient or public contribution.

Development of Predictive Model of Surgical Case Durations Using Machine Learning Approach

Optimizing operating room (OR) utilization is critical for enhancing hospital management and operational efficiency. Accurate surgical case duration predictions are essential for achieving this optimization. Our study aimed to refine the accuracy of these predictions beyond traditional estimation methods by developing Random Forest models tailored to specific surgical departments. Utilizing a comprehensive dataset, we applied several machine learning algorithms, including RandomForest, XGBoost, Linear Regression, LightGBM, and CatBoost, and assessed their performance using Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), and R-Squared (R2) metrics. Our findings highlighted that Random Forest models excelled in department-specific applications, achieving an MAE of 16.32, an RMSE of 31.19, and an R2 of 0.92, significantly outperforming general models and conventional estimates. This improvement emphasizes the advantage of customizing models to fit the distinct characteristics and data patterns of each department. Additionally, our SHAP-based feature importance analysis identified morning operation timing, ICU ward assignments, operation codes, and surgeon IDs as key factors influencing surgical duration. This suggests that a detailed and nuanced approach to model development can substantially increase prediction accuracy. By providing a more accurate, reliable tool for predicting surgical case durations, our department-specific Random Forest models promise to enhance surgical scheduling, leading to more effective OR management. This approach underscores the importance of leveraging tailored, data-driven models to improve healthcare outcomes and operational efficiency.

Ultraviolet-C-based sanitization is a cost-effective option for hospitals to manage health care-associated infection risks from high touch mobile phones

Mobile phones have become essential tools for health care workers around the world, but as high touch surfaces, they can harbor microorganisms that pose infection risks to patients and staff. As their use in hospitals increases, hospital managers must introduce measures to sanitize mobile phones and reduce risks of health care-associated infections. But such measures can involve substantial costs. Our objective in this paper was to consider two mobile phone risk mitigation strategies that managers of a hypothetical hospital could implement and determine which involves the lowest cost. The first strategy required all staff to sanitize their hands after every contact with a mobile phone. The second involved the hospital investing in ultraviolet-C-based mobile phone sanitization devices that allowed staff to decontaminate their mobile phones after every use. We assessed each intervention on material and opportunity costs assuming both achieved an equivalent reduction in microbe transmission within the hospital. We found that ultraviolet-C devices were the most cost-effective intervention, with median costs of approximately AUD360 per bed per year compared to AUD965 using hand hygiene protocols. Our results imply that a 200-bed hospital could potentially save AUD1–1.4 million over 10 years by investing in germicidal ultraviolet-C phone sanitizers rather than relying solely on hand hygiene protocols.

Financial Literacy Among Healthcare Providers: A Systematic Review

Since the effectiveness of hospital management is influenced by financial management, healthcare professionals’ financial literacy has drawn the attention of researchers and policymakers. Previous research on medical students and healthcare professionals indicated that medical professionals frequently lack financial literacy; however, the evidence on the long-term status of financial literacy among healthcare providers throughout their careers is limited. In the current systematic review, we aim to examine the current evidence regarding financial literacy among healthcare providers throughout their career development. From the initial 1668 studies that were identified, 38 studies met the inclusion criteria and, thus, were included in the review. Twenty-eight studies evaluated financial literacy among either medical students or junior medical professionals, and ten studies were conducted on senior healthcare personnel. The body of evidence suggests that financial literacy is suboptimal in medical students and healthcare professionals, although it is of utmost importance for leading healthcare providers. Although senior healthcare providers or executive nurse leaders might be modestly financially literate, they are urged to cultivate skills and knowledge beyond their clinical expertise. Financial literacy depends on several factors, such as age, gender, qualification, or overall income. As the role of healthcare leaders is extended to their efficiency and participation in activities related to financial management, there is an urge for financial planning, financial monitoring, financial decision making, and financial control, while further studies are warranted to longitudinally explore the competencies of healthcare leaders in financial literacy.

FATORES ASSOCIADOS A SÍNDROME DE BURNOUT ENTRE PROFISSIONAIS DE SAÚDE

The present study seeks to know the factors associated with burnout syndrome among health professionals. An integrative literature review was conducted, and articles retrieved from the Virtual Health Library, Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online and Online System for Search and Analysis of Medical Literature were analyzed based on the descriptors burnout syndrome; health professional and occupational diseases, from the Boolean operators. Burnout syndrome has a significant prevalence among health professionals, associated with individual, economic and institutional conditions. Hospital managers should be aware of these data in order to develop systematic occupational health programs in order to favor the integral health of workers.

Community-driven ecotourism in the trans Himalayan region: A sustainable model for cultural and environmental preservation

ABSTRACT Himalayan destinations, rich in natural and cultural wealth, are increasingly vulnerable to ecological degradation due to unregulated tourism growth. This research examines community-driven ecotourism (CDE) as a model to reconcile economic imperatives with environmental stewardship in Ladakh, a region facing rapid tourism expansion and ecological fragility. Using a qualitative case study approach, the study draws on semi-structured interviews with 22 stakeholders, including community leaders, tourism entrepreneurs, environmental experts, and hospitality managers. Thematic analysis reveals the interplay between local engagement, cultural preservation, and ecological resilience. Key findings introduce a strategic framework that supports cultural and environmental sustainability while aligning with Sustainable Development Goals (SDGs) 8, 12, and 15. Community-managed homestays, wildlife tours, and heritage conservation emerge as key mechanisms for fostering local livelihoods and preserving heritage. However, challenges such as infrastructure deficits, capacity gaps, and insufficient policy coherence limit the broader impact of these initiatives. This study underscores the importance of local community participation in shaping resilient tourism practices and offers recommendations to bridge policy and practice. The research positions Ladakh as a model for sustainable tourism in the Himalayas, emphasizing the symbiosis between cultural identity and environmental integrity.

Evaluasi Keamanan Sistem Informasi Rumah Sakit: Metode Pengujian ISO 27001 di RS Khusus Mata Purwokerto

As service quality becomes paramount, ICT governance is increasingly important for organizations. This study will audit Purwokerto Eye Specialty Hospital's SIMRS against ISO/IEC 27001 standards to evaluate its information security posture. The implemented Hospital Management Information System (SIMRS) aims to support the integration of services and administrative processes, but faces various security challenges such as data loss and potential manipulation. The audit was conducted through observation, interviews, and analysis of existing security policies. The audit results show that information security incident management is in accordance with procedures, including handling, reporting, and corrective actions, with a fairly high level of security maturity. The study recommends periodic evaluation and security enhancements to ensure system resilience against future threats.

Diagnostic performance of prehospital EFAST in predicting CT scan injuries in severe trauma patients: a multicenter cohort study.

The early mortality of trauma patients, mainly from hemorrhagic shock, raises interest in detecting the presence of non-exteriorized bleeding. Intra-hospital EFAST (Extended Focused Assessment with Sonography for Trauma) has demonstrated its utility in the assessment and management of severe trauma patients (STP). However, there is a lack of data regarding the diagnostic performance of prehospital EFAST (pEFAST). The main objective of our study was to evaluate the pEFAST performance to predict a positive CT scan in STP. This was a retrospective, multicenter, database-driven study. All severe trauma patients managed by a prehospital medical team were included. The results of pEFAST were compared with the admission CT scan. Data from 495 patients were included. The pEFAST had sensitivity of 27% (95% CI 22; 32) and specificity of 94% (95% CI 90; 97) for predicting the presence of a lesion on CT scan at hospital admission. The area under the curve (AUC) was 0.66 (95% CI 0.57; 0.63), the positive predictive value 84% (95% CI 75; 87), the negative predictive value was 51% (95% CI 44; 66), the positive likelihood ratio was 4.24 (95% CI 2.46; 7.3) and the negative likelihood ratio 0.78 (95% CI 0.72; 0.85). Prehospital EFAST has an excellent specificity but a poor sensitivity for predicting a positive CT scan on hospital admission. We do not know whether this low sensitivity is secondary to the delay between the two examinations or to the poor performance of pEFAST. Therefore, a negative pEFAST should not be reassuring. A positive pEFAST is highly informative, as it predicts a lesion and enables hospital management to be prepared accordingly.

Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay

ObjectivesTo study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.DesignA retrospective nationwide observational study.SettingSecondary and tertiary acute-care hospitals in Belgium.ParticipantsWe studied 4 560 993 hospital...

The Role of the Organization in Promoting Information Security-Related Behavior Among Resident Physicians in Hospitals in Germany: Cross-Sectional Questionnaire Study.

Nowadays, optimal patient care should be based on data-driven decisions. In the course of digitization, hospitals, in particular, are becoming complex organizations with an enormously high density of digital information. Ensuring information security is, therefore, essential and has become a major challenge. Researchers have shown that-in addition to technological and regulatory measures-it is also necessary for all employees to follow security policies and consciously use information technology (compliance), because noncompliance can lead to security breaches with far-reaching consequences for the organization. There is little empirical research on information security-related behavior in hospitals and its organizational antecedents. This study aimed to explore the impact of specific job demands and resources on resident physicians' information security-related compliance in hospitals through the mediating role of work engagement and information security-related awareness. We used a cross-sectional, survey-based study design to collect relevant data from our target population, namely resident physicians in hospitals. For data analysis, we applied structural equation modeling. Our research model consisted of a total of 7 job demands and resources as exogenous variables, 2 mediators, and information security-related compliance as the endogenous variable. Overall, data from 281 participating physicians were included in the analyses. Both mediators-work engagement and awareness-had a significant positive effect on information security-related compliance (β=.208, P=.001 vs β=.552, P<.001). Quality of leadership was found to be the only resource with a significant indirect effect on physicians' compliance, mediated by work engagement (β=.086, P=.03). Furthermore, awareness mediated the relationships between information security-related communication and information security-related compliance (β=.192, P<.001), as well as between further education and training and the endogenous variable (β=.096, P=.02). Contrary to our hypothesis, IT resources had a negative effect on compliance, mediated by awareness (β=-.114, P=.02). This study provides new insights into how a high standard of information security compliance among resident physicians could be achieved through strengthening physicians' security work engagement and awareness. Hospital management is required to establish an information security culture that is informative and motivating and that raises awareness. Particular attention should be paid to the quality of leadership, further education and training, as well as clear communication.