RESUMO
Patient satisfaction is becoming increasingly important for the successful operation of private and public hospitals. The quality of the service provided can be improved if internal and external customers' opinions are taken into account during the definition of hospital operating objectives. This research presents a new methodology, called the simulation service quality system (SSQS), developed to improve operating performance measures in the light of customer preferences. The motivation for the development of the SSQS methodology arose from the need to achieve timeliness standards at United States Veterans' Hospitals. The Harry S. Truman Memorial Veterans' Hospital in Columbia Missouri served as the validation and initial application site for the SSQS methodology. Details one such project: the objective of reducing customer waiting times to 30 minutes or less at an outpatient treatment clinic. Through the identification of relationships and interactions, discrete-event simulation techniques are applied to model and experiment with the system to ultimately arrive at recommended changes in hospital operating policies which achieve the objective.
Assuntos
Eficiência Organizacional , Hospitais de Veteranos/normas , Ambulatório Hospitalar/estatística & dados numéricos , Satisfação do Paciente , Gestão da Qualidade Total/métodos , Agendamento de Consultas , Simulação por Computador , Relações Hospital-Paciente , Hospitais de Veteranos/organização & administração , Missouri , Estudos de Casos Organizacionais , Objetivos Organizacionais , Ambulatório Hospitalar/normas , Design de Software , Estudos de Tempo e Movimento , Listas de EsperaRESUMO
BACKGROUND: There are no chilean reports on gallstone dissolution using oral medications. AIM: To measure the proportion of asymptomatic adult women eligible for gallstone dissolution therapy and to test the effectiveness and tolerance of lovastatin for this purpose. SUBJECTS AND METHODS: Three hundred fifty six women working at health care institutions were subjected to a gallbladder ultrasound examination. Non pregnant women with radiolucent gallstones of less than 2 cm phi were invited to receive lovastatin 20 mg od and were followed during six months. RESULTS: Twenty two women had gallstones and eight eligible women received lovastatin therapy. No reduction in stone size was observed in these women. CONCLUSIONS: Less than half of asymptomatic women with gallstones are eligible for oral dissolution therapy. Lovastatin did not reduce gallstone size after six months of therapy.
Assuntos
Anticolesterolemiantes/uso terapêutico , Colelitíase/tratamento farmacológico , Lovastatina/uso terapêutico , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Cooperação do PacienteRESUMO
The aim of this study was to know if cholecystectomy rates have decreased in young women, considering that these rates have decreased in the last years in the general chilean population. The frequency of previous cholecystectomy was compared in 1582 women aged 23.9 +/- 5.8 years admitted to a maternity for delivery between 1985 and 1986 and 4943 women aged 24.6 +/- 5.9 years admitted between 1989 and 1990 for the same reason. There was a reduction in cholecystectomy frequency from 4.7 to 2.5% specially among women 21 to 35 years old. Cholecystectomy was performed at a mean age of 23 years in both groups and 42.6% of the procedures were done before the first pregnancy. An unexpected finding was a lower body weight among women studied in the second period (62.5 +/- 9.1 vs 67.7 +/- 8.4 k).
Assuntos
Colecistectomia/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Distribuição de Qui-Quadrado , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Gravidez , Fatores de TempoRESUMO
A prospective survey was carried out in 205 males and 667 females who had their gallbladder removed for gallstone disease during 1989 at a general hospital in Chile. Females had a greater prevalence of disease with an earlier appearance of symptoms leading to surgery at a younger age. In contrast, males developed a more aggressive form of the disease, with a shorter interval from appearance of symptoms and surgery.