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Objetivo: Determinar la frecuencia, las causas y los factores asociados de suspensión de cirugías programadas en un hospital de alta complejidad en un periodo de 5 años. Materiales y Método: Se realizó un estudio descriptivo transversal, en un hospital terciario del sur de Chile durante los años 2014 a 2018. Se describe la frecuencia de suspensión quirúrgica del establecimiento y por especialidad, especificando sus principales causas. Además, se identificaron aquellas suspensiones evitables y sus factores asociados mediante regresión logística. Resultados: La tasa de suspensión en los 5 años de estudio fue de 11,2%. Neurocirugía y Traumatología tuvieron la mayor tasa de suspensión (18,8% y 13,9%, respectivamente), mientras que Ginecología y Obstetricia la menor (4,1%). Las causas más frecuentes fueron la inasistencia del paciente (16,9%), la prolongación de la cirugía anterior (16,4%) y la paralización de actividades por motivos gremiales (7,9%). Un 80,1% de las causas fueron evitables. La especialidad quirúrgica y la edad del paciente fueron los factores asociados más relevantes. Discusión: Se evidenció una alta tasa de suspensiones quirúrgicas y la mayoría por causas evitables. Su disminución puede ser la intervención más costo efectiva para contribuir a reducir las extensas listas de espera quirúrgica posterior a la crisis sanitaria por COVID 19, ya que sólo requiere optimizar los recursos existentes. Conclusiones: La suspensión quirúrgica es un problema frecuente en el proceso quirúrgico. Nuestros resultados permiten identificar a los grupos de mayor riesgo de suspensión, asignar responsabilidades a los equipos quirúrgicos y desarrollar estrategias efectivas para su prevención.

Aim: To determine the frequency, the causes and the associated factors of the surgical cancellation of scheduled surgeries at the Hospital Base Valdivia between the years 2014 and 2018. Materials and Method: A descriptive cross-sectional study was carried out. Were described the frequency of suspension of scheduled surgeries of the establishment, by specialty and their main causes, identifying those that can be avoided. In addition, the factors associated with suspension were identified by logistic regression. Results: The suspension rate in the 5 years of study was 11.2%. Neurosurgery and Traumatology had the highest frequency of surgical cancellation (18.8% y 13.9%, respectively), Obstetrics, and Gynecology the lowest (4.1%). The most frequent causes of suspension were the absence of the patient (16.9%), the prolongation of the previous surgery (16.4%) and the suspension of activities due to Union reasons (7.9%). 80.1% of the causes were avoidable. The age and surgical specialty were the most relevant associated factorsm Discussion: A high rate of surgical suspensions and most for avoidable reasons were evident. Reducing surgical cancellations can be the most cost effective intervention to help reduce the extensive post-health crisis surgical waiting lists by COVID 19, as it only requires optimizing existing resources. Conclusions: Surgical suspension is a common problem in the surgical process. Our results allow to identify the groups most at risk of suspension, assign responsibilities to surgical teams and develop effective strategies for their prevention.

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Introdução: A pandemia de COVID-19, no Brasil, constituiu uma ameaça ao sistema de saúde pelo risco de esgotamento dos leitos de Unidade de Terapia Intensiva (UTI). O objetivo do estudo foi projetar a ocupação de leitos de UTI com casos de COVID-19 no pico em Porto Alegre. Para isso, resolvemos utilizar uma ferramenta matemática com parâmetros da pandemia desta cidade.Métodos:Utilizamos o modelo matemático SEIHDR. Analisamos os casos de hospitalização por COVID-19 em Porto Alegre e RS até 3 de agosto de 2020 a fim de extrair os parâmetros locais para construir uma curva epidemiológica do total de casos prevalentes hospitalizados em UTI. Também analisamos as taxas de reprodução básica (R0) e reprodução efetiva (Re).Resultados: O modelo matemático projetou um pico de 344 casos prevalentes, em UTI, para o dia 22 de agosto de 2020. Calculamos 1,56 para o R0 e 1,08 no dia 3 de agosto para o Re.Conclusão: O modelo matemático simulou uma primeira onda de casos ocupando leitos de UTI muito próxima dos dados reais. Também indicou corretamente uma queda no número de casos nos dois meses subsequentes. Apesar das limitações, as estimativas do modelo matemático forneceram informações sobre as dimensões temporal e numérica de uma pandemia que poderiam ser usadas como auxílio aos gestores de saúde na tomada de decisões para a alocação de recursos frente a calamidades de saúde como o surto de COVID-19 no Brasil.

Introduction: The COVID-19 pandemic in Brazil has been a threat to health services due to the risk of bed shortage in the intensive care unit (ICU). This study aimed to estimate the bed occupancy at the ICU with patients with COVID-19 during the peak of the pandemic in Porto Alegre, capital of Rio Grande do Sul (RS), the southernmost state of Brazil. To this end, we used a mathematical model with pandemic parameters from the city.Methods: We used the SEIHDR mathematical model. We analyzed hospitalizations for COVID-19 in Porto Alegre and RS until August 3, 2020, to extract local parameters to create an epidemiological curve of the total number of prevalent cases in the ICU. We also analyzed the basic reproduction rate (R0) and effective reproduction rate (Re). Results: The mathematical model estimated a peak of 344 prevalent cases in the ICU on August 22, 2020. The model calculated an R0 of 1.56 and Re of 1.08 on August 3, 2020.Conclusion: The mathematical model accurately estimated the first peak of cases in the ICU. Also, it correctly indicated a drop in the number of cases in the following two months. Despite the limitations, the mathematical model estimates provided information on the temporal and numerical dimensions of a pandemic that could be used to assist health managers in making decisions on the allocation of resources in a state of public calamity such as the COVID-19 outbreak in Brazil.

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Este informativo é uma iniciativa da Gerência de Vigilância de Risco e Núcleo de Segurança do Paciente (GVR/NSP) do Hospital Geral de Palmas (HGP), e tem por objetivo fornecer informações para auxiliar as lideranças na tomada de decisão dos processos de melhorias envolvendo eventos adversos. Apresenta dados referentes as notificações.

This newsletter is an initiative of the Risk Surveillance Management and Patient Safety Center (GVR / NSP) of the Hospital Geral de Palmas (HGP), and aims to provide information to assist the leaders in making decisions about the improvement processes involving Adverse events. Displays data regarding notifications.

Este boletín es una iniciativa del Centro de Gestión de Vigilancia de Riesgos y Seguridad del Paciente (GVR / NSP) del Hospital Geral de Palmas (HGP), y tiene como objetivo brindar información para asistir a los líderes en la toma de decisiones sobre los procesos de mejora que involucran Eventos adversos. Muestra datos sobre notificaciones.

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Traditional management practices are sometimes considered merely a necessary condition for superior performance. Other resources and competencies with higher barriers to imitation are assumed to be potential sources of competitive advantage. This study describes and analyzes the effect of traditional management practices on the performance of medium-sized hospitals. Medium-sized companies frequently display the greatest differences in management practices, and only recently did the hospital sector seek ways to develop its competitiveness in the administrative arena. The results generally indicate that basic management practices can make differences in performance, offering support for the new practice-based view (PBV). Hospitals with the highest rate of adoption of practices had the highest occupancy rate, hospital-bed admissions, and accreditation. Lack of adoption of management practices by medium-sized hospitals limits their competitive capacity and can be viewed as a component of the so-called Brazil cost, but in this case an internal component.

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OBJECTIVES: Describe the operating characteristics of a proposed set of revenue center codes to correctly identify ICU stays among hospitalized patients. DESIGN: Retrospective cohort study. We report the operating characteristics of all ICU-related revenue center codes for intensive and coronary care, excluding nursery, intermediate, and incremental care, to identify ICU stays. We use a classification and regression tree model to further refine identification of ICU stays using administrative data. The gold standard for classifying ICU admission was an electronic patient location tracking system. SETTING: The University of Pennsylvania Health System in Philadelphia, PA, United States. PATIENTS: All adult inpatient hospital admissions between July 1, 2013, and June 30, 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 127,680 hospital admissions, the proposed combination of revenue center codes had 94.6% sensitivity (95% CI, 94.3-94.9%) and 96.1% specificity (95% CI, 96.0-96.3%) for correctly identifying hospital admissions with an ICU stay. The classification and regression tree algorithm had 92.3% sensitivity (95% CI, 91.6-93.1%) and 97.4% specificity (95% CI, 97.2-97.6%), with an overall improved accuracy (χ = 398; p < 0.001). CONCLUSIONS: Use of the proposed combination of revenue center codes has excellent sensitivity and specificity for identifying true ICU admission. A classification and regression tree algorithm with additional administrative variables offers further improvements to accuracy.

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Resumo: As práticas tradicionais de gestão são, por vezes, consideradas uma condição apenas necessária para o desempenho superior. Outros recursos e competências com maiores barreiras à imitação é que seriam as potenciais fontes de vantagem competitiva. Este estudo descreve e analisa o efeito de práticas tradicionais de gestão no desempenho em hospitais de médio porte. As empresas de médio porte são aquelas em que se costuma encontrar maiores diferenças no uso das práticas, e o setor hospitalar só mais recentemente tem buscado, na área de administração, formas de desenvolver sua competitividade. De forma geral, os resultados indicam que as práticas básicas de gestão podem sim trazer diferenças de desempenho, oferecendo suporte à nova perspectiva da PBV (practice-based view). De fato, verificou-se que hospitais que apresentaram uma maior taxa de adoção de práticas possuíam maior taxa de ocupação, internações por leito e certificado de acreditação. A não adoção das práticas por hospitais de médio porte traz uma limitação de capacidade competitiva que pode ser entendida como mais um componente do custo Brasil, mas, dessa vez, um componente interno.

Abstract: Traditional management practices are sometimes considered merely a necessary condition for superior performance. Other resources and competencies with higher barriers to imitation are assumed to be potential sources of competitive advantage. This study describes and analyzes the effect of traditional management practices on the performance of medium-sized hospitals. Medium-sized companies frequently display the greatest differences in management practices, and only recently did the hospital sector seek ways to develop its competitiveness in the administrative arena. The results generally indicate that basic management practices can make differences in performance, offering support for the new practice-based view (PBV). Hospitals with the highest rate of adoption of practices had the highest occupancy rate, hospital-bed admissions, and accreditation. Lack of adoption of management practices by medium-sized hospitals limits their competitive capacity and can be viewed as a component of the so-called Brazil cost, but in this case an internal component.

Resumen: Las prácticas tradicionales de gestión se consideran a veces una condición meramente necesaria para un cometido superior. Otros recursos y competencias con mayores dificultades de ser susceptibles de imitación son las que serían los potenciales aspectos que suponen una ventaja competitiva frente a la competencia. Este estudio describe y analiza el efecto de prácticas tradicionales de gestión en el desempeño de hospitales de tamaño medio. Las empresas de tamaño medio son aquellas en las que es habitual encontrar mayores diferencias en el uso de las prácticas, y el sector hospitalario sólo ha buscado recientemente, en el área de administración, formas de desarrollar su competitividad. De manera general, los resultados indican que las prácticas básicas de gestión sí pueden conllevar diferencias de desempeño, ofreciendo apoyo a una nueva perspectiva de la PBV (practice-based view). De hecho, se verificó que los hospitales que presentaron una mayor tasa de adopción de prácticas, poseían una mayor tasa de ocupación, internamientos por cama y certificado de acreditación. La no adopción de las prácticas por parte de los hospitales de tamaño medio conlleva una limitación de su capacidad competitiva, que puede ser entendida como un componente más del coste Brasil, sin embargo, esta vez, como un componente interno.

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Publicly reported hospital performance data have become widely available to health care consumers in recent years. In response to a growing demand for more readily available health care information, various organizations have begun assessing hospital performance. These performance reporting systems have tremendous potential to aid patients, families, and primary care providers in their clinical decision making. This study takes a systematic approach to review the main features of 9 existing hospital rating systems, each of which is described using 9 areas of evaluation. The hospital rating systems included in this study vary widely in scope, methodology, transparency, and presentation of their results. Their results often present conflicting conclusions regarding the performance of the same hospital. This review of hospital rating systems demonstrates how public reporting may add confusion to patients' health care decision making.

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OBJECTIVE: Over 200,000 in-hospital cardiac arrests occur in the United States each year and many of these events may be preventable. Current vital sign-based risk scores for ward patients have demonstrated limited accuracy, which leads to missed opportunities to identify those patients most likely to suffer cardiac arrest and inefficient resource utilization. We derived and validated a prediction model for cardiac arrest while treating ICU transfer as a competing risk using electronic health record data. DESIGN: A retrospective cohort study. SETTING: An academic medical center in the United States with approximately 500 inpatient beds. PATIENTS: Adult patients hospitalized from November 2008 until August 2011 who had documented ward vital signs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Vital sign, demographic, location, and laboratory data were extracted from the electronic health record and investigated as potential predictor variables. A person-time multinomial logistic regression model was used to simultaneously predict cardiac arrest and ICU transfer. The prediction model was compared to the VitalPAC Early Warning Score using the area under the receiver operating characteristic curve and was validated using three-fold cross-validation. A total of 56,649 controls, 109 cardiac arrest patients, and 2,543 ICU transfers were included. The derived model more accurately detected cardiac arrest (area under the receiver operating characteristic curve, 0.88 vs 0.78; p < 0.001) and ICU transfer (area under the receiver operating characteristic curve, 0.77 vs 0.73; p < 0.001) than the VitalPAC Early Warning Score, and accuracy was similar with cross-validation. At a specificity of 93%, our model had a higher sensitivity than the VitalPAC Early Warning Score for cardiac arrest patients (65% vs 41%). CONCLUSIONS: We developed and validated a prediction tool for ward patients that can simultaneously predict the risk of cardiac arrest and ICU transfer. Our model was more accurate than the VitalPAC Early Warning Score and could be implemented in the electronic health record to alert caregivers with real-time information regarding patient deterioration.

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O artigo descreve a percepção de profissionais de saúde a respeito do prontuário eletrônico do paciente na gestão de hospitais e o impacto dessa tecnologia no trabalho. A coleta de dados ocorreu em 2009 e 2010 com 336 usuários deste prontuário, em dois hospitais universitários, sendo um no Brasil e outro na Espanha. Os participantes da pesquisa preencheram um questionário contendo respostas padronizadas em escala de concordância do tipo Likert. Foram realizadas análises estatísticas descritivas e inferenciais e os resultados mostram que: a) esta tecnologia é percebida como um mecanismo que contribui com a gestão e a assistência hospitalar mediante mecanismos de controle; b) os respondentes com maior domínio de informática concordam mais do que aqueles com menor domínio a respeito do impacto desse prontuário no respectivo desempenho; c) há diferenças estatisticamente significativas nas médias de percepção do papel desse prontuário no desempenho quando considerado o tempo de serviço e o hospital (ou o país) onde o participante da pesquisa trabalha. Estudos adicionais são sugeridos no final.

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Este estudo analisa o desempenho de um hospital de ensino antes e após a contratualização com o Sistema Único de Saúde (SUS), mediante avaliação das dimensões "estrutura" e "resultado" e as respectivas categorias de análise. Foram selecionados indicadores referidos nacionalmente e parâmetros nacionais. O instrumento foi apreciado por profissionais envolvidos com a contratualização do hospital em estudo. A análise comparativa do desempenho mostrou que, na dimensão "estrutura", houve melhora nas categorias instalações e equipamentos e receita, e piora na de recursos humanos; na dimensão "resultado", houve melhora nas categorias produção e ensino e pesquisa, e piora, na de custos e qualidade; não houve alteração de desempenho na categoria "produtividade". Os principais resultados atribuídos à contratualização foram: aumento dos equipamentos de saúde, aumento dos procedimentos ambulatoriais e hospitalares de alta complexidade, ampliação da oferta de consultas especializadas e aumento da receita.

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