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A limpeza é a primeira e mais essencial etapa antes que qualquer processo de desinfecção ou esterilização possa ocorrer. Nesta etapa ocorre a fricção manual dos materiais com escovas apropriadas a fim de eliminar sujidades. A depender das características, estas escovas podem ter um custeio elevado para os serviços de saúde, especialmente em países com recursos limitados como o Brasil. Elucidar, em tempo oportuno, o que traz a literatura sobre as características necessárias às escovas de limpeza em Centrais de Materiais e Esterilização (CME), especialmente sobre a necessidade de serem autoclavadas.

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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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This exploratory case study was performed aiming at implementing the Activity-based Costing (ABC) method in a sterile processing department (SPD) of a major teaching hospital. Data collection was performed throughout 2006. Documentary research techniques and non participant closed observation were used. The ABC implementation allowed for learning the activity-based costing of both the chemical and physical disinfection cycle/load: (dollar 9.95) and (dollar 12.63), respectively; as well as the cost for sterilization by steam under pressure (autoclave) (dollar 31.37) and low temperature steam and gaseous formaldehyde sterilization (LTSF) (dollar 255.28). The information provided by the ABC method has optimized the overall understanding of the cost driver process and provided the foundation for assessing performance and improvement in the SPD processes.

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Esta pesquisa exploratória descritiva, na modalidade de estudo de caso, teve por objetivo a aplicação do Custeio Baseado em Atividades (ABC) em Centro de Material e Esterilização (CME) de um hospital de ensino de capacidade extra. A coleta de dados ocorreu durante o ano de 2006, utilizando-se as técnicas de análise documental e observação direta não participante. A análise de processos possibilitou o conhecimento dos custos do ciclo/carga de desinfecção química ($9.95) e física ($12.63), e esterilização por vapor saturado sob pressão ($31.37) e por vapor de Baixa Temperatura e Formaldeído Gasoso ($255.28). As informações geradas pelo ABC resultaram na compreensão do processo gerador de custos e forneceram base para a mensuração de desempenho e melhorias de processos do CME.

This exploratory case study was performed aiming at implementing the Activity-based Costing (ABC) method in a Sterile Processing Department (SPD) of a major teaching hospital. Data collection was performed throughout 2006. Documentary research techniques and non participant closed observation were used. The ABC implementation allowed for learning the activity-based costing of both the chemical and physical disinfection cycle/load: ($9.95) and ($12.63), respectively; as well as the cost for sterilization by steam under pressure (autoclave) ($31.37) and low temperature steam and gaseous formaldehyde sterilization (LTSF) ($255.28). The information provided by the ABC method has optimized the overall understanding of the cost driver process and provided the foundation for assessing performance and improvement in the SPD processes.

Esta investigación exploratoria descriptiva efectuada en la modalidad de estudio de caso, tuvo por objetivo la aplicación del Costeo Basado en Actividades (ABC) en un Centro de Material y Esterilización (CME) de un hospital de enseñanza de capacidad extra. La recolección de datos se efectuó durante el año 2006 utilizándose las técnicas de análisis documental y observación directa no participativa. El análisis de procesos posibilitó el conocimiento de los costos de ciclo/carga de desinfección química ($9,95) y física ($12,63), y de esterilización por vapor saturado bajo presión ($31,37) y por vapor de baja temperatura y formaldehido gaseoso ($255,28). Las informaciones generadas por el ABC favorecieron la comprensión del proceso generador de costos y brindaron una base para la medición de desempeño y mejorías de procesos del CME.

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Municipal managers need to dedicate special attention to hospitalizations, due to the financial volume they consume and to the possibility of reorganizing the local health system. This descriptive and cross-sectional study characterizes the production of hospitalizations, in physical and financial terms, between 1996 and 2003, in Ribeirão Preto, SP, Brazil. Data were obtained from a secondary data source, the Datasus database, and showed an increase of 56% in hospitalizations, and 156.3% in financial resources during this period. The largest growth occurred in the clinical surgery area (72.4%), which concentrates more complex and technological procedures, implying higher financial remuneration than in other specialties.

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Cost estimates are derived for services provided at the Milton Cato Memorial Hospital (previously known as the Kingstown General Hospital) using the step-down accounting method Both total and average unit cost estimates are provided Among the findings of note is that the cost per patient per day spent on the Maternity Ward is 57.4% higher than for the Surgical Ward. Even with the 1995 increase in user fees, the levels of subsidization for inpatient services remains relatively high at 78%-96% for public patients and 43%-72% for private patients. Ancillary services werefoundto have lower levels of subsidization and in most cases the full costs were recovered from private patients. Laboratory services are not subsidized.

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INTRODUCTION: The influence on health costs of variations in the clinical practice of doctors makes it necessary for them to be involved in the administration of resources so as to increase the efficacy, effectiveness and efficiency of clinical units. OBJECTIVES: To analyze the activity of the Neurology Department of the Virgen de las Nieves Hospital of Granada and to determine its costs per GRD. PATIENTS AND METHODS: Activity during 1996 was compared with that of the previous year and with a standard using measurements of cases, efficiency in administration of beds, quality of data and quality of care. The GRD costs of the service were found. RESULTS: Ninety percent of the discharges were grouped in 20 GRD, and GRD 014 and 015 represented 44% of the productivity. Complexity of the cases was 5% more than in 1995, similar to that of Rule IV [20]. Extreme cases led to a third of all admissions. Mortality was less than expected (3.13%). Hospital stays made up 82% of the total cost. The cost of one stay in hospital was 463.686 pesetas. CONCLUSIONS: It is essential to improve the structure and procedures related to hospital care of patients with cerebral vacular pathology. Those with uncomplicated conditions should be attended as outpatients or in smaller hospitals. The GRD costs obtained are not comparable to those of other authors. Hospital activity should be measured homogeneously and use should be made of analytical accounting systems with common operators and standardized applications so as to obtain reliable, comparable data.

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Se realizó un análisis económico en el Servicio de Neuropediatría del Hospital Pediátrico Provincial Docente "José Luis Miranda", de Santa Clara, en el año 1989. Este servicio de 48 camas, 33 para afecciones clínicas neurológicos y 15 para neurocirugía, hospitaliza 2 644 pacientes por año y el costo día/paciente en ese período fue de $ 18,13. Se analiza la baja positividad de los exámenes de laboratorio y los estudios radiográficos, fundamentalmente la radiografía de cráneo, en los que la positividad fue del 2 por ciento . Se estudian las causas fundamentales de hospitalización y se sugieren medidas específicas para el período especial en relación con el empleo racional de los exámenes complementarios y la positividad de disminuir objetivamente el número de ingresos de forma considerable

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User fees and other forms of copayment for health care are becoming of increasing interest to policymakers in developing countries. As indigenous populations continue to expand in response to current and historically high fertility, and government resources become constrained due to macroeconomic circumstances, publicly provided health care is being squeezed financially. Most developing countries have committed their governments to either providing for all health care or at least ensuring that all citizens have access to health care regardless of ability to pay. This has translated in most contexts into blanket coverage for the entire population financed and generally provided by the government. Recent periods of slow growth, high debt burdens and restricted spending on high recurrent cost sectors, such as health care under International Monetary Fund and other donor agreements have reduced many developing countries' budgets and often the real value of health expenditures. The costs of inputs (personnel, drugs and consumables), however, have not declined and quality or quantity have been necessarily reduced. At the same time, options for financial relief outside the tax system have become of increasing interest to financially constrained governments. User charges are straightforward, easily understood and can in theory be profitable in the short term. From a fairness perspective, they also charge those who actually use the health system. Their major drawback for policymakers is the potential for undermining equity in the health system.

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Nosocomial infections increase the morbidity, mortality and cost of hospitalization. The Hospital Infection Committee of the Metropolitan Hospital Complex of the Caja de Seguro Social de Panama studied the problem of nosocomial infections in 1987 and showed that of 29,576 admissions, 820 patients developed 994 nosocomial infections (an annual incidence of 3.69%). This resulted in 5191 additional days of hospitalization, at a conservatively estimated cost of B/ 840,153, and was responsible for 24 deaths. An adequate and efficient program of control of nosocomial infections in recommended.

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Las infecciones nosocomiales aumentan la morbilidad, la mortalidad y el costo de la reclusión institucional. El Comité de Infecciones Nosocomiales del Complejo Hospitalario Metropolitano de la Caja de Seguro Social de Panamá (CHMCSS) hizo el estudio del problema en el año de 1987 y determinó que de un total de 29.576 pacientes admitidos, 820 pacientes desarrollaron 994 infecciones asociadas al hospital (prevalencia anual de 3.69 por ciento). Esta incidencia representó 5,191 días adicionales de reclusión, un costo conservador de $840.153 balboas, y fue la causa de 24 fallecimientos. Se recomienda un eficiente y adecuado programa de control de las infecciones asociadas al nosocomio

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Hospital administrators, nurses, and physicians must strive to improve efficiency as new payment systems constrain health care spending. Our purpose in this project was to confirm the hypothesis that four clinical variables (emergency or intensive care unit [ICU] admission, and blood or plasma product use) could predict hospital costs and outcome for adult patients with hypertension. We analyzed hospital costs (exclusive of physician fees) for all patients with either a primary or secondary diagnosis of hypertension (N = 4289) receiving treatment during a 2-year period at an academic medical center. In addition to predicting outcome (i.e., whether the patient lived or died), these four clinical variables predicted differences in hospital cost per patient, and financial risk per Diagnosis-Related Group (DRG) as measured by percentage of "outliers" (patients whose length of stay exceeds the cutoff point) or profit/loss per patient under DRG prospective hospital payment. The cost and predictive effect on cost and mortality of the variables were also cumulative; patients with hypertension with one variable had two times the cost of patients with no variables; patients with hypertension with two variables, 2.2 times the cost; patients with three variables, 4.3 times; and patients with four variables, 6.8 times. The mortality of patients with no variables was 0.8%; one variable, 7.7%; two variables, 12.7%; three variables, 15.7%; and four variables, 25.8%. Patients with hypertension can thus be stratified by cost and outcome by clinical events that occur during the patient's hospital stay.(ABSTRACT TRUNCATED AT 250 WORDS)

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Al conocer el medio ambiente que rodea al individuo y las interacciones que ejercen los factores culturales, sociales y economicos, se lo puede ubicar dentro del contexto que le corresponde y de esta forma planificar y desarrollar programas que lo ayuden a su realización como persona. La buena administración de un servicio de nutrición, es parte fundamental en la prevención, promoción, recuperación y rehabilitación de la salud del individuo, ya que asi se lo incorpora como miembro activo en nuestra sociedad. La administración eficiente de todos los recursos disponibles, contribuye a lograr un mayor rendimiento al menor costo posible. Estas acciones se someten a supervisión y evaluación constante para lograr los objetivos propuestos

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El enfoque metodológico diseñado para realizar este trabajo, generó la necesidad de entregar un equipo de trabajo multidisciplinario para orientarlo de una manera integral y sistemática, a fin de poder obtener resultados concretos y confiables. En relación al alcance. Se propuso determinar la realidad de perfiles industriales para un proyecto de centralización de servicios definiendo cuales servicios deben ser centralizados

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