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RESUMO: Importância do problema: É indiscutível a importância do hospital na organização no Sistema Único de Saúde (SUS). Os hospitais com 50 leitos ou menos, também chamados de hospitais de pequeno porte (HPP) são essenciais para a construção das redes de atenção à saúde (RAS) considerando sua capilaridade no sistema. Objetivo: Descrever a caracterização dos hospitais de pequeno porte e sua adequação à política vigente. Método: Trata-se de um estudo transversal, descritivo, realizado a partir de dados secundários obtidos de bases de dados nacionais: Cadastro Nacional de Estabelecimentos de Saúde (CNES-MS), Sistema de Informações Hospitalares (SIH/SUS) e o sistema de registro de dados hospitalares da Regional de Saúde. O estudo foi realizado em uma região de saúde localizada no norte do Paraná, Brasil. Resultados: Neste estudo, 100% dos hospitais em cidades pequenas da 17ª Regional de Saúde do Paraná são de pequeno porte. A oferta de leitos atende à estabelecida pela portaria do Ministério da Saúde n° 1.101/2002. Observou-se a extrema ociosidade da capacidade instalada, centros cirúrgicos inativos e baixíssima ocupação dos leitos hospitalares. Conclusão: Conclui-se que a forma de pactuação/contratualização isolada de cada hospital não surtiu os efeitos desejados pela Política Nacional de HPP (PNHPP). Sugere-se que uma nova vinculação ocorra de forma regionalizada e que se criem um sistema unificado de gestão. (AU)

ABSTRACT: Importance of the problem: The importance of the hospital in the organization of the Brazilian Unified Health System (UHS)is indisputable. Hospitals with 50 beds or fewer, also called small hospitals are essential for building health care networks considering their capillarity in the system. Objective: Describing the characterization of small hospitals and their adequacy to current policy and confirm the results presented so far in the literature. Method: This is a cross-sectional, descriptive study based on secondary data obtained from the national databases: National Registry of Health Establishments, Hospital Information System, and registry of data of the Regional of Health. The study was conducted in a health region located in northern Paraná, Brazil. Results: In this study, more than 90% of the hospitals in towns of the 17th Regional of Health of Paraná are small. The supply of beds meets the guidelines of the Ministry of Health n. 1,101/2002. It was observed the extreme idleness of facilities, inactive surgical centers, and low occupation of hospital beds. Conclusion: It is concluded that the form of agreement isolated from each hospital did not have the desired effects by national small hospital policy. It is suggested that a new connection occurs regionally and that a unified management system might be created. (AU)

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Chile is experiencing a period of rapid aging, which increases the need of long-term care services in the country. Nursing homes have been the traditional alternative to deal with the increase of elderly population in the country, with services supplied by a mix of for-profit and nonprofit providers. Additionally, population exhibits a high degree of geographical concentration. The study aims to identify the determinants of the geographical location of nursing homes in Chile at municipality level. The analysis takes into account the different location criteria for different types of nursing homes as well as potential spatial effects. The paper uses spatial analysis tools to identify clusters of nursing homes and population characteristics and to estimate the determinants of nursing homes availability and coverage in the country. The analysis-based on spatial global and local tests, and spatial autoregressive models- show the existence of clusters of nursing homes as well as clusters of municipalities according to elderly population, income, poverty, population density, and public health insurance coverage. Residuals from ordinary least squares regressions were spatially autocorrelated, showing the need of using spatial models. Estimations show that availability and coverage of nursing homes are positively related with municipality income, and that for-profit and nonprofit facilities respond differently to different factors. A negative coefficient was found for poverty in nonprofit nursing homes, raising doubts about the effectiveness of giving public subsidies to incentive the installation of facilities in areas with high needs and low income.

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OBJECTIVE: To evaluate pharmaceutical services in public hospital pharmacies of  the Federal District Health Department - Brazil (Secretaria de Saúde do Distrito  Federal, SES-DF). METHOD: A cross-sectional evaluative study involving the 15 public hospitals under the SES-DF management. Hospitals were characterized and classified into four hierarchical strata. The pharmaceutical services related  to programming (quantity of medication to order), acquisition, storage,  distribution, management, selection, information, pharmacotechnical  component, pharmacotherapy follow-up, teaching and research were evaluated  using validated indicators. Next, algorithms were applied and the approximation percentages of service compliance were calculated, then  correlated to variables that could influence their results through linear regression analysis. RESULTS: Only four hospital pharmacies presented good compliance with the  evaluated services, three of them belonging to less complex hospitals. Only the  storage and management services presented good performance. The variables  that most influenced the performance of the services were managerial aspects  related to pharmacists and non pharmacists' workload per bed, the existence of  a program for human resources qualification, planning goals and targets and a  manual of norms and procedures, as well as professional qualification and  adequacy of the area in which the services were performed (p < 0.01). CONCLUSIONS: The evaluated hospital pharmacies had average performance for  services compared to the ideal and better performance in logistics activities.  Pharmaceutical services require constant evaluation for rational interventions  that increase the proportion of executed health care activities and local  management capacity to make such actions more effective, efficient, qualified  and safe in the context of the SES-DF hospital network.

Objetivo: Evaluar los servicios farmacéuticos en farmacias públicas de hospitales del Departamento de Salud del Distrito Federal ­ Brasil (Secretaria de Saúde do Distrito Federal, SES-DF).Método: Estudio transversal evaluativo de los 15 hospitales públicos bajo  gestión de la SES-DF. Los hospitales fueron caracterizados y se clasificaron en  cuatro estratos jerárquicos. Los servicios de programación, adquisición, almacenamiento, distribución, gestión, selección, información, farmacotécnica, seguimiento farmacoterapéutico, enseñanza y  investigación fueron evaluados utilizando indicadores validados. Se aplicaron  algoritmos y se calcularon los porcentajes de aproximación del cumplimiento del  servicio, que se correlacionaron con variables que podrían influir en los  resultados a través de la regresión lineal.Resultados: Solo cuatro farmacias hospitalarias presentaron un buen cumplimiento de los servicios evaluados; tres pertenecientes a hospitales menos complejos. Solo el almacenamiento y la gestión presentaron  un buen desempeño. Las variables que más influyeron en el desempeño de los  servicios fueron la carga de trabajo de farmacéuticos y no farmacéuticos por  cama; la existencia de un programa de cualificación de recursos humanos,  objetivos y metas; el manual de normas y procedimientos, y la cualificación  profesional y la adecuación del área de ejecución de los servicios (p < 0,01).Conclusiones: Las farmacias hospitalarias evaluadas presentaron un cumplimiento medio de los servicios en comparación con el ideal y el mejor desempeño de las actividades logísticas. Los servicios farmacéuticos requieren una evaluación constante con vistas a intervenciones  racionales que amplíen la ejecución de las actividades asistenciales y la  capacidad de gestión local con el objetivo de hacer tales acciones más efectivas, eficientes, cualificadas y seguras.

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OBJECTIVE: Tracheal intubation in PICUs is associated with adverse tracheal intubation-associated events. Patient, provider, and practice factors have been associated with tracheal intubation-associated events; however, site-level variance and the association of site-level characteristics on tracheal intubation-associated event outcomes are unknown. We hypothesize that site-level variance exists in the prevalence of tracheal intubation-associated events and that site characteristics may affect outcomes. DESIGN: Prospective observational cohort study. SETTING: Fifteen PICUs in North America. SUBJECTS: Critically ill pediatric patients requiring tracheal intubation. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Tracheal intubation quality improvement data were collected in 15 PICUs from July 2010 to December 2011 using a National Emergency Airway Registry for Children with robust site-specific compliance. Tracheal intubation-associated events and severe tracheal intubation-associated events were explicitly defined a priori. We analyzed the association of site-level variance with tracheal intubation-associated events using univariate analysis and adjusted for previously identified patient- and provider-level risk factors. Analysis of 1,720 consecutive intubations revealed an overall prevalence of 20% tracheal intubation-associated events and 6.5% severe tracheal intubation-associated events, with considerable site variability ranging from 0% to 44% tracheal intubation-associated events and from 0% to 20% severe tracheal intubation-associated events. Larger PICU size (> 26 beds) was associated with fewer tracheal intubation-associated events (18% vs 23%, p = 0.006), but the presence of a fellowship program was not (20% vs 18%, p = 0.58). After adjusting for patient and provider characteristics, both PICU size and fellowship presence were not associated with tracheal intubation-associated events (p = 0.44 and p = 0.18, respectively). Presence of mixed ICU with cardiac surgery was independently associated with a higher prevalence of tracheal intubation-associated events (25% vs 15%; p < 0.001; adjusted odds ratio, 1.81; 95% CI, 1.29-2.53; p = 0.01). Substantial site-level variance was observed in medication use, which was not explained by patient characteristic differences. CONCLUSIONS: Substantial site-level variance exists in tracheal intubation practice, tracheal intubation-associated events, and severe tracheal intubation-associated events. Neither PICU size nor fellowship training program explained site-level variance. Interventions to reduce tracheal intubation-associated event prevalence and severity will likely need to be contextualized to variability in individual ICUs patients, providers, and practice.

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PURPOSE: The aim of this study is to identify the occurrence of Burnout Syndrome (BS) and assess its relationship with different labour-related aspects, among nursing professionals at two medium-sizes hospitals in the city of Cáceres. METHOD: This is a transversal and descriptive study, with a sample totalling 141 subjects. As an instrument of research, we used a questionnaire for the limitation of labour-related aspects, with the addition of the Maslach Burnout Inventory (MBI). RESULTS: Out of the 141 professional people considered, 13 had BS, according to the MBI. In relation to the different labour aspects, the professional people most affected were those with: work regime based on pay by the day, a working week of 30 hours, regularly hired, with double employment, lower graduation period, less time spent at the unit, and active in the administrative segment. CONCLUSIONS: Hence, there was the demonstration of the presence of BS within the sample, showing the need for the proposal of organisational changes within the working environment so as to reduce these factors and their interference on the health of the worker.

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PURPOSE: The aim of this study is to identify the occurrence of Burnout Syndrome (BS) and assess its relationship with different labour-related aspects, among nursing professionals at two medium-sizes hospitals in the city of Cáceres. METHOD: This is a transversal and descriptive study, with a sample totalling 141 subjects. As an instrument of research, we used a questionnaire for the limitation of labour-related aspects, with the addition of the Maslach Burnout Inventory (MBI). RESULTS: Out of the 141 professional people considered, 13 had BS, according to the MBI. In relation to the different labour aspects, the professional people most affected were those with: work regime based on pay by the day, a working week of 30 hours, regularly hired, with double employment, lower graduation period, less time spent at the unit, and active in the administrative segment. CONCLUSIONS: Hence, there was the demonstration of the presence of BS within the sample, showing the need for the proposal of organisational changes within the working environment so as to reduce these factors and their interference on the health of the worker.

OBJETIVO: identificar a incidência da Síndrome de Burnout (SB) e avaliar sua relação com os aspectos laborais, em profissionais de enfermagem de dois hospitais de médio porte de Cáceres, MT. MÉTODO: trata-se de estudo descritivo, transversal, com amostra de 141 sujeitos. Como instrumento de pesquisa utilizou-se um questionário para o delineamento dos aspectos laborais, acrescido do Maslach Burnout Inventory (MBI). RESULTADOS: dos 141 profissionais, 13 apresentaram SB, segundo o MBI. Em relação aos aspectos laborais, os profissionais mais acometidos foram aqueles com regime de trabalho diarista, 30 horas semanais de serviço, contratado, duplo emprego, menor tempo de formação, pouco tempo na unidade e atuantes no setor administrativo. CONCLUSÕES: logo, demonstrou-se a presença da SB na amostra, revelando necessidade de se propor mudanças organizacionais no ambiente de trabalho, a fim de diminuir a interferência desses fatores na saúde do trabalhador.

OBJETIVO: Identificar la incidencia de síndrome de Burnout (BS) y evaluar su relación con los aspectos laborales, personal de enfermería de dos hospitales de medio portea de Cáceres. MÉTODO: Se trata de un estudio descriptivo, de corte transversal de la muestra de 141 sujetos. Como instrumento de investigación se utilizó un cuestionario para el delineamiento de los aspectos laborales, aumentando del Maslach Burnout Inventory (MBI). RESULTADOS: De los 141 profesionales, 13 presentaron SB según MBI. Con relación con los aspectos laborales los profesionales más acometidos son aquéllos con: régimen de trabajo diarista, 30 horas semanales de servicio, contratado, doble empleo, menor tiempo formación, poco tiempo en la unidad y actuación en el sector administrativo. CONCLUSIONES:Luego, se demostró la presencia de SB en la muestra, revelando necesidad de proponerse cambios organizacionales en el ambiente de trabajo a fin de apocar estos factores interfieren en la salud del trabajador.

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OBJECTIVE: To determine the effectiveness and costs of different organizational models in caring for colorectal cancer patients through either clinical management functional units or traditional clinical services. METHOD: Post-operative and long-term (after 30 days and 5 years) mortality was analyzed according to number of patients undergoing surgery because of colorectal cancer. Mortality was adjusted for patient-related confounding factors. With that purpose a thorough review of the literature was conducted; information obtained was used in a meta-analysis of randomized effects. Concerning costs, a literature search was run to describe differences in number of patients per year between hospitals. RESULTS: Surgery costs were found to be smaller, and mean hospital stay shorter, in big-sized hospitals. The meta-analysis showed that the risk of death at 30 days and 5 years was lower in big hospitals versus smaller ones (OR: 1.112; 95% CI 0.986-1.255, and OR: 1.114; 95% CI 1.105-1.183, respectively). CONCLUSIONS: Short- and long-term postoperative mortality is lower in hospitals with a high number of cases per year.

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BACKGROUND: We sought to identify affordable and sustainable methods to strengthen trauma care capabilities globally, especially in developing countries, using the Guidelines for Essential Trauma Care. These guidelines were created by the World Health Organization (WHO) and the International Society of Surgery and provide recommendations on elements of trauma care that should be in place at the range of health facilities globally. METHODS: The guidelines were used as a basis for needs assessments in 4 countries selected to represent the world's range of geographic and economic conditions: Mexico (middle income; Latin America); Vietnam (low income; east Asia); India (low income; south Asia); and Ghana (low income; Africa). One hundred sites were assessed, including rural clinics (n=51), small hospitals (n=34), and large hospitals (n=15). Site visits utilized direct inspection and interviews with administrative and clinical staff. RESULTS: Resources were partly adequate or adequate at most large hospitals, but there were gaps that could be improved, especially in low-income settings, such as shortages of airway equipment, chest tubes, and trauma-related medications; and prolonged periods where critical equipment (e.g., X-ray, laboratory) were unavailable while awaiting repairs. Rural clinics everywhere had difficulties with basic supplies for resuscitation even though some received significant trauma volumes. In all settings, there was a dearth of administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and regular in-service training. CONCLUSIONS: This study identified several low-cost ways in which to strengthen trauma care globally. It also has demonstrated the usefulness of the Guidelines for Essential Trauma Care in providing an internationally applicable, standardized template by which to assess trauma care capabilities.

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O presente estudo, parte de um projeto mais amplo, teve por objetivo caracterizar a estrutura física das UTIs do município de Säo Paulo, enquanto recurso indispensável da qualidade dos serviços de saode. Os dados foram coletados em 43 UTIs de 32 hospitais escolhidos por sorteio. Os resultados demonstraram que as UTIs, em média, têm 10 leitos, rea total de 234,5 m2, sendo de 7,4 m2 a área por unidade de paciente, portanto, abaixo das recomendaçöes oficiais. O acesso ao Centro Cirúrgico e Recuperaçäo P1/2s-Anestésica é fácil para a maioria das UTIs, porém dificultado para os Serviços de Apoio Diagnóstico. Nenhuma UTI dispöe da totalidade das áreas de infra-estrutura indicada para o seu funcionamento, embora essa seja uma determinaçäo das normas oficiais que regulamentam a construçäo e reforma da estrutura física das instituiçöes de saúde no Brasil.

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The present study analyses the organization of newborn care in different nurseries in the region of Ribeirão Preto as well as how nursing participates in this work. Through observation and interviews in 4 nurseries, we found that the work organization varies according to the hospital size and complexity. Action is centred on the child and in more complex cases, priority is given to the pathology and clinical care. We also observe enlarged actions, involving the binomial mother-child and the family. The quality of care is a result of a complex combination of human resources, material and installation. Bigger and more complex institutions present a diversity of personnel, more bureaucracy and hierarchy, information and technology system, routine procedures by written norms and more sophisticated equipment. The object of action is centred on the child, but there are practices in which the object is enlarged to the binomial mother-child and the family.

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This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.

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Geographical localization and size are two factors which play an important role in accessibility to health services. This accessibility, in its turn, is a basic requirement for ensuring the access of the population to health. A study was undertaken, in Santo Amaro, a suburb of the city of S. Paulo, Brazil, on the application of a methodology which takes into account the relationships among the geographical, demographic and social variables, in each particular situation, leading to the formulation of alternative proposals for the localization and size of health services. The kind of approach to each situation employed in this study proved fundamental in opening up a broad range of possibilities for the study of other subjects through the application of the same methodology, especially recommended for the implanting of local health systems.

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A localizaçäo geográfica e dimensäo dos serviços de saúde säo fatores que interferem em sua acessibilidade. Esta, por sua vez, É um prÉ-requisito fundamental para se garantir o acesso da populaçäo à saúde. Assim, foi ralizado trabalho que se baseia na aplicaçäo de uma metodologia que considera as relaçöes de variáveis geográficas, demográficas e sociais, em nível de cada realidade, possibilitando o estabelecimento de propostas alternativas para a localizaçäo e dimensäo de serviços de saúde. Tal metodologia foi aplicada à Regiäo de Santo Amaro, Município de Säo Paulo, Brasil. A contribuiçäo dada pela abordagem geográfica, demográfica e social de cada realidade abre ampla perspectiva quanto ao estudo de novos objetos, pela utilizaçäo da mesma metodologia cuja aplicaçäo É recomendada à implementaçäo de sistemas locais de saúde

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