Improving performance of the hospitalization process by applying the principles of Lean Thinking

Purpose: The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS). Design/methodology/approach: The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018. Findings: The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001. Originality/value: The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare

Impact of the hospitalization process on children

Trabajo fin de grado en EnfermeríaIntroducción: La actividad sanitaria ha evolucionado desde tener un enfoque únicamente de la esfera biológica, hasta centrar su atención en toda la esfera biopsicosocial. Así bien, el contexto psicosocial del niño hospitalizado cobra un papel importante para su bienestar y adaptación al ámbito hospitalario, haciéndose imprescindible el papel de la enfermería para la detección y prevención de eventos adversos, que este proceso pueda desencadenar. Objetivo: se establece un objetivo general, explorar la experiencia del paciente pediátrico y de sus familiares durante el proceso de hospitalización; y unos objetivos específicos: identificar efectos negativos documentados en el niño y en sus padres; identificar estrategias de afrontamiento de niños y padres; conocer el papel desempeñado por los profesionales de enfermería durante el proceso de institucionalización; y determinar las secuelas de la hospitalización infantil. Metodología: Se llevó a cabo una revisión bibliográfica en las principales bases de datos y bibliotecas electrónicas de ciencias de la salud, Pubmed, CINAHL, Cuiden, PsyInfo, SciElo y Enferteca. Resultados: Se analizaron 17 artículos con dos perspectivas diferentes; el impacto de la hospitalización pediátrica en niños y el impacto de la hospitalización pediátrica en padres. Conclusiones: Es importante que los profesionales de enfermería conozcan y satisfagan todas las necesidades que rodean al niño (incluyendo su contexto familiar), con unos cuidados de calidad, para conseguir la mejor adaptación posible al proceso de hospitalización y que este sea menos traumático. Así bien, estos profesionales han de buscar servir como figura de apoyo tanto para el paciente pediátrico como para su familia.Introduction: Health activity has evolved from a focus exclusively on the biological sphere, to a focus on the entire biopsychosocial sphere. Thus, the psychosocial context of the hospitalized child has an important role for their welfare and adaptation to the hospital context, making the role of nursing essential in the detection and prevention of adverse events that this process may trigger. Objective: a general objective is set, to explore the experience of children and their family members during the hospitalization process. In addition, the aim consist on, the identification of documented negative effects on children and their parents, to identify coping strategies for children and parents; to know the role played by nursing professionals during the institutionalization process; and to determine the consequences of child hospitalization. Methodology: A literature review was carried out on the main health sciences databases and electronic libraries, Pubmed, CINAHL, Cuiden, PsyInfo, SciElo and Enferteca. Results: 17 articles were analysed with two different perspectives; the impact of paediatric hospitalisation on children and the impact of paediatric hospitalisation on parents. Conclusions: It is important that nurses know and satisfy all the needs surrounding the child (including the family context), with quality care, to achieve the best possible adaptation to the hospitalization process and make it less traumatic. Thus, these professionals must try to become a support figure for both the paediatric patient and his family

Effects of clown therapy in the child's hospitalization process

Objetivo: Analisar as repercussões da Clownterapia no processo de hospitalização da criança. Métodos: Estudo exploratório-descritivo com abordagem qualitativa, desenvolvido no período de agosto a setembro de 2012 junto à equipe de Enfermagem de hospital pediátrico do município de Cajazeiras, PB. Resultados: Os principais problemas inerentes ao processo de hospitalização da criança, na ótica dos profissionais de enfermagem, consistiram na mudança do ambiente natural da criança e no tempo de permanência no hospital. Dentre as modificações dadas a partir da Clownterapia, notou-se a formação espontânea de vínculos entre a equipe de enfermagem, as crianças e seus respectivos responsáveis, facilitando a compreensão e colaboração destes em todas as etapas do cuidar. Conclusão: A Clownterapia mostra-se como facilitadora das práticas específicas da enfermagem no aspecto individual e coletivo das crianças hospitalizadas, trazendo a perspectiva de promoção da saúde para estes sujeitos

The daily life of relatives of patients admitted in icu: a study with social representations

Identifying which social representations of family members of patients admitted to the Intensive Care Unit (ICU) about the ICU and the hospitalization process and analyzing the implications of these for their everyday life. Method: this was a qualitative study based on the Theory of Social Representations. Results: the Statements of the relatives were synthesized in four themes: the perception of family members with respect to ICU; the family of the suffering of daily life; the "technological shock"; Religiosity: Hope of Salvation. Conclusion: through all the above was possible to observe the importance of looking for ways to understand and respond more humanized and warmly family lying in a hospital setting

Acute Psychiatric Hospitalization of the Mentally Ill in the Metropolis: An Empirical Study

Part I describes the development of the legal framework for legally-proscribed criteria for nonvoluntary hospitalization. Part II is a description of how the purportedly regulated system actually works, applied at various points in the process. While the discussion is structured as a description of the steps from the community to full-time hospitalization, the descriptions and the illustrative examples should present a fairly complete picture of the variety of situations with which a metropolitan public acute psychiatric hospitalization service is called upon to deal. Part III is a discussion of one central legal issue, the role of the judiciary in the hospitalization process, in light of the conclusions reached in Parts I and II

O significado da interação das profissionais de enfermagem com o recém-nascido/família durante a hospitalização

This study aimed to understand the meaning of the nursing team's communication with newborns and families during care delivered in a neonatal unit and also to develop a theoretical model. Symbolic Interactionism and Hargie's model were used as theoretical and Grounded theory as the methodological reference framework. The study was carried out at the nursery of a hospital in São Paulo, SP, Brazil. The study sample was composed of three nurses and four nursing auxiliaries. The theoretical model Being mediated by the strength of motivation was based on findings and revealed the role the nursing professionals' motivation played during interactions with newborns and families. The conclusion is that more humanized interactions with newborns and families result from the nursing professionals' motivation.Este estudio tuvo por objetivos comprender el significado de la comunicación del equipo de enfermería con el recién nacido/familia en la asistencia prestada en una unidad neonatal, y desarrollar un modelo teórico. Se utilizó el Interaccionismo Simbólico y el modelo de Hargie como marcos teóricos y la Teoría Fundamentada en los Datos como referencia metodológica. El estudio fue conducido en la sala cuna de un hospital del municipio de San Pablo. La muestra fue constituida por tres enfermeras y cuatro auxiliares de enfermería. Los resultados posibilitaron obtener el modelo teórico siendo intermediada por la fuerza de la motivación, que reveló la actuación de la motivación de las profesionales de enfermería en la interacción con el recién nacido y la familia. También, se concluyó que las interacciones con el recién nacido y la familia como esencia más humanizada son provenientes de la motivación que las profesionales de enfermería presentan.Este estudo teve por objetivos compreender o significado da comunicação da equipe de enfermagem com o recém-nascido/família na assistência prestada em unidade neonatal, e desenvolver um modelo teórico. Utilizou-se o Interacionismo Simbólico e o modelo de Hargie como referenciais teóricos e a Teoria Fundamentada nos Dados como referencial metodológico. O estudo foi conduzido em berçário de um hospital do município de São Paulo. A amostra foi constituída por três enfermeiras e quatro auxiliares de enfermagem. Os resultados possibilitaram obter o modelo teórico sendo mediada pela força da motivação, que revelou a atuação da motivação das profissionais de enfermagem na interação com o recém-nascido e família. Concluiu-se, também, que as interações com o recém-nascido e a família como essência mais humanizada são decorrentes da motivação que as profissionais de enfermagem apresentam

Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study)

Background: Although results of case series support the use of spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain, no confirmatory randomized controlled trial has been undertaken in this patient group to date. PROMISE is a multicenter, prospective, randomized, open-label, parallel-group study designed to compare the clinical effectiveness of spinal cord stimulation plus optimal medical management with optimal medical management alone in patients with failed back surgery syndrome and predominant low back pain. Method/Design: Patients will be recruited in approximately 30 centers across Canada, Europe, and the United States. Eligible patients with low back pain exceeding leg pain and an average Numeric Pain Rating Scale score >= 5 for low back pain will be randomized 1:1 to spinal cord stimulation plus optimal medical management or to optimal medical management alone. The investigators will tailor individual optimal medical management treatment plans to their patients. Excluded from study treatments are intrathecal drug delivery, peripheral nerve stimulation, back surgery related to the original back pain complaint, and experimental therapies. Patients randomized to the spinal cord stimulation group will undergo trial stimulation, and if they achieve adequate low back pain relief a neurostimulation system using the Specify (R) 5-6-5 multi-column lead (Medtronic Inc., Minneapolis, MN, USA) will be implanted to capture low back pain preferentially in these patients. Outcome assessment will occur at baseline (pre-randomization) and at 1, 3, 6, 9, 12, 18, and 24 months post randomization. After the 6-month visit, patients can change treatment to that received by the other randomized group. The primary outcome is the proportion of patients with >= 50% reduction in low back pain at the 6-month visit. Additional outcomes include changes in low back and leg pain, functional disability, health-related quality of life, return to work, healthcare utilization including medication usage, and patient satisfaction. Data on adverse events will be collected. The primary analysis will follow the intention-to-treat principle. Healthcare use data will be used to assess costs and long-term cost-effectiveness. Discussion: Recruitment began in January 2013 and will continue until 2016