Idenficacion de los factores determinantes en la calidad de servicio de atenciones cerradas de un hospital afectado por una campana negativa de desempeno; caso Hospital Regional de Talca

142 p.Conocer la calidad de un servicio en particular, es relevante para poder elevar los niveles de atención que este brinda. Siendo los servicios de atención pública relevantes de analizar para permitir brindar un servicio completo, el cual proporcione soluciones eficientes a los pacientes que recurren a éstos.El presente estudio busca identificar los factores determinantes en la calidad de servicio en atenciones cerradas en el Hospital Regional de Talca, institución que se ha visto afectada por una campaña negativa de desempeño, donde sus negligencias han sido parte de la contingencia nacional. La metodología empleada fue el desarrollo de un instrumento de medición compuesto por tres partes; una adaptación del modelo SERVQUAL, que posee 40 preguntas, el modelo KANO y, por último, características demográficas. El instrumento fue aplicado a 262 ex usuarios hospitalizados en el Hospital Regional de Talca entre el 01 de Julio de 2008 y 30 de Junio de 2009. La información obtenida fue analizada a través del programa estadístico SPSS, donde se realizó un análisis factorial de las respuestas obtenidas a través de la adaptación del modelo SERVQUAL, obteniendo 9 factores relevantes; comodidad social, calidad de las salas de hospitalización, servicios psicológicos, comunicación, capacidades profesionales y tecnológicas, compromiso con la atención, calidad de espera por atención, calidad de los servicios administrativos e higiene sanitaria. El modelo KANO arrojó que los atributos analizados se clasifican de la siguiente manera; básicos, decisión del tratamiento, higiene institucional y trato humano;lineales, información externa, información al paciente, tiempo de respuesta y rapidez de hospitalización; deleite, experiencia profesional, entretención, avances tecnológicos, ambientación de la habitación y privacidad de la habitación. Al cumplir los objetivos planteados, se detectó que los factores comunicacionales son los que poseen mayor peso en la satisfacción del usuario; seguido por la comodidad social que tiene el usuario durante su estadía en la institución, la calidad de las salas de hospitalización

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons