Hospital Practices and Research

Abstract The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) showed that over the past decade, the global disability-adjusted life years (DALYs) had increased mainly due to population aging and the associated increase in the incidence of non-communicable diseases (NCDs). In 2021, NCDs caused two-thirds of all-cause mortality, with cardiovascular disease, cancer, chronic respiratory disease, and diabetes accounting for more than 80% of NCD mortality. Thus, NCDs should be prioritized from a public health perspective, with an ambitious Sustainable Development Goal (SDG) of a reduction in NCDs by one-third from 2015 to 2030. Unfortunately, the likelihood of achieving this target appears slim.

Abstract Background: Today, providing household health expenses for the health system is an important challenge. The increase in health service costs has created some problems. In this regard, the insurance seems to play a key role in such expenses for the household. One of the major problems between healthcare centers and insurance organizations is about the reimbursement of services provided to patients by the insurers according to the contract. Substantial amounts of these expenses, categorized as deductions, are not reimbursed to the healthcare centers by the insurance organizations.
Objectives: The purpose of this study was to investigate the effective measures in reducing insurance financial deductions with an emphasis on the role of insurance.
Methods: The current research was descriptive-analytical and cross-sectional, which was conducted in Shahid Rajaei Hospital of Gachsaran. For this purpose, 170 patients (families) were selected as research samples, and finally 165 patients (families) were included in the study. The research population consisted of 400 employees of Shahid Rajaei Hospital in Gachsaran, and a simple random sampling method was employed to select 196 participants, according to Cochran's formula. A researcher-developed questionnaire with 21 questions was used for data collection. The formal and content validity of the questionnaire was confirmed, and its reliability was verified using Cronbach's alpha. The collected data were analyzed using parametric tests by SPSS software.
Results: The research data indicated that uncompromised elements such as not distorting the date and prescription, having the stamp and signature on insurance prescriptions, transparent and digitally typed medical orders, proper completion of medical procedures descriptions by physicians, accurate and precise registration of equipment, drugs, and supplies, proper registration and documentation of daily requests, and request for basic care instructions in medical and nursing orders, have an impact on reducing insurance financial deductions at Shahid Rajaei Hospital in Gachsaran, across the inpatient, clinical, and administrative departments.
Conclusion: Based on the obtained results, by implementing effective and transparent measures, identifying and eliminating factors contributing to the increase in insurance deductions, it is possible to reduce the disputes between hospitals and insurance organizations. The findings show a significant relationship between health insurance coverage and use of preventive care services, adverse health outcomes, reduced performance, preventable health problems, severe disease at the time of diagnosis, and premature mortality.

Abstract Background: The COVID-19 virus has created many problems for human beings in the real world, particularly in the health sector. One of the issues is in emergency hospitals, which are vital pillars of the healthcare system in every country. Providing timely treatment and access to healthcare facilities is a major problem in developing countries.
Objectives: The aim of the study was to simulate a hospital emergency department under COVID-19 conditions.
Methods: This study simulates the operations of an emergency department in a hospital under COVID-19 conditions as a case study in Iran. This study considers several assumptions about hospital facilities, including doctors, nurses, and patients. The patients are divided into two categories: some require immediate examination, while others wait in line for appropriate services.
Results: A flow diagram for the department is provided and converted into a model, which is implemented using GPSS software. The model is then run multiple times, and the outputs are collected. The outputs of the simulation and their statistical distributions are analyzed, and the performance of various statistical tests is examined. Finally, recommendations for improving the performance of the emergency system are presented.
Conclusion: The findings of this study can be used as the first step in preparing this tool. Accordingly, this study was conducted to identify existing and valid tools for measuring hospital readiness against the COVID-19 virus, translate those tools, and compare them.

Abstract Background: Human rights, which are very important for the health system and hospital accreditation requirements, include the issue of patient rights in hospitals. Artificial Intelligence (AI) is one of the advanced technologies in this industry, which aims to improve the standard of medical services for patients.
Objectives: This study was conducted with the aim of improving the enhancing patient's rights criteria in hospital accreditation standard by using AI (case study: selected hospitals in Zahedan county), which examines the factors affecting patient rights and the benefits of using AI.
Methods: According to the subject and purpose, the research approach is cross-sectional and descriptive, which was conducted in several hospitals in Zahedan in 2023. Experts in this field were given a questionnaire to complete as part of this study. Then the most important effects in this field were ranked.
Results: Experts ranked the factors of better disease diagnosis, prevention and prediction, advanced treatment methods, and easier access to medical data as the most important factors. The findings of this study indicate that if AI is used in selected hospitals of Zahedan, the rights of patients will be consistent with international validation criteria.
Conclusion: The factors covered in this study are necessary for the successful integration of AI in the health system, as well as following the guidelines that apply to any other intelligent system, including technical training and considering organizational, managerial and economic aspects. In order to intelligently adapt these systems, stakeholders in the health sector must use these components.

Abstract Letter to Editor

Abstract Background: During disasters, hospitals play a key role in providing quality and appropriate medical services to increase resilience.
Objectives: This study was carried out with the aim of determining the response rate of the emergency department of Shiraz University of Medical Sciences hospitals to the Corona pandemic in 2021.
Methods: This cross-sectional descriptive research was conducted in educational-therapeutic hospitals of Shiraz University of Medical Sciences. For this purpose, 230 senior and middle managers, emergency department nurses and emergency medicine specialists participated in this study. Hospitals were placed in two categories: special centers for COVID-19 (3 hospitals) and other educational and medical centers (general and specialized centers) (8 hospitals). The information was collected by the hospital readiness assessment checklist (2020) for the management of infectious disease epidemic crisis based on the guidelines of the World Health Organization for the response of hospitals to the COVID-19. After collecting the data, it was entered into SPSS 22 and analyzed.
Results: Findings of this study showed that the readiness of hospitals is at a good level (87%). The studied hospitals performed very well in items of support and management of financial resources, communication management, human resources management, diagnosis and management of patients, but in item of rapid identification and control and prevention of infection, they performed very poorly. The centers of COVID-19 scored higher than other educational-treatment centers, continuation of services and increased capacity, rapid identification, diagnosis, prevention and control of infection, which was statistically significant (p <0.05).
Conclusion: Rapid identification of patients seems to be an important challenge in Shiraz University of Medical Sciences. The allocation of special hospitals for the care of COVID-19 patients is also effective in preparing them for the pandemic.

Abstract Background: Hospital nurses are more exposed to health anxiety due to close contact with patients.
Objectives: This study aimed to determine the mediating role of mental toughness in the relationship between meta-emotion and co-rumination with nurses' health anxiety.
Methods: The research method was structural equations type correlation. The statistical sample of the research included 250 nurses from hospitals in West Azarbaijan province in 2022, who were selected by simple random sampling. Salkovskis and Warwick's (2002) health anxiety scale, Mitmansgruber et al.'s meta-emotion questionnaire (2009), Clough et al.'s (2002) mental toughness scale, and Davidson's co-rumination questionnaire (2014) were used to measure the variables. The data were analyzed using Pearson's correlation coefficient, Sobel test and bootstrap.
Results: Findings indicated that the meta-emotion and co-rumination variable interact with the mediating role of mental toughness which has a role in explaining the nurses’ model of health anxiety. In total, 38% of the variance of health anxiety was explained through the variables of negative and positive meta-emotion, co-rumination and psychological stability. The direct effect of positive meta-emotion (-0.327), negative meta-emotion (0.318), mental toughness (-0.452), and co-rumination (0.367) are significant in explaining the health anxiety model. Furthermore, the indirect effect of negative meta-emotion (0.158), positive meta-emotion (-0.161), and co-rumination (0.155) with the mediation of the role of mental toughness is significant.
Conclusion: Considering the direct and indirect effects of meta-emotion, mental toughness and co-rumination variables on the level of health anxiety variable, it seems that by strengthening positive meta-emotion and mental toughness, and improving co-rumination and negative meta-emotion, the health anxiety in nurses can be reduced.

Abstract Background: Canceling surgery imposes the high cost of the healthcare provider system and wasted many energy and time from the patient and the care team.
Objectives: This study examined the extent and reasons of canceling of surgeries in one of the hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Methods: This was a descriptive-applied study. In order to get the number of operations from April 2018 to March 2020, the hospital used HIS software and then extracted the reasons from the operating room office and the quality improvement office in the hospital. Data were analyzed by SPSS version 21 software.
Results: Among 8654 planned surgeries, 0.9% were cancelled. The highest frequency of surgical cancellation is associated with general surgery, and the highest rate of surgical cancellation is associated with the ENT specialty. The highest cancellation rate was 1.82% in August 2018 and 2.87% in February 2019. The lack of preparation of patients and patients did not require surgery was the main and worst reason for discontinuing surgery, respectively.
Conclusion: The lack of clinical preparation of the patient was the main reason for the cancellation. Therefore, pre-surgery patient evaluation can help solve this problem, make the operating room more effective, and increase patient satisfaction.

Abstract Background: Overcrowding is an important problem for outpatient services in healthcare facilities. Patient flow analysis (PFA) is a useful method for identifying inefficiencies in and facilitating patient flow.
Objective: PFA was used to estimate patient wait time and determine how different clinical disciplines impact wait times in the studied hospital.
Methods: This cross-sectional study investigated a study population comprised of outpatients who referred to clinics at a general hospital in Tehran, Iran. A total of 3836 samples were selected from different stations. Nonrandomized quota sampling was used, and data was gathered using workflow checklists, the content validity of which was proven by experts and hospital authorities. SPSS statistical software was used for data analysis.
Results: Total patient stay in the outpatient setting was an estimated 77 minutes (without considering para-clinic units and pharmacy). More than 90% of this time was spent waiting. The wait time of patients at the clinic was greater than that at other stations, and it was less at the cash station than at other stations. Wait times varied at different clinics (P value < 0.001) and were correlated with physician delay (P value < 0.001).
Conclusion: The most important result of using PFA in the outpatient setting was managing wait times. This study indicated that a considerable amount of a patient’s total stay in the system was related to waiting for physical examinations. This suggests that the first priority in improving the system should be managing patient wait times for physical examinations.

Abstract Background: Although all jobs can be stressful, occupational stress is an important issue in jobs that deal with human health. Evidence indicates that nursing is a stressful occupation.
Objective: This research evaluated factors affecting occupational stress and strategies for coping with it.
Methods: This cross-sectional descriptive-analytic study was conducted in 2015. The study population comprised all nurses at Shahid Rajaee hospital, from whom 190 nurses were selected by random sampling. Data was collected by questionnaire and analyzed using SPSS software (version 19), Pearson correlation coefficient tests, Mann-Whitney tests, and t tests.
Results: Occupational stress was rated as moderate among the studied nurses. Significant positive correlations were found between occupational stress level and less effective coping method, occupational stress level and work experience level, and ineffective coping methods and age. Moreover, a significant difference was seen between men and women in terms of emotion-focused coping.
Conclusion: According to the research findings, occupational stress was at a moderate level among the studied hospital nurses, indicating that the authorities need to focus on efforts to reduce occupational stress for nurses.