Hospital Practices and Research

Abstract Background: Smart hospitals today use Artificial Intelligence to improve the quality of their services. In this sense, optimizing the patient's electronic medical record is one of the most significant issues that these hospitals face.
Objectives: This study aimed to determine the role of AI in patient electronic records in a smart hospital.
Methods: This study was a systematic review, with keywords searched in PubMed, Scopus, Google Scholar, and SID databases. In Persian and English, the keywords were artificial intelligence algorithms, electronic medical records, service quality, and hospital. The inclusion criteria included publication in Persian or English, full-text papers, current publications, and a focus on the use of AI in electronic medical records. Finally, about 57 papers related to the investigation were picked.
Results: After reviewing previous related studies, it was discovered that AI can play a role in various aspects of electronic patient records, such as disease diagnosis, predicting relapse and recovery periods, improving treatment accuracy and reducing medical errors, digital care, and decision-support systems. This can result in a 20-30% improvement in resource planning, a 30% decrease in wait times, better resource use, and more accurate predictions.
Conclusion: Leveraging AI in electronic patient records is critical for maximizing benefits while minimizing hazards. Despite the limitations, AI has the potential to become a critical tool for smart hospitals in improving healthcare delivery and efficiency. Accordingly, healthcare leaders that incorporate AI algorithms into their systems can give more effective and up-to-date care to their patients.

Abstract Background: Parasitic infections are most prevalent in developing nations and among individuals with weakened immune systems or immunocompromised.
Objectives: Due to the lack of epidemiologic information on such infections, the prevalence of enteric, respiratory, and urogenital parasites was investigated among patients in teaching hospitals in Alborz province, Iran.
Methods: In this cross-sectional study, 1248 samples were collected from January to July 2023. Microscopic examination was performed using direct wet mount, formalin-ether concentration techniques, and trichrome staining. To detect Enterobius vermicularis parasite, we have used the Scotch test method.
Results: The prevalence of parasitic infections was 7.1%. The most commonly identified parasitic infections in the study were Entamoeba histolytica/dispar (29 cases, 2.3%), and Blastocystis sp. (26 cases, 2.1%). 40.2% of our studied cases showed gastrointestinal symptoms and the majority of symptoms were relating to anorexia and abdominal pain.
Conclusion: Given the significant global prevalence of parasitic infections, it is crucial to identify and treat infected individuals, implement urban water improvement programs, avoid the use of human feces as fertilizer in agriculture, and maintain public, and personal hygiene.

Abstract Letter to Editor

Abstract Background: The field of neurology encompasses a wide range of disease types, and recognizing the most common manifestations of these diseases, particularly in subgroups, is critical for improving appropriate diagnostic and therapeutic measures.
Objectives: The purpose of this study was to determine the frequency of common manifestations of neurological diseases in patients referred to a military hospital’s internal neurology clinic.
Methods: This was a cross-sectional descriptive study of patients referred to the internal neurology clinic of a reference military hospital, Tehran, Iran in 2020. The sampling was done at random using a checklist. Finally data was analyzed by using SPSS software.
Results: Women made up the majority of patients in 336 samples 182 (54.2 %) versus 154 (45.8 %). The patients’ average age was 49.5 ± 16.5 years, with 28.3 % (n = 95) being elderly. The three most common complaints raised by patients were headache, movement disorder, and sensory disorder, accounting for 29.5%, 27.7%, and 27.7% of complaints, respectively. Seventeen patients (5.1%) also mentioned other issues, with anger, anxiety, depression, and nausea being the most common complaints.
Conclusion: Headache, movement disorder, and sensory disorder are the most common neurological disorders referred to a military hospital. Because of the high prevalence of these issues, it is necessary to establish specialized clinics and conduct additional research to determine the most common types of sensory and movement disorders, as well as the most effective methods of prevention and treatment in medical centers.

Abstract Background: Various studies indicate that in many cases, fire has broken out in hospitals.
Objectives: This study aims to assess fire protection in the selected units of Imam Khomeini hospital located in Tehran, Iran in 2020.
Methods: In this descriptive-analytic study, first, a researcher-made checklist was developed for the data collection by valid scientific resources (CVI = 0.90 and CVR > 0.62). After revising and the final confirmation of reliability, the checklist was separately completed by two members of the risk management committee in 22 units of Imam Khomeini Hospital, Tehran, Iran. Cronbach’s weighted Kappa statistical test was calculated.
Results: The domain of Ability and Capability of Fire Prevention was 66.1%; the domain of Responsiveness was 65.1%, and the domain of Urgent Evacuation Ability was 27.3%. In the domain of Responsiveness, the highest scores were relevant to accessing fire extinguishers cylinder in the units (95.5%) and holding fire extinguishing practice courses, and doing seasonal practices with that region’s fire station (90.9% for both). The highest scores in the domain of Urgent Evacuation Ability were assigned to accessing adequate ambulances to evacuate patients (90.9%) and mapping the units as well as determining patient evacuation routes when a fire breaks out (72.7%).
Conclusion: The essential protection measures should be taken in order to improve the hospitals’ fire protection by better access to the exits, increasing the number of the exits and standardizing the emergency exits, enhancing the due fire extinguishing practices and hospital evacuation as well as training the staff.

Abstract Background: The cost of health care is a large part of every household’s budget. On the other hand, as an economic entity, the hospital is constantly faced with different aspects of cost and revenue. So, we are dealing with conflicting objectives.
Objectives: The main purpose of the research is to help financial management in a specialty hospital. This article provides part of operational research under bi-level optimization for hospital managers to provide targeted financial planning. The method is based on the fact that the objective is to maximize the hospital income on one level, and on the other level, the objective is to reduce the patient’s payment.
Methods: The hierarchical and decentralized optimization problem is written as a bi-level model that minimizes patient costs and maximizes hospital revenues, which is an NP-Hard problem. The optimal solution to this problem is obtained using a genetic algorithm. Then, the hospital’s performance is evaluated by the Pabon Lasso diagram. It is shown that the use of this model has a significant effect on the hospital’s performance.
Results: Implementation of this model in the studied hospital shows that patient payment costs decreased and hospital income increased (reaching equilibrium point).
Conclusion: Hospital performance after model implementation was evaluated by the Pabon Lasso diagram and showed that it has an effective role in hospital performance.

Abstract Background: Overcrowding of emergency departments (EDs), which are not suitable places to treat chronic pain and are responsible for managing acute disorders, leads to prolonged waiting times, delays in treating conditions requiring rapid intervention, patient dissatisfaction, and chaos and exhaustion in the ED.
Objectives: Examine the characteristics of patients who presented to the ED with non-malignant chronic pain to determine the frequency of use and factors that caused ED use.
Methods: This cross-sectional study was conducted in an ED. Three hundred ninety-two patients with chronic pain were included.
Results: The mean age of the patients was 48.1 ± 15.3 years, 62.2% were female, and 37.8% were male. Of the patients, 59.2% were married, 42.6% had elementary school education, and 56.1% were unemployed. The most common cause of ED admission was low back pain (LBP), the 32.7% used non-steroidal anti-inflammatory drugs, 16.3% used opioid analgesics, 15.8% used anticonvulsants, 13.2% used anticonvulsants antidepressant drugs, 22% did not use any medication. The reasons for presenting to the ED for chronic pain were 13.3% for medication prescription, 74.5% for receiving analgesics, and 12.2% for a diagnosis. The mean Patient Health Questionnaire-9 (PHQ-9) scale score of the participants was 12.82 ± 3.98, which indicated moderate depressive symptoms. The mean Generalized Anxiety Disorder-7 scale score was 9.84 ± 3.23, which indicated mild generalized anxiety disorder.
Conclusion: Instead of trying to suppress pain, emphasis should be put on preventing overcrowding in EDs, which are intended to manage acute conditions rather than chronic pai

Abstract Background: Provision of quality and accessible health services comes with its challenges. Therefore, the need to highlight how motivation and job satisfaction can impact nurses’ performances at the Korle-Bu teaching hospital.
Objectives: The research aimed to practically highlight nurses’ motivation and job satisfaction by identifying what constituted motivation packages of nurses and how the work they did could give them satisfaction at the Korle-Bu teaching hospital.
Methods: The research employed a qualitative method with a case study design. In-depth interviews and focus group discussions (data triangulation) were used for primary data collection. A total of 40 respondents, including ten key informants, were selected using the purposive and convenience sampling techniques.
Results: The research found that the recognition of needs of nurses, improved remunerations, enhanced conditions of service of the nurses’, regular payment of nurses’ salaries’, the institution of study leave with pay policy, among others, were considered as factors that could contribute to nurses’ motivation and job satisfaction. These findings are consistent with the findings of other studies. Again, the study found that professional allowances paid to nurses, reduced rent, and the like are current motivation packages directed at nurses at the Korle-Bu teaching hospital.
Conclusion: It is important to state that for motivation to accomplish its intended purpose, there is the need for the hospital to identify the individual needs to satisfy to enhance job satisfaction.

Abstract Background: Hospitals are the most important and largest providers of health services in the health system.
Objectives: This study aimed to examine hospital managers’ attitudes toward health promotion policies at a teaching hospital in Tehran, Iran.
Methods: This research was a descriptive-analytical study. The study population consisted of 75 senior and middle managers of a teaching hospital in Tehran, Iran in 2018. Sampling was conducted through a census. The study instrument was a researcher-made questionnaire assessing managers’ attitudes toward health promotion. The questionnaire was validated. Data were collected and then analyzed using SPSS 20 software.
Results: Total score of health promotion policies was estimated to be 84.5 ± 10.6 out of 100. The highest scores of the components associated with health promotion policies were 94.9 ± 9.34 and 93.8 ± 10.36 of 100 belonging to “Awareness of hospital staff of health promotion policies” and “Enjoyment of a written health promotion policy” items, respectively; while the lowest score was 75.4 ± 20.68 out of 100 belonging to “Informing patients, their companions, and staff about factors associated with the disease whose health is supported by the hospital”. The highest score of components associated with health promotion activities was 94.1 ± 9.74 out of 100 belonging to “Increasing patients’ trust by providing health promotion services” item and the lowest was 72.2 ± 19.4 out of 100 belonging to “Assessment of patient’s needs for health promotion” item.
Conclusion: Hospital managers’ attitudes score was high toward health promotion policies and activities, but there are still problems with health promotion activities, the most important of which is a therapeutic-centered perspective.

Abstract Background: One of the most important issues in the health system is to provide the necessary resources to present health services. To increase the role of charities and facilitate public participation in the treatment area and to develop hospital units, the cooperation between charity organizations and public hospitals must be highlighted.
Objectives: This study aimed at identifying the type of contract for the transfer of health services to charities in the teaching hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.
Methods: This study was conducted in hospitals of Shahid Beheshti University of Medical Sciences in 2019. The statistical population of the study consisted of 411 people, including managers, chiefs, and deputies, contracting experts, hospital social workers, managers and lawyers of the university, trustees, and managers, and charity experts. The research sample consisted of 330 people who were selected using a stratified random sampling method. SPSS version 18 and AMOS software were used to analyze the data.
Results: By identifying the selection criteria of a charity to operate in the hospital, identifying the contract model, identifying the share of capital and current costs, and selecting the type of department in the contract with path coefficients of 0.78, 0.72, 0.68, 0.73, and 0.73, respectively, it can be ensured that the costs of an inpatient ward were supplied by the charity during the contract term.
Conclusion: The study showed that the partnership contract model is the most appropriate type of contract in the transfer of health services to charities.

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Abstract Background: Foodservice is an important issue in hospital settings, and patients’ levels of satisfaction are often indicated by consumption and plate waste.
Objective: The current study compared patient satisfaction in hospital areas and other factors and determined the relationship between patient satisfaction and plate waste.
Methods: This quantitative research was performed in four East Malaysian public hospitals. Patients at these hospitals were asked to complete a questionnaire which had three parts: A) general information, B) patient satisfaction questionnaire (Acute Care Hospital Foodservice Patient Satisfaction Questionnaire), and C) plate waste scale (Comstock 6-point scale).
Results: A total of 189 patients participated. The results indicated that overall, 53.3%, 29.3%, 14.1%, 2.7%, and 0.5% of respondents rated the hospital foodservice as okay, good, poor, very good, and very poor, respectively. Average plate waste was 35% for all hospitals, and only 11% of patients finished all the food served. Satisfaction with hospital food differed according to the catering system (in-house and outsourced). However, the results also indicated that satisfaction with hospital foodservice was not significantly related to food wastage (r=-0.018, n=189, P=0.809).
Conclusion: Various factors in hospital foodservice, especially food quality, should be improved to motivate patients to consume hospital food.

Abstract Background: In the treatment and health process, there are a lot of dangers to patients, and the increased number of medical errors is one of the most important circumstances of this process.
Objective: The present research purposed to decrease medical errors through disclosure of them in hospitals of Tehran University of Medical Sciences.
Methods: This qualitative-quantitative study included a population of 232 individuals, selected through targeted non-random selection, who were somehow connected with medical errors made in hospitals affiliated with Tehran University of Medical Sciences. The triangulation technique was utilized to collect data. Data was analyzed using the factor analysis technique. After the effective factors were determined, their internal correlation was determined through regression correlation.
Results: Disclosure is made up of organizational culture, the factors related to the patient, the factors related to the presenter, the factors involved in the error, structural factors, and disclosure situation indexes, and is an effective factor in managing the medical errors in hospitals of Tehran University of Medical Sciences. Disclosure increases the immunity of patients.
Conclusion: Disclosure is an effective factor in managing the medical errors that occur at hospitals affiliated with Tehran University of Medical Sciences. It is essential that managers identify the effective factors in disclosure and take steps to apply a suitable disclosure system to decrease errors.

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Abstract Background: The high workload of nurses in hospitals has been identified as a patient safety and worker stress problem. Psychological empowerment is a motivational concept demonstrated in four dimensions: meaning, competence, self-determination, and impact.
Objective: This study investigated the relationship between nurses’ workloads and psychological empowerment using structural equations modeling (SEM).
Methods: This descriptive correlation study was conducted using SEM. The study was conducted at 17 public hospitals affiliated with Iran University of Medical Sciences (IUMS) in the city of Tehran. The population study was nurses employed in critical care departments. Two questionnaires were used to gather data: the NASA and the Psychological Empowerment Questionnaires. Differences in categorical variables were analyzed using one-way analysis of variance (ANOVA). Confirmatory factor analyses were used to confirm the relationships between latent variables and indicator variables; SEM was used to find the direct and indirect effects of nurse’s workload on psychological empowerment. Data analyses were performed using SPSS 18, and all models were tested in LISREL 8.8.
Results: Correlations among indicators of nurse’s workload showed that highest correlations were performances (0.61), and the highest correlations among psychological empowerment were competence (0.03). The overall correlations among nursing workloads and psychological empowerment were 0.74. The proposed structural model fit was acceptable (χ2 = 525.5, df = 89, RMSEA = 0.13, GFI = 0.91).
Conclusion: Increasing the workload of nurses in hospitals will better engage the nurses and allow them to face new problems they encounter in their jobs.

Abstract Background: For over 2 decades, Ghana’s Ministry of Health (MOH) has been resolved to continuously improve the quality of healthcare in a cost-effective manner. Strategies have been adopted to enhance client satisfaction with healthcare services and delivery.
Objective: The current study examined patient satisfaction with the quality of healthcare in Ghana by comparing healthcare services at the University of Ghana Hospital (UGH) and the University of Cape Coast Hospital (UCH).
Methods: This cross-sectional study was conducted in 2014-2015 with primary data collected from patients at UGH and UCH. Structured questionnaires were administered based on the stratified and convenience sampling methods to select patients receiving healthcare at the outpatients departments of the 2 hospitals. Descriptive statistics and linear regression analysis were used to analyze the data with the help of SPSS version 20.
Results: The findings indicated that empathy (β=0.14, P=0.003), communication (β=0.26, P=0.00), culture (β=0.17, P=0.008), tangibles (β=0.12, P=0.040), and priority (β=0.18, P=0.002) are significant predictors of patient satisfaction.
Conclusion: Management at the 2 studied hospitals should streamline their quality healthcare policies based on the dimensions of effective communication, empathy, culture, tangibles, and priority to enhance patient satisfaction.

Abstract Background: Today, patient safety is an important issue in providing hospital services. Any failure in this area can cause undesirable consequences.
Objective:  The present study evaluated the status of patient safety culture in Educational Hospitals of Tehran, Iran.
Methods: This cross-sectional study surveyed 205 therapeutic and diagnostic personnel of three Tehran hospitals selected using the clustered method; samples were collected in a randomized manner. To examine patient safety culture, the standard questionnaire of patient safety culture with 12 dimensions was used. Data was analyzed using SPSS software.
Results: In the 12 dimensions of patient safety culture, exchange of data, expectations, and organization management had the lowest means of 3.28 (±0.87), and 3.32 (±0.74) among the various aspects of patient safety culture. Additionally, the two dimensions of teamwork within the organization’s units and frequency of reporting events with means of 3.71 (±0.79) and 3.73 (±0.7) had the highest means among the studied 12 dimensions of patient safety culture. The total mean of patient safety culture in the studied hospitals was 3.5 (±0.5).
Conclusion: Increasing the attention paid to patient safety culture will lead to the development and progress of hospitals in the country and will guide them toward becoming patient-friendly hospitals. Those dimensions which had low mean values in this study should be paid more attention so as to promote and protect them.

Abstract Background: Drugs play a strategic role as a health commodity. Thus, the supply chain management of drugs is an important issue to reducing costs and thereby improving patient health.
Objective: This study evaluated the status of drug supply chain management and health reform in the pharmaceutical sector of teaching hospitals in Ahvaz, Iran.
Methods: This cross-sectional study was carried out in pharmacies of teaching hospitals in Ahwaz, Iran in 2015. Data was collected through a checklist extracted from the Evaluation Checklist of the Food and Drug Deputy and related articles. The study checklist examined six dimensions of the Evaluation Checklist, including drug storage, administrative regulations, preparation of medicines, drug distribution, taking medication, and implementation of health reforms in the pharmaceutical sector. The content validity of the checklist was confirmed by experts and pharmaceutical specialists. Data was analyzed for descriptive characteristics such as frequency and percentage using EXCEL version 2010 software.
Results: The findings show that hospitals met standards for administrative regulations with 78.5% and preparation of medicines with 77.25%. The dimensions of drug storage with 74.75%, taking medication with 74.25%, implementation of health reforms with 71.5%, and drug distribution with 62.5% were in a near-standard state.
Conclusion: Supply chain management systems of medicines in teaching hospitals are near-standard. To improve hospitals, offering proper training to employees, using the fixed-rate shopping system, and providing facilities to patients are recommended.

Abstract Background: Hospitalization compared to outpatient care leads to better diagnosis. Stability of diagnosis varies among different psychiatric disorders and is associated with some demographic and mental health variables.
Objective: The current study evaluated the stability of diagnosis in Baqiyatallah Hospital Psychiatric Ward. 
Methods: In this retrospective study, 908 inpatient records from the psychiatric ward of Baqiyatallah Hospital in the years 1997-2015 were randomly selected. Having primary and final diagnoses was the inclusion criterion. Demographic variables (age, sex, marital status, education, and employment) and mental health variables (primary and final psychiatric diagnoses, duration of hospitalization, psychiatric history, and medication history) were recorded. Ultimately, 429 cases were entered into the study.
Results: The overall diagnostic stability rate was 57.6%. In mood, anxiety, psychotic, and personality disorders, the diagnostic stability rates were 84%, 63.8%, 46.3%, and 36.4%, respectively. For depressive and bipolar disorders, the stability of diagnosis rates were 85.5% and 86%, respectively. A significant relation between diagnosis axis, number of diagnoses, drug abuse and somatic disease history and diagnostic stability was seen (p<0.05).
Conclusion: According to the present study, the maximum diagnostic stability rate was related to mood disorders with anxiety disorders ranking second. The minimum stability was related to personality disorders. Other studies have reported completely different results which may be due to different situations. Future studies in this field seem to be essential.

Abstract Background: Optimal allocation of resources commensurate with performance improvement is the concerns of all countries including Iran. Estimation hospitals production function is important in the economic management of hospitals.
Objective: The aim of this study was to estimate the production function of Iranian selected public hospitals as well as analyze the economic behavior in use of hospital resources.
Methods: The study was conducted by using the input data of 67 Iranian selected public hospitals at 2013. In this study, expected production level of hospitals and marginal productivity of inputs were calculated by regression estimation of Cobb-Douglas production function.
Results: The results showed that a 10% increase in net working hours of specialized human resources in public hospitals would cause 8.8% increase in average production level of inpatient services. Moreover, 10% increase of active beds would cause 1.1% increase in average production level of inpatient services in the studied hospitals. Also, the production levels in 40% of hospitals were lower than the average expected production level and did not have full performance.
Conclusion: With the proper utilization of human resources and beds, production level in a significant number of hospitals can be improved.

Abstract Background: Intravenous catheterization is a routine technique in medical centers which can cause diverse problems such as thrombophlebitis.
Objective: This study aimed to resolve replacement scheduling and proper cannula diameter and position issues for intravenous catheters.
Methods: In this 2015 experimental cohort study, 232 hospitalized patients receiving medication intravenously were assessed for the occurrence of thrombophlebitis (TF). Involved TF factors such as age, gender, cannula size, site of cannula in hand veins, duration of usage, and underlying disease were evaluated in patient and healthy control groups.
Results: TF developed in 55 of 232 patients. The percentages of incidence were similar in men and women (30%). The patient mean age was lower than that of the control, but the difference was not significant. Average weight was significantly higher in the patient group than in the control group. The average duration of cannula in situ was significantly lower in patients than in the control group. The highest rate of TF occurred in the narrowest cannula usage and dorsal hand vein positions. The mean time of developing TF was lower than that indicated in CDC guidelines. Furthermore, 24 patients with TF (34%) had diabetes mellitus.
Conclusion: In the current study, the percentage of TF occurrence was higher in patients with weight increase, use of narrower cannulae, dorsal hand vein positions, and a history of diabetes. Furthermore, TF can develop within 72 hours. It was concluded that some patients may be more susceptible to TF and require more care. Accordingly, the CDC guidelines’ offered scheduling for intravenous catheter replacement is not trustworthy.

Abstract Background: Person-organization fit is an effective factor for recruiting, selection, and retention of human resources in organizations.
Objective: This study examined the correlation between person-organization fit and performance indicators used in healthcare in the hospitals affiliated with Qazvin University of Medical Sciences (QUMS).
Methods: This descriptive cross-sectional study was conducted in 2014. A total of 324 employees were randomly selected from among the study population comprising the staff of teaching hospitals affiliated with QUMS. The sample size was distributed between the hospitals using the class-ratio method. Data were collected using person-organization fit (Scroggins) questionnaires, and their validity and reliability were evaluated. Data analysis was done using Spearman-Pearson correlation, chi-square, and Kruskal-Wallis tests.
Results: In terms of values fit, personality fit, and skills, knowledge, and ability fit, hospital C ranked first among the hospitals tested with average ratings of 175.99, 195.53, 199.49, respectively. Significant relationships were found between person-organization fit and patients admitted per bed, median duration of patient stay, and crude mortality rate. No significant relationships were found between person-organization fit and the performance indicators of bed circulation and bed occupancy rate (p ≤ 0.05).
Conclusion: In order to show an association between person-organization fit and the performance indicators, more efficient use of resources and improved efficiency is suggested. Policymakers must pay more attention to person-organization fit during recruitment, selection, and assignment of staff.

Abstract Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a critical element in patient safety efforts.
Objective: The current study used a Theory of Planned Behavior (TPB) framework to investigate predictors of patient safety intentions and behavior of physicians.
Methods: This descriptive analytical study was conducted in 8 hospitals with 52 physicians participating. A researcher-designed questionnaire was prepared to investigate patient safety behaviors and behavior constructs of physicians based on the guidelines of constructing a TPB Questionnaire: Conceptual and Methodological Considerations. The content validity and reliability of the questionnaire were confirmed. Binary logistic regression analysis was performed using SPSS₁₈.
Results: The total mean score of physician safety behavior indicated that 3.8±0.92. 42% of physicians reported their safety behavior at a good level. There was no significant difference between the patient safety function of physicians in public and private hospitals (P=0.8) and working in medical or surgical wards (P=0.4). Among TPB constructs, “normative beliefs” had the greatest influence on physician intention for safety behaviors (wald=3.828, P=0.05).
Conclusion: The results showed that “normative beliefs” had the greatest influence on physician intention for safety behaviors; therefore, it seems that patient safety must be the most important concern of all health care staff, specifically managers and executives throughout health care centers.

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