Enhanced recovery after surgery (ERAS) has been widely used in the world for near 20 years, which should be considered as the milestone of modern medicine advancement, changing the routine perioperative principle, accelerating the recovery speed following operation, minimizing the postoperative pain, and saving the medical resources. Despite the remarkable advance, the quality and application of ERAS in the west China needs further improvement if compared with international level or even some domestic hospitals. The postoperative hospital stay in west China is much longer than the reported 3 to 5 days according to published references. Several suggestions can be help: (1) Based on the published consensus and the successful experiences of ERAS in colorectal surgery, the medical institution should make great effort to extend this technique to change the profound traditional idea in medical staffs and patients. (2) The medical administrations should take the application of ERAS as a key performance index and annual work plan in hospital. (3) Multiple disciplinary team including anesthetist, surgeon, dietitian, and nurses is essential for hospital to promote the quality of ERAS. Undoubtedly, ERAS is going to be the conventional medical care in the western area of China. We may look forward to seeing more researches from western China to update the ERAS consensus.
China ; Clinical Competence ; Colorectal Surgery ; rehabilitation ; Consensus ; Digestive System Surgical Procedures ; rehabilitation ; Health Knowledge, Attitudes, Practice ; Humans ; Length of Stay ; statistics & numerical data ; Patient Care Team ; standards ; trends ; utilization ; Personnel Administration, Hospital ; methods ; Postoperative Care ; methods ; psychology ; standards ; Postoperative Period ; Quality of Health Care ; standards ; trends

PURPOSE: Current increase and complexity of medical tests and surgical procedures at outpatient department (OPD) require OPD nurses to have customer orientation focusing on various customers' interests and needs. The purpose of this study was to identify the factors associated with customer orientation in nurses working at OPD of hospitals. METHODS: The study used a descriptive correlational design with cross-sectional survey. The study settings were four general hospitals in Seoul and its metropolitan area. Data were collected from 138 OPD nurses from general hospitals. Study variables were personal traits, emotional intelligence, internal marketing, service management and customer orientation. RESULTS: Factors associated with customer orientation were identified as conscientiousness from personal traits (β .37, p < .001), emotional intelligence from individual characteristics (β .21, p = .032), and internal marketing from environmental characteristics (β .21, p = .001). CONCLUSIONS: Hospital administrators should support OPD nurses to cultivate sincere and sociable personal traits and emotional intelligence, and to consider employees as internal customers to improve patient-oriented services and satisfaction.
Adult ; Attitude of Health Personnel ; Cross-Sectional Studies ; *Emotional Intelligence ; Female ; Humans ; Male ; Marketing/*methods ; Middle Aged ; *Nurse-Patient Relations ; Nursing Staff, Hospital/*psychology ; Organizational Culture ; Outpatient Clinics, Hospital/*organization & administration ; Outpatients/*psychology ; *Patient-Centered Care ; Seoul ; Surveys and Questionnaires ; Young Adult

PURPOSE: This study was done to evaluate the experience of securing patient safety in hospital operating rooms. METHODS: Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. RESULTS: The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. CONCLUSION: The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.
Adult ; Attitude of Health Personnel ; Female ; Humans ; Interviews as Topic ; Male ; Nursing Staff, Hospital/*psychology ; Operating Room Nursing/organization & administration/*standards ; Patient Safety/*standards

INTRODUCTIONDistractions and interruptions of doctor's work, although common and potentially deleterious in the intensive care unit (ICU), are not well studied.

METHODSWe used a simple observational method to describe the frequency, sources and severity of such distractions, and explore at-risk situations in the ICU. Independent paired observers separately shadowed eight residents and three fellows for 38 sessions (over 100 hrs) in a 20-bed medical ICU.

RESULTSIn total, 444 distractions were noted. Interobserver agreement was excellent at 99.1%. The mean number of distractions/doctor/hr was 4.36 ± 2.27. Median duration of each distraction was 2 mins (interquartile range 2-4 mins; range 1-20 mins). The top three initiators of distractions were other doctors (35.1%), nurses (30.4%) and oneself (18.7%). Of the 444 distractions, 107 (24.1%) were prolonged (lasting ≥ 5 mins), 210 (47.3%) led to a complete pause of current activity and 85 (19.1%) led to complete abandonment of the current activity. On multivariate analysis, physician seniority, time of session and day of week did not predict frequency of distraction. After adjusting for time of session, day of week and type of current activity, urgent distractions (to see another patient, perform immediate procedures or administer medications) and physician juniority were associated with major distractions (complete interruption or termination of current activity), while only urgent distractions were associated with prolonged distractions.

CONCLUSIONDistractions are common in the ICU and junior doctors are particularly susceptible to major distractions.

Adult ; Attention ; Attitude of Health Personnel ; Continuity of Patient Care ; Critical Care ; methods ; organization & administration ; Female ; Humans ; Intensive Care Units ; Internship and Residency ; Linear Models ; Male ; Medical Staff, Hospital ; Nurses ; Observer Variation ; Physicians ; Risk Factors ; Time Factors

PURPOSE: This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used. METHODS: A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed. RESULTS: The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high. CONCLUSION: This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.
Adult ; Attitude of Health Personnel ; Female ; Humans ; Interprofessional Relations ; Male ; Middle Aged ; Nursing Staff, Hospital/organization & administration/*psychology ; Organizational Culture ; *Patient Identification Systems ; Questionnaires ; Workplace

PURPOSE: This study was done to develop and implement the Nursing KMS (knowledge management system) in order to improve knowledge sharing and creation among clinical nurses in outpatient departments. METHODS: This study was a methodological research using the 'System Development Life Cycle': consisting of planning, analyzing, design, implementation, and evaluation. Quality Function Deployment (QFD) was applied to establish nurse requirements and to identify important design requirements. Participants were 32 nurses and for evaluation data were collected pre and post intervention at K Hospital in Seoul, a tertiary hospital with over 1,000 beds. RESULTS: The Nursing KMS was built using a Linux-based operating system, Oracle DBMS, and Java 1.6 web programming tools. The system was implemented as a sub-system of the hospital information system. There was statistically significant differences in the sharing of knowledge but creating of knowledge was no statistically meaningful difference observed. In terms of satisfaction with the system, system efficiency ranked first followed by system convenience, information suitability and information usefulness. CONCLUSION: The results indicate that the use of Nursing KMS increases nurses' knowledge sharing and can contribute to increased quality of nursing knowledge and provide more opportunities for nurses to gain expertise from knowledge shared among nurses.
Ambulatory Care/*organization & administration ; Attitude of Health Personnel ; Humans ; Internet ; Nursing Staff, Hospital/*psychology ; *Program Development ; *Program Evaluation ; Tertiary Care Centers ; User-Computer Interface

Humans ; Pediatrics ; manpower ; Personnel Administration, Hospital ; Respiratory Therapy Department, Hospital ; manpower

INTRODUCTIONWe sought to determine the opinions of patients, their visitors and healthcare workers regarding Influenza A (H1N1) response measures instituted within a tertiary hospital in Singapore.

MATERIALS AND METHODSThis questionnaire study was undertaken from 21 May 2009 to 31 August 2009.

RESULTSThere were 92 respondents, ranging in age from 15 to 77 years. Of the 90 who identified their role, 35.6% were patients, 12.2% visitors and 52.2% health care professionals. About 23% of respondents disagreed that one could have H1N1 without fever or fl u-like symptoms, while 14.3% thought influenza could not be caught from an asymptomatic infected person. About 30% perceived the H1N1 death rate as high. From this study, 82.2% of respondents agreed or strongly agreed that Singapore's H1N1 responses were essential, while 14.6% found it overdone. In particular, healthcare workers and doctors found their professional work to be inconvenienced. Although more than two-thirds of doctors held this view, an equal proportion agreed the outbreak response was essential.

CONCLUSIONSThere was a high level of acceptance of response measures as essential, despite the perceived inconvenience. We propose that the success of containment measures requires unity of purpose and understanding among stakeholders at all levels.

Adolescent ; Adult ; Aged ; Attitude to Health ; Communicable Disease Control ; organization & administration ; Disease Outbreaks ; Female ; Hospitals, Public ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; Male ; Middle Aged ; Patient Satisfaction ; Personnel, Hospital ; psychology ; Public Health ; Singapore ; epidemiology ; Surveys and Questionnaires ; Visitors to Patients ; psychology ; Young Adult

PURPOSE: The purpose of this study was to examine the impact of strategies to promote reporting of errors on nurses' attitude to reporting errors, organizational culture related to patient safety, intention to report and reporting rate in hospital nurses. METHODS: A nonequivalent control group non-synchronized design was used for this study. The program was developed and then administered to the experimental group for 12 weeks. Data were analyzed using descriptive analysis, chi-square-test, t-test, and ANCOVA with the SPSS 12.0 program. RESULTS: After the intervention, the experimental group showed significantly higher scores for nurses' attitude to reporting errors (experimental: 20.73 vs control: 20.52, F=5.483, p=.021) and reporting rate (experimental: 3.40 vs control: 1.33, F=1998.083, p<.001). There was no significant difference in some categories for organizational culture and intention to report. CONCLUSION: The study findings indicate that strategies that promote reporting of errors play an important role in producing positive attitudes to reporting errors and improving behavior of reporting. Further advanced strategies for reporting errors that can lead to improved patient safety should be developed and applied in a broad range of hospitals.
Adult ; Attitude of Health Personnel ; Humans ; Internet ; Medical Errors/*nursing/prevention & control ; Nursing Staff, Hospital/organization & administration/*psychology ; Organizational Culture ; Patient Care ; Program Evaluation ; Questionnaires ; Risk Management ; Young Adult

OBJECTIVE. This study was conducted to describe areas of concern with respect to occupational health and safety (OHS) program administration at eleven (11) Metro Manila hospitals, particularly: level of OHS knowledge and skill of personnel, the nature of occupational hazards perceived to exist in the hospitals, and how these relate to OHS program staffing and implementation.
METHODS. Participants were surveyed on OHS knowledge and skills, as well as perceived occupational hazards, during the pilot of the "Occupational Health and Safety for Hospital Workers" training course held last April 2009.
RESULTS AND DISCUSSION. The participants needed improvement in many of the OHS knowledge and ability items assessed. Familiarity and mastery of some items were demonstrated, but for effectiveness to be assured, it is necessary for other areas to be improved. Occupational hazards from all categories (chemical, ergonomic, physical, biological, and safety-related) are observed in the hospitals, with the most frequently cited being chemical and ergonomic in nature. Health and safety committees and OHS programs exist, but staff abilities limit their operation and effectiveness.
CONCLUSION AND RECOMMENDATIONS. Improvement of certain OHS personnel abilities in the hospitals surveyed is suggested, and may help improve administration of OHS programs.

Occupational Health ; Perception ; Personnel, Hospital ; Philippines ; Safety ; Surveys And Questionnaires ; Hospital Administration ; Staff Development