Implementation of Lean Management in a Multi-Specialist Hospital in Poland and the Analysis of Waste

At the beginning of the 21st century, Lean Management (LM) tools were introduced into the healthcare sector around the world. In Poland, there are still few LM implementations, and they are not of a comprehensive nature. The aim of this article is to present the application of the LM concept in a hospital in Poland as a tool for the identification and analysis of waste and its impact on the process of organizing the provision of medical services on the example of improvements in the process of patient admission. In the period from 1 July 2019 to 31 December 2019, a project of LM implementation was carried out at the Provincial Specialist Hospital in Wroclaw. The project was based on the method of value-stream mapping and 5Why. Standardized interviews (before and after the project) were conducted with people from the hospital management and middle-level managers. The implementation of LM tools resulted in the identification of a number of wastes, which have been divided into groups. The most important waste was paper medical documentation. Its change to an electronic form allowed for a better use of human capital resources; savings included 2.3 nursing positions and 1.09 medical staff positions.

First study of the RuPatient health information system with optical character recognition of medical records based on machine learning

RuPatient health information system (HIS) is a computer program consisting of a doctor-patient web user interface, which includes algorithms for recognizing medical record text and entering it into the corresponding fields of the system.Aim. To evaluate the effectiveness of RuPatient HIS in actual clinical practice.Material and methods. The study involved 10 cardiologists and intensivists of the department of cardiology and сardiovascular intensive care unit of the L. A. Vorokhobov City Clinical Hospital 67 We analyzed images (scanned copies, photos) of discharge reports from patients admitted to the relevant departments in 2021. The following fields of medical documentation was recognized: Name, Complaints, Anamnesis of life and illness, Examination, Recommendations. The correctness and accuracy of recognition of entered information were analyzed. We compared the recognition quality of RuPatient HIS and a popular optical character recognition application (FineReader for Mac).Results. The study included 77 pages of discharge reports of patients from various hospitals in Russia from 50 patients (men, 52%). The mean age of patients was 57,7±7,9 years. The number of reports with correctly recognized fields in various categories using the program algorithms was distributed as follows: Name — 14 (28%), Diagnosis — 13 (26%), Complaints — 40 (80%), Anamnesis — 14 (28%), Examination — 24 (48%), Recommendations — 46 (92%). Data that was not included in the category was also recognized and entered in the comments field. The number of recognized words was 549±174,9 vs 522,4±215,6 (p=0,5), critical errors in words — 2,1±1,6 vs 4,4±2,8 (p<0,001), non-critical errors — 10,3±4,3 vs 5,6±3,3 (p<0,001) for RuPatient HIS and optical character recognition application for a personal computer, respectively.Conclusion. The developed RuPatient HIS, which includes a module for recognizing medical records and entering data into the corresponding fields, significantly increases the document management efficiency with high quality of optical character recognition based on neural network technologies and the automation of filling process.

Epidemiological Community and Differences of Transmissive Infections in Astrakhan Region

Relevance. The territory of the Astrakhan region hosts natural foci of severe infections of arbovirus etiology – Crimean-Congo hemorrhagic fever (CCHF) and Astrakhan fever (spotted fever resembling the Mediterranean spotted fever, Astrakhan spotted fever (ASF). The long-term average incidence of CCHF and ASF in the Astrakhan region is to 11 and 135 times higher, respectively, than the average incidence in the Russian Federation. Aims. To present, based on epidemiological data, a comparative characterization of transmissible infections of CCHF and ASF in the Astrakhan region. Materials & Methods. The main method of the study was epidemiological. The data for 2000−2016 of primary medical documentation Ф.058/у «Emergency notification of infectious disease, food, acute occupational poisoning, unusual reaction to vaccination», federal statistical observation Ф. 2 «Information on infectious and parasitic diseases», Ф. 357/у «Epidemiological examination card of infectious disease focus», Ф. .003/у «Medical card of inpatient patient», presented by Center of hygiene and epidemiology in Astrakhan region. For retrospective epidemiological analysis, we studied the absolute and intensive morbidity indicators (per 100 ths population), by age, professional groups, and among the urban and rural population. Based on the average long-term morbidity indicators of the population, a mapping of the territory of the Astrakhan region was carried out. The influence of natural and climatic conditions on the epidemic process of CCHF and ASF was assessed by meteorological data (amount of precipitation, air temperature, etc.). Materials of long-term observation over 11 districts of Astrakhan region and Astrakhan city were analyzed, including data on the spread of Ixodid ticks, population contact with them (according to the attendance of people to treatment-and-prophylactic organizations of the region). Statistical data processing was carried out using the method of straight-line alignment of dynamic series of morbidity indicators, calculation of the average annual rate of decrease/increase. Correlation analysis was used to assess the direction and strength of the relationship between the indicators, and quantitative dependence between epidemic process characteristics. Differences between the indicators were considered to be reliable if p < 0.05. Results. During the analyzed period 151 cases of CCHF and 3951 cases of ASF were identified. By 2016. CCHF was registered in all 11 districts of the region and the area of foci covered 44,000 km2 and 44,100 km2, respectively. There are no differences significantly affecting the epidemic process of CCHF and ASF, so preventive measures are mainly aimed at controlling the vectors of the pathogens of these infections. The comprehensive study of the territory of Astrakhan region carried out in 2000–2016 revealed expansion of CCHF and ASF areal of disease (by 11.8% and 23.4% respectively) and determined the territories with the highest risk of infection, which allowed to increase and redistribute the volumes of acaricide treatments of the territories with the highest infection risk and ensure the decrease of CCHF and ASF morbidity rates. Conclusion. As a result of the comprehensive study conducted in 2000–2016 in the territory of Astrakhan region, the expansion of CCHF and ASF areal of disease was revealed (by 11.8% and 23.4% respectively) and the areas of highest infection risk were identified, which allowed to increase and redistribute the volume of acaricide treatments of the areas of highest infection risk and ensure the reduction of CCHF and ASF morbidity.

Metachronous multiple primary cancer of the pancreatic head and liver: a case of hepatocellular carcinoma 10 years after pancreatoduodenal resection

The Aim. Study of a clinical case of metachronous primary multiple cancer of the head of the pancreas and liver.Materials and methods. The work was carried out with modern domestic and foreign literature sources devoted to the problem of primary multiple malignant neoplasms. A retrospective analysis of the patient’s clinical and anamnestic data was performed, the necessary medical documentation was studied.Results. In 2011, a pancreatoduodenal resection was performed on a patient for ductal adenocarcinoma of the head of the pancreas. In 2021, an MRI scan revealed a formation in S5-S6 with dimensions up to 34x35x29 mm. According to the histological examination of the biopsy material, hepatocellular carcinoma was confirmed. Resection of the 5th segment of the liver was performed in the conditions of the NMIC Oncology in Rostov-on-Don.Conclusion. The presented case of primary multiple cancer of the head of the pancreas and hepatocellular carcinoma of the liver is of direct interest both from the point of view of oncological surgery and chemotherapy.

Speech recognition for medical documentation: an analysis of time, cost efficiency and acceptance in a clinical setting

Background/Aims Medical documentation is an important and unavoidable part of a health professional's working day. However, the time required for medical documentation is often viewed negatively, particularly by clinicians with heavy workloads. Digital speech recognition has become more prevalent and is being used to optimise working time. This study evaluated the time and cost savings associated with speech recognition technology, and its potential for improving healthcare processes. Methods Clinicians were directly observed while completing medical documentation. A total of 313 samples were collected, of which 163 used speech recognition and 150 used typing methods. The time taken to complete the medical form, the error rate and error correction time were recorded. A survey was also completed by 31 clinicians to gauge their level of acceptance of speech recognition software for medical documentation. Two-sample t-tests and Mann–Whitney U tests were performed to determine statistical trends and significance. Results On average, medical documentation using speech recognition software took just 5.11 minutes to complete the form, compared to 8.9 minutes typing, representing significant time savings. The error rate was also found to be lower for speech recognition software. However, 55% of clinicians surveyed stated that they would prefer to type their notes rather than use speech recognition software and perceived the error rate of this software to be higher than typing. Conclusions The results showed that there are both temporal and financial advantages of speech recognition technology over text input for medical documentation. However, this technology had low levels of acceptance among staff, which could have implications for the uptake of this method.

Medical and organizational approaches to early diagnosis of skin melanoma

Introduction. The most significant problem is the early diagnosis of skin melanoma (SM). In many countries of the world, there is a constant increase in the incidence rate, and the organization of population screening can help solve this problem. Purpose of the study. Evaluation of the use of multi-agent technology in the diagnosis of SM. Material and methods. Study design: at the 1st stage, primary medical documentation was studied - Charts No. 090/y; 027-2/y, statistical reports of the Samara Regional Clinical Oncological Dispensary - Charts No. 7, No. 35, according to the results revealed at stage 2. There was developed and implemented multi-agent technology for SM diagnostics, including various agents of both qualified and specialized levels, these were both individuals and teams of departments who worked in close contact: a public relations agent; artificial intelligence secondary prevention planning agent; agent for training doctors and nurses, patients in the basics of early diagnosis and assessing their level of training; an agent for evaluating performance indicators. Results. After introducing the multi-agent system, the indicator of the share of 1-2 stages of MC in 2010-2019. increased by 48.3% compared to the period 2000-2009 and outpaced the growth in the total number of patients with SM by 6.96%; from 2010 to 2019 the proportion of patients with SM who were actively identified began to increase; one-year mortality rate from 2010 to 2019 decreased in waves (y = 0.0003x5 - 0.0104x4 - 0.2647x3 + 1.4818x2 - 1.8942x + 10.585; R2 = 0.554). Conclusion. The use of multi-agent technology makes it possible to reduce the one-year mortality rate, to achieve a faster growth rate of the newly detected number of patients with an early stage of SM (stage 1-2) compared to the increase in the number of cases, to improve the indicators of early diagnosis, active detection of skin melanoma, which is a positive result.

Osteopathic status in patients with new coronavirus infection COVID-19

Introduction. The appearance of COVID-19 has set tasks for healthcare professionals related to the rapid diagnosis and provision of medical care to patients. Currently, intensive study of the clinical and epidemiological features of the disease continues, and of the development of new means of its prevention and treatment. At the same time, it is necessary not only to provide medical care in the acute period of the disease, but also to carry out rehabilitation measures for the consequences of a coronavirus infection. In accordance with the approved clinical recommendations, osteopathic correction in the acute period of an infectious disease is contraindicated. However, there is a potential interest of the possibility of osteopathic correction methods use during the period of convalescence, as well as within the framework of rehabilitation measures after a new coronavirus infection.At the same time, for objective reasons, there is no data on the structure of somatic dysfunctions in this group of patients in the literature. All of the above has predetermined the purpose of the research.The aim of the study is to draw up a map of the most common somatic dysfunctions and analyze their relationship with other subjective and objective manifestations of the disease based on the data of the osteopathic status assessing of patients who have undergone a new coronavirus infection COVID-19.Materials and methods. A cross-sectional study was conducted on the basis of Samara medical and sanitary unit № 2 and on the basis of the Saint-Petersburg «City Mariinsky Hospital» in the period from May 2020 to March 2021. There were 70 patients under observation in the rehabilitation department who had undergone a new coronavirus infection COVID-19. There were assessed the osteopathic status of all patients (by an osteopathic doctor with using personal protective equipment) and the level of anxiety; the data was copied from medical documentation.Results. Somatic dysfunctions of all three levels of manifestation are revealed in patients with the new coronavirus infections during the convalescence period. The global and regional somatic dysfunctions were distributed almost equally (45,7 and 54,3 %, respectively) in the structure of dominant somatic dysfunctions in patients with new coronavirus infections during the convalescence period. Patients with new coronavirus infections during the convalescence period are characterized by medium and high levels of both situational and personal anxiety. In the course of the work, a moderate positive relationship was established between a global rhythmogenic disorder (violation of the production of a thoracic rhythmic pulse) and a large volume of lung tissue damage (CT-2) according to the multispiral computed tomography of the thoracic cavity, as well as between a global psychoviscerosomatic disorder and a high level of situational anxiety.Conclusion. Somatic dysfunctions of all three levels of manifestation are revealed in patients with new coronavirus infections during the convalescence period. In addition, this group of patients is characterized by an average and high level of both situational and personal anxiety.The revealed correlations suggest that the inclusion of osteopathic correction in comprehensive rehabilitation programs for this group of patients may be pathogenetically reasonable.

A pilot study about methods to reduce prescription errors in a chemotherapy day unit – Aspects to consider in pharmacist verification process

Introduction Prescribing errors can happen unintentionally during the prescribing process, or when choosing a treatment therapy. Prescribing errors have the highest prevalence amongst common error types related to chemotherapy medication in outpatient settings. According to the Joint Commission International (JCI), prescriptions should be reviewed for appropriateness by someone else than the prescriber or practitioner to prevent medication errors. Aim The study was aimed to map out the existing type and amount of occurring deviations in prescribing and to clarify the current chemotherapy prescribing practices at the Comprehensive Cancer Center at Helsinki University Hospital. Similar research has not been published in Finland before. Methods and patients The researcher selected patients randomly from the daily outpatient attendance list following a predetermined numerical order. Data was collected by conducting a medication verification review in line with the JCI guidance by a clinical pharmacist the day before the patient's clinic appointment using the available medical documentation. A clinical pharmacist evaluated findings from prescriptions and contacted an oncologist if the findings were considered clinically significant. Results A clinical pharmacist verified prescriptions from 101 patients for appropriateness and found discrepancies in four percent of the prescriptions ( n = 4/101). The oncologist approved 50 percent of the suggested amendments by the pharmacist as clinically significant ( n = 2/4). The study revealed that patient’s regular home medications were not always correctly recorded into the database, so verification of medicine interactions could not be trusted as completely accurate. It took on average 16 min per patient to perform a medication verification review. The process was slowed down by the lack of detailed enough protocols for this purpose and the current patient care record system not having structural formatting of data entry. Conclusions Verification of prescriptions provides a tool to identify prescribing discrepancies and to prevent unintended medication errors affecting patients. The development of detailed protocols and guidelines, as well as an appropriate training program, would support pharmacists in compiling clinical medication reviews for chemotherapy patients. More research is needed to further develop the operating model in Finland. Information gathered from this study can be used for identifying training requirements.

Electronic Document Management System (EDMS) Implementation: Implications for the Future of Digital Transformation in Philippine Healthcare

The COVID-19 pandemic is raising concerns all around the globe, as many lives have been lost and families have been left without hope. The Digital Era has started, and many sectors, including healthcare, are adapting to the innovative human-machine integration that has developed. However, the new systems still offer benefits and limits that will influence certain nations' choice to accept this platform owing to their unique requirements and circumstances. The earliest electronic health records were developed in the early 1960s to store long-term patient data. However, it was not maintained since the system's foundation is very demanding, and medical practitioners stopped utilizing it. After a decade, the growth of technology was unavoidable, gradually altering areas such as business and healthcare. However, every development has ramifications. The implementation of the new system may enhance organizational performance, but there are still uncertainties, notably about sustainability and how it will affect the firm in the future. Now, sufficient medical documentation has long been a source of contention in the healthcare industry, and management should begin introducing new processes to address the underlying problem. If the government already has a system in place to ensure the country's long-term existence, this system should be used to ensure the consistency of each patient's medical records. Will an Electronic Document Management System (EDMS) adaptation in the Philippines, a third-world nation with a poor healthcare system, be the best option to modify and enhance medical care quality?

ALCOHOL ABUSE AS AN UNDERESTIMATED CAUSE OF NON-TRAUMATIC OSTEONECROSIS OF THE FEMORAL HEAD (DESCRIPTION OF CLINICAL CASES)

Osteonecrosis of the femoral head is a severe degenerative-dystrophic disease, which is characterized by the destruction of the bone substance in the head in the most vulnerable (loaded) parts. Due to a rapid progression in the absence of proper surgical treatment, osteonecrosis of the femoral head, as a rule, results in disability. There is a wide range of causes that cause the development of osteonecrosis. According to the authors, alcohol abuse should be attributed to the underestimated causal factors of this pathology. The article presents two clinical observations which convincingly demonstrate the role of alcohol abuse as a cause of osteonecrosis. In a 44-year-old man prolonged alcohol abuse led to a progressive (within a year) advance of osteonecrosis in the heads of both femurs, and in a 26-year-old woman, along with a short-term intake of glucocorticoids, it contributed to the formation of multifocal non-traumatic osteonecrosis with damage to the pelvic, right knee, shoulder joints. The authors explain underestimated role of alcohol abuse as a causal factor of osteonecrosis as follows. Firstly, patients, as a rule, try not to display their addiction, and therefore, unlike other predictors of developing femoral bone osteonecrosis (injuries, serious somatic diseases, taking glucocorticoids), this fact is not reflected in medical documentation. Secondly, patients with idiopathic forms of osteonecrosis often do not have an "assigned" doctor who could dynamically follow up the patient and, consequently, monitor more carefully his condition and risk factors for osteonecrosis. When consulting such a patient, a subspecialist, as a rule, sets himself the task first of all to exclude "his disease", which makes the patient vulnerable in terms of finding out the causes of osteonecrosis. These clinical cases demonstrate the need to take into account alcohol abuse as a significant causal factor in the development of osteonecrosis.