Francesco Frosini

Development of sustainable models for technology evaluation in hospital

BACKGROUND This paper reports the development of standard techniques for technology evaluation in hospital carried out at the Florence Teaching Hospital Careggi (AOUC), where, as a complex system, the technological evaluation is a strategic and essential element for the maintenance of high-quality clinical activity and maximization of available resources. OBJECTIVE The aim of this paper has been the development of a system of economically sustainable models for the implementation of HTA and HS analyses in the hospital environment as well as presenting, in addition to a valid scientific resilience, the methodological and temporary flexibility to satisfy needs of hospital decision-makers. METHODS The evaluation models call for 3 main phases: an initial analysis of the in-hospital request, a collection of data, and finally a draft of a specific, easily usable set of reports. RESULTS Three standardized and tested models of evaluation were developed, which, in relation to the objective of the request and schedule of the assignment, provide for the production of a speedy report (1-week), an intermediate report (1-month), or a extensive report typical of classical studies of hospital based HTA (1-year). It is then related to the evaluation model of the IORT (Intra-Operative Radiation Therapy) technology. DISCUSSIONS AND CONCLUSION The developed models have permitted the construction, using personnel and laboratories within the hospital, of an evaluation system reliable and responsive to the HOSPITALs temporary needs based on the HS and HTA analyses in the hospital environment. Regarding the applicable case of IORT, this has shown how in-hospital requests have been satisfied in the preset time: although it establishes expected improvements on the social effect and weight of the illness and reveals a high territorial strategic relevance, the introduction of IORT in the hospital presents some criticalities on the impact on the healthcare organization and the necessity of specific training of medical technologist personnel.

Experience of Lean Six Sigma Quality Approach to Hospital Laboratory Services

The Lean Six Sigma method is a process analysis methodology that focuses on improving customer requirements understanding, business systems, productivity, and financial performance [1]. Motorola invented Six Sigma with the goal of setting tolerance limits for defective products at 3.4 units per million.

Careggi Smart hospital: A mobile app for patients, citizens and healthcare staff

This paper presents a mobile app called “Careggi Smart Hospital” which has been developed for the Careggi Polyclinic in Florence. The application is designed for Android smartphones and tablets and it is freely downloadable from the Google Play Store. It provides various useful tools to the hospitals users such as personnel and structures finding, way-finding and the possibility to access personal medical records collected on regional electronic health record.

Lean Thinking in Hospital: Case Study at the Pathology Laboratory

When a good is produced a lot of transformations have to be made in order to satisfy client request. All of the phases are made in specific work-cells: the material is moved between the cells with an high risk of errors or lost of efficiency.

Hospital Based Economic Assessment of Robotic Surgery

The aim of the following paper is reporting the hospital based assessment of robotic surgery at the teaching hospital AOU Careggi in Florence (Italy). The analysis was mainly focused on the economic assessment of robotic surgery at the hospital context by evaluating different acquisition simulated scenarios and by comparing two different robotic solutions: the daVinci© and the Kymerax©.

A Decision Support System for Operating Theater in Hospitals: Improving Safety, Efficiency and Clinical Continuity

Surgical area is onne of the most critical components within the hospital system as it represents the core activity in terms of health services’ production, patients’ infections and technology management.

Evidence-based approach to medical equipment maintenance monitoring

Maintenance is a crucial part of the life cycle of medical equipment. We applied a specific set of codes to classify the corrective and scheduled maintenance work orders at the University Hospital of Careggi (Florence, Italy). A set of Key Performance Indicators (KPI) (financial, technological and organizational) helps in evaluating the performance of the medical equipment maintenance. The analysis of KPIs (related to costs, age and SM completion rate) revealed some problems in maintenance strategy. The results show, starting from the evidences (i.e. the failures), that the combination of these two methods can give a periodical cross-analysis of the maintenance performance and indicate the most appropriate procedure.

Development of a web based monitoring system for safety and activity analysis in operating theatres

BACKGROUND The management and the monitoring of the operating rooms on the part of the general management have the objective of optimizing their use and maximizing the internal safety. The expenses owed to their safe use represent, besides reimbursements coming from the surgical activity, important factors for the analysis of the medical facility. OBJECTIVE Given that it is not possible to reduce the safety, it is necessary to develop supporting systems with the aim to enhance and optimize the use of the rooms. METHODS The developed analysis model of the operating rooms in this study is based on the specific performance indicators and allows the effective monitoring of both the parameters that influence the safety (environmental, microbiological parameters) and those that influence the efficiency of the usage (employment rate, delays, necessary formalities, etc.). This allows you to have a systematic dashboard on hand for all of the OTs and, thus, organize the intervention schedules and more appropriate improvements. RESULTS A monitoring dashboard has been achieved, accessible from any platform and any device, capable of aggregating hospital information. The undertaken organizational modifications, through the use of the dashboard, have allowed for an average annual savings of 29.52 minutes per intervention and increase the use of the ORs of 5%. The increment of the employment rate and the optimization of the operating room have allowed for savings of around

Integrated HTA and FMECA Methodology for the Evaluation of Robotic Surgery

299,88 for every intervention carried out in 2013, corresponding to an annual savings of

Discrete event simulation-based approach for hospital services development and monitoring

343,362,60. CONCLUSIONS Integration dashboards, as the one proposed in this study as a prototype, represent a governance model of economically sustainable healthcare systems capable of guiding the hospital management in the choices and in the implementation of the most efficient organizational modifications.