Giulio Cecconi

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.

HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence

BACKGROUND A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. OBJECTIVE This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. METHODS The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. RESULTS A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. CONCLUSIONS The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.

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.

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.

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

Operating theatre model for activity monitoring and planning in hospitals

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

A Robust Tool to Compare Pre- and Post-Surgical Voice Quality

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.

Hospital-based health technology assessment on the use of mitral clips in the treatment of mitral regurgitation

Operating Theatre (OT) is one of the most complex areas within the hospital in terms of activity management and safety control. Although OT activity represents a serious issue in hospital, there is still a lack of guidelines or regulations currently available. On the other hand for post-surgery infections many studies and guidelines have been already provided, especially regarding specific prevention and control measures. Moreover the high cost deriving from the OT management represent a further key which must be precisely monitored for its heavy weight on the hospital economic balance. Hence, the main goal of this paper is to develope a supporting model, which is based on specific performance indicators, able to support health departments. The aim of the model is to monitor and control the main aspects contributing to the efficiency of OT activity. This topic allows hospital decision makers to have a usable and widely accessible tool for planning and simulating possible modifications within the OT organization. Finally, for the tool validation, the dashboard is currently being applied to a real hospital department.