Physicians＇ and Managers＇ Approach to Quality --Experience in Italian Hospitals

Literature provides many contributions about quality management and quality improvement. A few authors investigated the kind and strength of contribution to quality from physicians and managers. This study investigates the different approaches of physicians and managers towards managing and improving quality within healthcare organizations. Research questions are focused on the existence of any kind of correlation between physicians＇ and quality managers＇ skills as regards quality management. Do they work independently or is it possible to find out some relationship between their effort in enforcing service quality. In addition to that, the paper investigates if there is a correlation between organization＇s characteristic （dimension, ownership, teaching/not-teaching hospital） and quality of services. The study investigates an Italian regional-wide external assessment program （performed by Joint Commission International） focusing on a selection of item/standard related to physicians and quality managers＇ behaviours. The study did not found significant correlation between behaviours and hospitals＇ structural characteristics as well as between physicians＇ managerial behaviours and managers＇ behaviours as regards to quality. Physicians＇ and managers＇ contributions are independent to each other. The influence of managers on clinical behaviours is weak. Quality management depends mainly on people, not on structural elements.

Does shifting to professional emergency department staffing affect the decision for chest radiography?

BACKGROUND: The study aims to determine whether shifting to professional emergency department(ED) teams leads to a higher rate of radiologic workup.METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1(G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013(all patients were examined by an internal medicine specialist);group 2(G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019(all patients were examined by an emergency physician).RESULTS: The chest X-ray(CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR(38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found(47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1.CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.