Análisis de los indicadores de calidad de la actividad asistencial, docente e investigadora del servicio de cirugía general y digestivo del Hospital Clínico Universitario Virgen Arrixaca (2019-2022)

Zusammenfassung

Objectives: the main objective of this thesis has been to monitor the care, teaching and research activity of the General and Digestive Surgery Service of the HCUVA, as well as its evolution in the last 4 years (2019-2022). In order to achieve the main objective, the following secondary objectives were established: i) To implement a strategic management web tool to monitor the care, teaching and research activity of the General and Digestive Surgery Department of the HCUVA. ii) To evaluate indicators of efficiency in the management of care resources of the General and Digestive Surgery Department of the HCUVA (LEQ, operating room occupancy, hospital stay) and accessibility (to consultations and to the operating room). iii) To evaluate indicators of Quality and Safety of the General and Digestive Surgery Service of the HCUVA. iv) To evaluate indicators of Quality in Teaching and Research of the General and Digestive Surgery Service of the HCUVA. v) To measure the impact of COVID-19 on the Waiting List for consultations, on the activity and Surgical Waiting List of the General and Digestive Surgery Service. Material and Method: A longitudinal study was carried out, with a duration of four years, from 2019 to 2020. Data were collected on the indicators of care, teaching and research activity. A descriptive and comparative analysis by blocks was carried out to see the behavior of the indicators from 2019 to 2022. To measure the possible impact of the COVID-19 pandemic on the CGD service, three different analyses were performed: i) two time periods were compared (pre-COVID and COVID), ii) a comparative analysis was carried out between the COVID waves, iii) a discriminant function analysis was performed by COVID waves and by periods (Pre-COVID, COVID and Post-COVID) in order to determine whether the waves and/or periods have been significantly different from each other. The data were stored in the strategic plans web tool developed by the IMIB Bioinformatics Platform. Data analysis was performed with the SPSS v.28 statistical software. The Kolmogorov Smirnov test was used to check whether the data followed a normal distribution. For comparisons of means, Tukey's HSD test was used for two-to-two comparisons, and ANOVA for multiple comparisons. The level of statistical significance is 0.05 (p<0.05) for all results. Results: The CGD Service presents an average of 4700 interventions/year (33% interventions derived from other health areas due to their complexity). When comparing the data between 2019 and 2022, the surgical performance has experienced a progressive improvement (78% vs. 83%; p<0.0001) and the average structural waiting time has decreased by 7 days (95 vs. 88; p<0.0001). In hospitalization, the CGD service, in 2022, had a total of 2978 admissions, generating 13,663 stays, with an average length of stay of 4.6 days. Despite the increased pressure of care (increase of 294 admissions in 2022), the average length of stay of admitted patients decreased significantly (5.1 vs. 4.6; p<0.001). In terms of outpatient activity, a significant decrease in activity can be observed in 2020 (reduction of 6374 visits) as a consequence of the pandemic caused by COVID-19. This situation produced, in the following years, an increase in the number of patients waiting (p<0.006), average waiting time for the first consultation (p<0.0001), and the number of patients referred from other Health Areas (p<0.0001). With regard to the quality and safety indicators monitored, it can be seen that the CGD Service has shown a progressive improvement in recent years, complying with the standards established in the Area I Health Management Agreement. With regard to the monitoring of teaching and research activity indicators, it can be seen that the CGD Service maintains a stable number of residents who defend their thesis during the residency stage (n=3). In terms of scientific work, although the number of publications has been reduced in recent years (2021 and 2022), the impact factor has increased (with respect to 2019 and 2020), which translates into a scientific production of higher quality and relevance. Conclusions: i) The implementation of a strategic management web tool for monitoring the care, teaching and research activity of the CGD Department has made it possible to know the status of the department, its evolution, and the identification of areas for improvement. ii) The CGD Department has shown, over the 4 years, an overall improvement in some efficiency indicators for the management of care resources (surgical performance, rate of suspensions, average stay, discharge home before 12 hours) while maintaining a performance above the standard. However, there is still insufficient improvement in some aspects such as accessibility to outpatient consultations and the surgical waiting list (for priorities two and three). iii) The CGD Service has shown a significant improvement in the Quality and safety indicators included in the Management agreement of Servicio Murciano de Salud, although it is necessary to continue working on awareness and importance of the implementation and compliance with safety protocols, for greater satisfaction of professionals and patients. iv) The CGD Service shows a significant improvement in the indicators of Quality in Teaching and Research in the last 2 years (2021-2022). v) The pandemic caused by COVID-19 had a direct and differentiated impact according to the epidemic waves, significantly affecting the indicators of surgical activity and outpatient consultations, but less than expected or reported in other health areas and autonomous communities.