Evaluation of the risk of occupational exposure to antineoplastic drugs in healthcare sector: part II - the application of the FMECA method to compare manual vs automated preparation.

Healthcare workers handling antineoplastic drugs (ADs) in preparation units run the risk of occupational exposure to contaminated surfaces and associated mutagenic, teratogenic, and oncogenic effects of those drugs. To minimise this risk, automated compounding systems, mainly robots, have been replacing manual preparation of intravenous drugs for the last 20 years now, and their number is on the rise. To evaluate contamination risk and the quality of the working environment for healthcare workers preparing ADs, we applied the Failure Mode Effects and Criticality Analysis (FMECA) method to compare the acceptable risk level (ARL), based on the risk priority number (RPN) calculated from five identified failure modes, with the measured risk level (MRL).

[Lean, work and psychological well-being.].

Many studies have confirmed the existence of a close relationship between job satisfaction and health. The Siena University Hospital introduced the Lean approach to support personnel development/empowerment and promote a constant improvement in work organization, with the aim of creating value for patients, professionals and the whole organization. The purpose of this study was to examine whether the introduction and the development of this improvement approach in healthcare could contribute to the enhancement of psychological wellbeing and employee satisfaction, with a positive value in preventing related stress work.

Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery.

Objectives: The following study proposes and tests an integrated methodology involving Health Technology Assessment (HTA) and Failure Modes, Effects and Criticality Analysis (FMECA) for the assessment of specific aspects related to robotic surgery involving safety, process and technology.

Methods: The integrated methodology consists of the application of specific techniques coming from the HTA joined to the aid of the most typical models from reliability engineering such as FMEA/FMECA. The study has also included in-site data collection and interviews to medical personnel.

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.

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.

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

Background: This study, carried out at the Florence Teaching Hospital Careggi (AOUC), reports the technological evaluation, through the use of Health Technology Assessment (HTA), on the application of mitral clips in the treatment of mitral insufficiency.

Objective: The assessment, carried out by analyzing the clinical, technological, social, procedural, safety and economic elements, sought to answer the following research questions: Evaluation of the general technological status of the mitral clips in the treatment process of mitral regurgitation, with particular reference to traditional methods; and contextualisation of the analyses within the hospital structure, by identifying criticality issues and improvements.

Methods: The methodology was based on the following steps: technological description; areas of evaluation and the selection of Key Performance Indicators; research of scientific facts and the collection of expert opinions; evaluation and reporting of findings.

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.

Design of a decision support system for preventive maintenance planning in health structures.

The appropriate maintenance of medical devices, including performance inspections and preventive maintenance, is fundamental in mitigating clinical risk caused by adverse events in health care. Although several models for managing and planning preventive maintenance have been developed, the problem is lacking in standard methodology and still presents an open challenge for today's health experts. This paper aims to provide and develop methodology together with support systems able to assist decision makers in constructing preventive maintenance and performance inspection plans, taking into account both the technical and economic needs of hospital clinical engineering departments.

Health technology management: a database analysis as support of technology managers in hospitals.

Technology management in healthcare must continually respond and adapt itself to new improvements in medical equipment. Multidisciplinary approaches which consider the interaction of different technologies, their use and user skills, are necessary in order to improve safety and quality. An easy and sustainable methodology is vital to Clinical Engineering (CE) services in healthcare organizations in order to define criteria regarding technology acquisition and replacement.

Longitudinal expandable shelter for medical response during disasters.

Introduction: During medical emergencies, hospitals represent the final point of the whole rescue process. Therefore, effective health mobile structures have to be inserted between hospitals and the place of the event with the aim of giving the best of cures (using appropriate and easy to use equipment) for a safer and faster evacuation to hospitals.

Methods: Literature review and national and international disaster medicine standards were the basis for this study to provide clinical, hygienical, and organizational needs to satisfy for the medical structure design.

Custom active RFId solution for children tracking and identifying in a resuscitation ward.

In this work is discussed an active RFId system to track and identify patients in a children's critical care ward. The technical solutions may be very different according to the patients type, age and cognitive conditions and according to the hospital shapes. The proposed system to track and identify patients has been developed taking into account all the constraints induced by the particular environment.

Patients tracking and identifying inside hospital: a multilayer method to plan an RFId solution.

This paper shows a method to get a patient tracking RFId solution, basing on a multilayer planning architecture. This approach is thought to guarantee that the found technical solution is as much as possible coherent to the very initial idea. Project aims, functional requirements and technical constraints are defined in order to arrive to an active RFId solution to track and identify patients inside a hospital.

DSS for field hospitals planning. Technological and functional aspects.

During the last 50 years natural and social disasters have increased 250%, affecting at least 800 million people. The causes of these disasters are various and most of them are not predictable. A successful strategy is a well planned medical response.