Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems.

Background: Telemedicine is an expanded term in health information technology that comprises procedures for transmitting medical information electronically to improve patients’ health status. The objective of this research is to evaluate the cost-effectiveness of telemedicine interventions in various specialty areas. Methods: The Cochrane Library and Centre for Review and Dissemination were searched up to February 2013 using Mesh. Studies that compared any kind of telemedicine with any other routine care technique and used cost per health utility unit’s outcomes were included. Results: Twenty-one articles were included. According to the included studies, it seems that using telemedicine in cardiology can be effective and cost-effective enough but pre-hospital telemedicine diagnostics program are likely to have little impact on acute myocardial infarction fatality. In pulmonary, telemedicine can be a cost-effective strategy for delivering outpatient pulmonary care to rural populations which have limited access to specialized services, but telemedicine is not cost- effective in asthma and airways cancer. In ophthalmology, especially in the diagnosis of diabetic retinopathy, the use of telemedicine is a cost-effective tool. In dermatology, telemedicine is not cost-effective enough in comparison of conventional cares. In other fields such as physical activity and diet, eating disorder, tele-ICU, psychotherapy for depression and telemedicine on ships, telemedicine can be used as a cost-effective tool for treatments or cares. Conclusion: Most of the included studies confirmed that telemedicine is cost-effective for applying in major medical fields such as cardiology; but in dermatology, papers could not confirm the positive capability of telemedicine.

Problem statement: Today, organizations are willing to achieve quality as a source of competitive advantage. Therefore, their performance evaluation and quality improvement is essential. One of the international models in this field is Baldrige health care model. Approach: The study aimed to evaluate Performance Evaluation a teaching Hospital Affiliated to Tehran University of Medical Sciences Based on Baldrige Excellence Model. Performance was evaluated by two types Baldrige questionnaire (i.e., process and result criteria). Six process criteria (Leadership; Strategic Planning; Focus on Patients, Other Customers and Markets; Measurement, Analysis and Knowledge Management; Workforce Focus; and Process Management) with 12 sub-criteria, were evaluated based on four factors of Approach, Deployment, Learning and Integration. Results criteria with six subcriteria were evaluated based on four factors of performance level, rate and breath of performance improvement, comparative and benchmark data and relevance of evaluation result scales. Results: The teaching hospital obtained 145/21 scores (26/40 percent) out of a total of 550 points in process criteria and 90/37 scores (20/08 percent) out of a total of 450 points in result criteria. Studied hospital obtained the highest score in Measurement, Analysis and Knowledge Management 28/1 scores (31/22 percent). In Sum, the hospital obtained 235/58 scores (23/55 percent) out of 1000 points. Conclusion: Scores obtained by hospital showed the first level of excellence. The outcome of this study clearly indicates that Baldrige model criteria act as a powerful tool to analyze the quality performance of the hospitals. The researchers attempted to create a common language and a roadmap in order to follow the path of excellence in health care organizations in Iran

Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

Background:Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems.Objectives:This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.Patients and Methods:The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses.Results:Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively.Conclusions:The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.