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Background and Objective: Long stops in the emergency unit will result in patient dissatisfaction and increased casualties. The present study aimed to determine the waiting time of patients visiting the emergency unit of two selected teaching hospitals in Tehran and the factors affecting it. Methodology: The present research was a cross-sectional descriptive-analytic study which was conducted in 2016. The statistical population included all patients and their caregivers in the emergency unit of Mofid and Ali Asghar hospitals, 335 of whom were selected were selected as the sample. The required data were collected using the patient's waiting time form and an author-made questionnaire, whose validity was confirmed by experts and its reliability was obtained 90% using Cronbach's alpha. The data were analyzed using ANOVA and independent t-test in SPSS-22. Findings: The results indicated that factors such as the large number of patients, long distance between emergency units, poor communication, and the low number of manpower affect the prolonged patient waiting time. In addition, the results showed the patient waiting time has a significant relationship with working shift, the day of visit, and insurance coverage (p≤0.05). Conclusion: The study findings suggested that several factors increase the waiting time of patients in emergency units. Hence, it is recommended to take necessary measures for proper distribution of manpower in a different working shift and also on weekdays and holidays in order to reduce the patient waiting time. In addition, skills and experience of the emergency unit staff need to be improved through training courses.

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Background and Purpose: The electronic referral system was established in Iran with the aim of increasing access to care, improving interaction, and efficient use of resources. The purpose of this study was to determine the effective factors in the establishment and implementation of electronic referral system in Iran. Methods: The present study was qualitative with a content analysis approach. In order to collect information, in-depth and semi-structured interviews were used. After interviewing 42 people, the information was saturated. The interviews were transcribed and analyzed, and the main topics were quoted, cited, and coded. The content analysis method was used and all authors participated in the analysis process to avoid bias and agreement. Results: Four main themes and eleven sub-themes were mentioned as effective themes in the implementation of the electronic referral system by the interviewees including resource management (human resource management, financing and equipment, and infrastructure), stewardship (policy-making, inter-sectorial leadership, and intra-sectorial governance), advocacy stakeholders (senior officials and policy-makers related to the program, service providers, community), and social commitment (commitment and accountability of service providers). Conclusions: Successful implementation of electronic referral systems requires the development of an operational plan that correctly identifies the factors affecting the establishment and implementation, as well as the cooperation of all responsible organizations which can help improve the establishment and sustainability of the program. It is suggested that managers and officials active in the field of health services use the results of this study in the establishment and implementation of electronic referral system.

Background Health tourism or treatment tourism is one of threatening fields that causes (added s) increase in prevalence of job stress and illnesses among hospital staff of providing health tourism services (HSPHT). The aim of this study is to determine the prevalence of job stress and illnesses among hospitals staff of providing health tourism services in touristic cities as Tehran and Shiraz in Iran. Methods This cross-sectional, descriptive-analytical study was carried out among the staff of 10 hospitals providing health tourism services in cities of Tehran and Shiraz, Iran, in 2019. In these hospitals, 1250 staff were chosen by cluster sampling method from each job task as doctor, nurse, office worker, and paramedical and cleaner worker. Also, 1100 staff working in other general hospitals (non-HSPHTS) were selected as the control sample. Then, the demographic information and prevalence of job stress were gathered by Osipow job stress questionnaire and the illnesses were accumulated by self-reporting questionnaire. Finally, data were analyzed in SPSS 20 software. Chi-square and Pearson’s parametric tests were used in the study. Results Prevalence of illnesses among HSPHTS was more than that in general hospitals (Pvalue < 0.05). The most prevalent illnesses were respiratory (11.08%), digestive (9.2%), and cutaneous (9.04%), respectively. Also, the prevalence of job stress among HSPHTS was more than that in general hospitals (Pvalue < 0.05). There was a significant relationship between prevalence of illnesses and job stress among the staff of hospitals and the increase in the number of visited tourists in the hospitals providing health tourism services. Conclusion Results of the study showed that the prevalence of job stress (%33.76) and illnesses (%43.66) among the HSPHTS was respectively 2 and 2.6 times more than that among the staff of general hospitals. Thus, it is necessary to observe sanitary actions and considerations more seriously in these hospitals.