La empresa MOK Perú es subsidiaria de MOK Chile y brinda servicios que cubren distintas actividades relacionadas con la asistencia médica y servicios de extensión de garantías de productos, tanto a personas como a empresas. El objetivo principal de este trabajo de investigación, es desarrollar una propuesta de mejora en el proceso de atención de servicios médicos para los subprocesos de servicios de llamadas para consultas médicas, atención médica a domicilio y servicio de ambulancias para la empresa MOK Perú, utilizando soluciones de inteligencia artificial para mejorar el servicio a través de la eficiencia del proceso. Como resultado del estudio realizado para el presente trabajo, hemos identificado que los servicios médicos representan, el 43 % de ingresos del total MOK Perú. Los problemas críticos en la atención a clientes en el call center de los servicios médicos de la empresa se encuentran principalmente en atender las llamadas para el uso de los servicios médicos, las cuales tienen un nivel de 34% de llamadas no atendidas. Se analizó el escenario actual y el escenario con la incorporación de la tecnología del chatbot, el cual nos muestra que si se realiza una inversión de S/. 255,000.00 se estima un crecimiento de rentabilidad del 5% para el quinto año, así como cumplir con los indicadores de gestión de la empresa: disminuir el tiempo promedio de espera de 22 a 2 segundos, tiempo promedio de operación de 11.8 minutos a 7.5 minutos y la tasa de llamadas no atendidas del 34% al 16%. / The company MOK Peru is a subsidiary of MOK Chile and provides services that cover different activities related to medical assistance and product warranty extension services, both to individuals and companies. The main objective of this research work is to develop a proposal for improvement in the process of medical services for the subprocesses of call services for medical consultations, home health care and ambulance service for the company MOK Peru, using solutions of artificial intelligence to improve the service through the efficiency of the process. As a result of the study conducted for the present work, we have identified that medical services represent 43% of total MOK Peru income. The critical problems in customer service in the call center of medical services of the company are mainly in answering calls for the use of medical services, which have a level of 34% of unanswered calls. The current scenario and the scenario were analyzed with the incorporation of the chatbot technology, which shows us that if an investment of S /. 255,000.00 a 5% profitability growth is estimated for the fifth year, as well as comply with the company's management indicators: decrease the average waiting time from 22 to 2 seconds, average operating time from 11.8 minutes to 7.5 minutes and the rate of unattended calls from 34% to 16%. / Trabajo de investigación

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20290号 / 社医博第79号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 小池 薫, 教授 佐藤 俊哉, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21031号 / 社医博第85号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 小池 薫, 教授 今中 雄一, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Arbetet på en akutmottagning är både komplex och oförutsägbar där patienten är ett oskrivet blad vid ankomst. Detta ställer krav på sjuksköterskans omhändertagande och ledarskap. Det förväntas att sjuksköterskan har förmåga att omhänderta och ge patienter vård på en avancerad nivå och på ett patientsäkert sätt. Sjuksköterskans kompetens och erfarenheter har en avgörande betydelse på akutmottagningen där sjuksköterskan snabbt behöver identifiera, prioritera och påbörja adekvat behandling vid livshotande tillstånd. Centralt i arbetet är att sjuksköterskan med ett ledande ansvar samverkar i team med såväl patienter och närstående som kollegor. Sjuksköterskan leder och fördelar arbetet med tydlighet för att säkra vården av patienten. Syftet med studien var att belysa sjuksköterskans erfarenheter av att leda omvårdnaden på en akutmottagning. Metoden som användes var en litteraturöversikt. Datainsamlingen utgick från sökningar i databaserna PubMed, SveMed+ och CINAHL samt manuell sökning. Tolv kvalitativa, fyra kvantitativa och tre artiklar med mixad design låg till grund för resultatet. I resultatet framkom fem teman: betydelsen av kunskap inom ledarskap och akutsjukvård, erfarenhetens betydelse av att leda i akuta situationer, intuitions betydelse vid bedömning och prioritering, kommunikationens betydelse för att uppnå en säker vård och faktorer som påverkar sjuksköterskans ledarskap. Sjuksköterskors erfarenheter visade att identifierade och beskrivna teman hade en avgörande betydelse för effekten på ledarskapet. Därigenom sågs positiva effekter på både arbetsplats, patientflöde och teamarbete och vården koordinerades väl ur ett helhetsperspektiv. Slutsatsen av resultatet visade att teoretisk kunskap inom både ledarskap och akutsjukvård samt erfarenheter hade betydelse för ledarskapet i arbetet på akutmottagningar. De mindre erfarna sjuksköterskorna behövde mera tid och träning för att kunna utveckla strategier som de erfarna sjuksköterskorna skaffat sig över tid. Emellertid visade studien att sjuksköterskor med kompetens och erfarenhet inte kunde hantera hur hög arbetsbelastning som helst.

No description available.

Bakgrund: Sjuksköterskan har ett omfattande omvårdnadsansvar, speciellt i en kontext som akutsjukvården där ett högt patientflöde, akut sjuka patienter och kritiska situationer är vanligt förekommande. Stress kan påverka en människas psykologiska funktioner, vilket kan leda till svårigheter att fungera adekvat. Sjuksköterskor måste ständigt sträva efter att upprätthålla en god vård, även i stressfyllda situationer. Denna stressfulla arbetssituation kan ställa höga krav på sjuksköterskans förmåga att erbjuda en god och säker vård. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av stress i omvårdnadsarbetet inom akutsjukvården  Metod: Denna studie är en allmän litteraturstudie med sökningar i databaserna Cinahl och PubMed. Vald analysmetod är kvalitativ innehållsanalys. Resultat: Sjuksköterskor som arbetar inom akutsjukvården upplever återkommande stress, vilket upplevs kan försämra vårdkvaliteten, leda till kommunikationsbrist och som en konsekvens, brister i patientsäkerheten. Identifierade stressorer var att känna sig otillräcklig, att upplevas behöva mer stöd och resurser och upplevelser av att inte ha tillräcklig kompetens. Slutsats: Genom utveckling av bättre arbetsförhållanden, adekvat ledningsstöd och vidare utbildning kan sjuksköterskor få bättre resurser och redskap för stresshantering. / Background: Nurses have broad and extensive responsibility, especially in emergency medical care where high patient flow, critically ill patients, and challenging situations is a common occurrence. Extensive stress can lead a negative psychological impact, and therefore a difficulty functioning adequately. Nurse must constantly strive to maintain a good care, even in stressful situations. This stressful work situation makes high demands on the nurse’s ability to offer an adequate and safe care. Aim: The aim for this study was to describe nurses’ experiences of stress in the emergency medical service. Method: This study is a general literature review with searches in two scientific databases, CINAHL and PubMed. Chosen analytical method is a qualitative content analysis.  Results: Nurses working in the emergency medical services experience recurrent stress, can affect the quality of care given, lack of adequate communication, and as consequence deficiency in patient safety. Consequences of identified stressors where to feel inadequate, to feel the need for more support and resources and feelings of having lack of competence.  Conclusion: Through the development of better working conditions, adequate management support and further education, nurses can get better resources and tools to cope with their stress.

Thesis's Topic: The Activity Analysis of Rescue of Královehradecký kraj, station Trutnov 2006-2009 Aim of the thesis: To analyze the operation of the Emergeny Medical Service in Trutnov. Method: Research of available sources, data collection and the cooperation of the members of the Emergency Medical Service coming to the patient. Results: All here listed statistics data are base on intervetion documentation of Trutnov center. Therefore the presented results can't be taken, generalled to other centers and assumed that will be comparable. Keywords: Integrated Emergency Services, Emergency Medical Service, rapid response vehicle, advanced life support vehicle, calls for the crew of the Emergency Medical Service.

O pronto socorro é uma unidade do hospital destinada à assistência a pacientes externos com ou sem risco de morte, que necessitam de atendimento imediato, cujo funcionamento se dá nas 24 horas do dia sendo fundamental a determinação do número necessário de profissionais de enfermagem para prestar assistência com qualidade satisfatória, pois a falta de profissionais de enfermagem com diferentes níveis de formação e a sobrecarga de trabalho aumentam o risco de ocorrência de falhas com prejuízo da qualidade na assistência ao paciente. Os instrumentos de classificação de pacientes são utilizados pela enfermagem em qualquer unidade assistencial e estabelecem as características da população assistida de acordo com a necessidade de cuidados requerida, sendo indispensável para a determinação das necessidades de pessoal e alocação quantitativa e qualitativa dos mesmos. Com o objetivo de caracterizar o perfil assistencial dos pacientes adultos durante a internação no pronto-socorro como um dos subsídios para o dimensionamento do pessoal de enfermagem desenvolveu-se uma pesquisa exploratória no método do estudo de caso, em um pronto-socorro, clínico e cirúrgico, de um hospital geral, público estadual que possui 24 leitos de observação e dez leitos na unidade de atendimento de emergências, localizado no extremo leste do município de São Paulo que trabalha com demanda espontânea do usuário. Os sujeitos da pesquisa foram os pacientes adultos internados na unidade de emergência e nas salas de observação durante o mês de janeiro de 2009, os dados foram coletados por meio da aplicação do instrumento de classificação de pacientes de Fugulin (2002) que avalia nove áreas de cuidado (Estado mental, Oxigenação, Sinais Vitais, Motilidade, Deambulação, Alimentação, Cuidado Corporal, Eliminação e Terapêutica). Foram realizadas 1.228 avaliações, sendo verificados 91 pacientes na categoria de cuidados intensivos, 75 na categoria de cuidados semi-intensivos, 245 com alta dependência para assistência de enfermagem, 272 com complexidade assistencial intermediária e 545 com a mínima. Houve a constatação de muitos pacientes da psiquiatria internados no pronto-socorro a espera de vagas para internação na unidade especializada requerendo da equipe de enfermagem uma assistência diferenciada para a manutenção da integridade física desses pacientes. Verificou-se por meio do número médio mensal de atendimentos realizados que a maioria dos usuários do pronto-socorro não necessitava de internação mas foram atraídos para esse serviço em busca de consultas de rotina acabando por sobrecarregar a equipe multiprofissional que atua nessa unidade que apresentou uma taxa de ocupação média acima da previsão dos leitos oficiais disponíveis tornando a planta física inadequada para pacientes e profissionais devido às internações em macas pelos corredores, reflexo da falta de um serviço de regulação. / The emergency medical service is the hospital ward designated to outpatient care with or without death risk for those who need immediate care, whose attendance is 24 hours a day, being essential the determination of a required number of nursing professionals for delivering satisfactory quality care, since the lack of nursing professionals with different levels of background and work overload increase the risk of errors, impairing the quality of patient care. The instruments of patient classification are used by nursing in any care ward and set up the characteristics of the population assisted, according to the need of care required, being vital for determining the personnel needs and its quantitative and qualitative allocation. Aiming to characterize the adult patient care profile throughout the admission at the emergency medical service, as a support for nursing personnel dimensioning, it was developed an exploratory research in a study of case method, at a clinic and surgical emergency room of a general, public state hospital that holds 24 observation beds and 10 beds at the emergency attendance ward, located at the extreme east of São Paulo city and which works with spontaneous demand of users. The subjects of research were adult patients admitted at the emergency ward and the observation rooms throughout the month of January, 2009. Data was collected through the application of an instrument of patient classification by Fugulin (2002), which evaluates nine care areas (Mental Status, Oxygenation, Vital Signs, Motility, walking, Feeding, Body Care, Elimination and Therapeutics). It was made 1228 evaluations, in which 91 patients in the intensive care category were verified, 75 in the semiintensive care, 245 with high dependence of nursing care, 272 with intermediate care complexity and 545 with minimal one. There was the evidence of many psychiatric patients admitted in the emergency room waiting for a vacancy in the specialized ward requiring from the nursing staff special care for keeping the physical integrity of those patients. It was verified by the monthly average number of attendance that most emergency room users didnt need admission, but they were attracted to this service in search for routine appointments, leading to overload the multi-professional team that works in this ward, which presented an average occupancy rate above the prediction of official beds available, making the physical space inadequate for patients and professionals, due to the admissions in beds spread in corridors, result of lack of service control.

<p>The main purpose of this thesis was to evaluate and test the Job Stress Survey (JSS, Spielberger, 1991; Spielberger & Vagg, 1999), a self-report instrument which assesses workplace stress. In the thesis a thorough evaluation is made of JSS scales and items, and the relations to health, particularly musculoskeletal complaints. The aim of Study I was to evaluate the factor structure and the psychometric properties of a Swedish version of the JSS. The instrument was distributed to medical service personal and metal industry workers (n=1186). Factor analyses demonstrated a good resemblance between the present version and the American original version. The results also showed that the internal consistencies, as well as the test-retest reliabilities of the scales are high, and the concurrent validity are good. Study II examined work-related stress measured by JSS for the subgroups of gender, industry workers and medical service personnel, and special attention was given to the problem of differential item functioning (DIF) on these subgroups. The main findings were that both gender and occupation has a substantial impact on specific sources of work-related stress assessed by JSS scales and individual items. The result of the DIF analyses showed no item bias in the gender subgroup, but for the occupational subgroups there where items showing DIF in two of the scales. These items do not jeopardize the conclusions made on scale level since the number of items showing DIF are too few to make an impact on the overall result on the different scales. In Study III the relation between self-reported stress and health, particularly musculoskeletal problems were examined longitudinally in two metal industry factories. Results showed high levels of stress and musculoskeletal complaints in these factories and significant and strong relationships between the JSS scales and musculoskeletal, as well as psychosocial ratings. Lack of Organizational Support was found to be more related to musculoskeletal pain than Job Pressure. Longitudinal differences were found between the factories and between different types of musculoskeletal complaints. The general conclusions from the studies are that the present version of JSS shows a good resemblance with the American original, and that JSS is a useful instrument for studying relationships between stress and health.</p>

<p><strong>Introduktion:</strong> För att en räddningsinsats på olycksplats skall lyckas är en väl fungerande kommunikation nödvändig. Kommunikationen har visat sig vara ett vanligt problem vid utvärderingar av allvarliga händelser. Patientsäkerheten kan äventyras om det brister i informationsflödet mellan aktörerna i vårdkedjan. <strong>Syfte: </strong>Syftet med studien var att undersöka ambulanspersonalens uppfattningar av informationsöverföringen mellan sjukvårdens personal på olycksplats. Studien gjordes för undersöka om det fanns omständigheter som försvårar respektive underlättar informationsöverföringen. <strong>Metod: </strong>Enkätstudie bland ambulanspersonal (n= 103). <strong>Resultat: </strong>Tolv procent  ansåg att informationsöverföringen på olycksplats fungerade helt tillfredsställande. Av respondenterna var det 16,5 % som kände sig tillräckligt utbildade för att leda sjukvården på olycksplats, män kände sig signifikant oftare tillräckligt väl utbildade än kvinnor (p= < 0,02). Det var också fler män än kvinnor som kände sig säkra i rollen som sjukvårdsledning (p=< 0,01).  Det framkom att både mänskliga och tekniska faktorer påverkar kommunikationen samt att olycksplatsens geografiska läge, storlek och typ också hade påverkan. <strong>Konklusion:</strong> Faktorer som försvårar kommunikationen är låg tillit till en del av den tekniska utrustningen samt känslan av att vara otrygg i rollen som sjukvårdsledare. Erfaren personal samt erfarenhet av sjukvårdsledning anses vara faktorer som underlättar kommunikationen.  Fler studier behövs om  kommunikationen på olycksplats och även validerade skalor som mäter kommunikation bör utvecklas. <strong></strong></p> / <p><strong>Introduction: </strong>Well-functioning communication is essential for the success of rescue efforts at the scene of an accident. Problems in communication have proved to be a common occurrence in evaluations of serious incidents. Security of the patient might be adventured if there are problems in the flow of information between the actors in the chain of care. <strong>Purpose:</strong> The purpose of this study was to investigate paramedics’ experiences of the exchange of information within the medical service at the scene of accidents. The study was carried out to investigate if there were circumstances that aggravate or help the transfer of information. <strong>Method:</strong> A survey study among paramedics (n = 103). <strong>Result:</strong> Twelve percent perceived that communication of information worked completely satisfactorily. A total of 16.5 % of respondents felt well enough trained to lead the medical service at an accident scene and men felt significantly more often than women that they were well trained enough for the task (p= < 0,02). There were also significantly more men who felt confident in the roll as leader of the medical service(p=< 0,01).   <strong>Conclusion:</strong> Factors which make communication difficult included diminished trust in technical equipment and feelings of uncertainty in the roll of leader. Experienced personnel and leaders are seen as factors which positively affect communication. More studies concerning communication at accident scenes are needed and also validated scales for the measurement of communication skills.</p>