nÃo hà / A violÃncia no trÃnsito acomete milhares de pessoas, tornando-se um grave problema de saÃde pÃblica, ceifando a vida de jovens e sendo responsÃvel por altos gastos na saÃde. VÃrios serviÃos de saÃde estÃo envolvidos na assistÃncia aos acidentados no trÃnsito, dentre eles, o ServiÃo de Atendimento MÃvel de UrgÃncia (SAMU) que presta atendimento inicial Ãs vÃtimas ajudando a reduzir as sequelas. O estudo objetiva avaliar o ServiÃo de Atendimento MÃvel de UrgÃncia no suporte aos acidentes de trÃnsito na cidade de Sobral- CE. Utilizou-se a metodologia do tipo avaliativa com abordagem qualitativa, sob o enfoque de Donabedian avaliando estrutura, processo e resultados do ServiÃo de Atendimento MÃvel de UrgÃncia da cidade de Sobral â CE. Participaram da pesquisa 14 profissionais do serviÃo, sendo dois gerentes do serviÃo e trÃs funcionÃrios de cada categoria, sendo estas, mÃdicos, enfermeiros, tÃcnicos de enfermagem e condutores. Aos gerentes foi aplicado um formulÃrio sobre estrutura fÃsica e humana, jà aos profissionais da assistÃncia foi realizado um Grupo Focal sobre processo de trabalho e quanto ao Resultado foram analisadas as fichas de atendimento aos acidentes de trÃnsito atendidos pelo SAMU no ano de 2014. Os dados quantitativos foram processados no programa Microsoft Office Excel 2010, gerando grÃficos, sendo tambÃm feito o mapeamento dos acidentes de trÃnsito atravÃs do Software QGis 2.14, os qualitativos foram submetidos à anÃlise de conteÃdo do tipo anÃlise temÃtica proposta por Minayo. Esta pesquisa respeitou os princÃpios bioÃticos descritos na ResoluÃÃo n 466/12 do Conselho Nacional de SaÃde e foi aprovada pelo Comità de Ãtica em pesquisa sob protocolo de nÃmero 1.320.647. Na investigaÃÃo sobre estrutura identificamos que recursos materiais e ambulÃncias suficientes, com falha no sistema de radiocomunicaÃÃo, com quantitativo adequado de profissionais nas bases e Central de RegulaÃÃo. Na anÃlise do processo identificamos nas categorias que os enfermeiros possuem mais tempo de serviÃo que os demais profissionais, onde a maioria mostrou-se insatisfeito quanto à estrutura ofertada aos acidentes de trÃnsito, relatando pouca atuaÃÃo da EducaÃÃo Permanente em serviÃo.Sentiram-se insatisfeitos profissionalmente devido ao frÃgil vÃnculo empregatÃcio, ausÃncia de direitos trabalhistas,baixo valor salarial e respeito a integridade do empregado e sugerem melhorias ao serviÃo no atendimento aos acidentes de trÃnsito.Houve89,58 acidentados/mÃs com manutenÃÃo de acidentes entre os meses, tendo destaque para acidentes envolvendo motocicletas, principalmente as quedas de moto. Os acidentes acometeram mais jovens do sexo masculino e foram enviadas mais vezes ambulÃncias de suporte bÃsico, caracterizando acidentes com baixa gravidade e foram encaminhados para o Hospital de ReferÃncia em Trauma em 91% das ocorrÃncias. Os finais de semana noturnos e os dias da semana pela manhà foram responsÃveis pela maioria dos acidentes, respectivamente. Os bairros mais atingidos foram Centro, Junco e Sinhà Saboia, em ordem decrescente. Para reduÃÃo desses agravantes nÃmeros, entendemos que a educaÃÃo de trÃnsito de base aliado à rÃgida fiscalizaÃÃo Ãs diversas imprudÃncias e melhorias estruturais, sÃo necessÃrias para a melhoria da mobilidade dos veÃculos e pedestre no municÃpio, permitindo um trÃnsito saudÃvel.

Orientadores: Maria Inês Monteiro, Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T01:12:40Z (GMT). No. of bitstreams: 1 Vedovato_CleuzaAparecida_M.pdf: 3883476 bytes, checksum: 64d4ccd4c16cc11e2c90a6cc5d7eb813 (MD5) Previous issue date: 2012 / Resumo: Introdução: A logística da estruturação existente nos serviços de atendimento préhospitalar (APH) das empresas concessionárias deve oferecer o suporte inicial para a sequência do cuidado às vítimas em situações de emergência, independente do local da ocorrência. A adequada estruturação do serviço APH móvel nas rodovias direciona os planos de assistência que determinam a seqüência de cuidados às vitimas proporcionando melhor qualidade da sobrevida. Objetivos: Descrever a constituição das equipes de atuação nos serviços de atendimento móvel rodoviário da região de Campinas; verificar materiais e equipamentos presentes nas viaturas, para atendimento das ocorrências; verificar o conteúdo dos impressos de registros dos atendimentos feito pelas equipes e identificar como é realizada a comunicação do atendimento pré-hospitalar com o local do encaminhamento. Método: Estudo descritivo/exploratório que utilizou instrumentos pré-elaborados e validados por especialistas, aplicado aos coordenadores dos serviços de APH das concessionárias da malha rodoviária da região de Campinas, compreendendo todas as concessionárias. Os entrevistados foram indicados pelos responsáveis das empresas que responderam os instrumentos. As empresas foram denominadas de A, B, C e D para manutenção do sigilo. Os dados obtidos foram armazenados em banco de dados informatizados, por meio do programa MSExcel® 2000 e realizado a análise descritiva. Resultados: A amostra foi constituída por quatro coordenadores dos serviços de APH móvel das concessionárias prestadoras. A maioria dos profissionais que atuava nestes serviços era do sexo masculino, com média de idade de 34,75 ±6,9 anos, com tempo de formação de três a dezenove anos, tempo de permanência na empresa entre três e nove anos. O número médio de profissionais nas empresas foi de dez médicos, sete enfermeiros, 38 técnicos de enfermagem e a empresa D tinha 40 profissionais contratados como resgatistas. A distribuição da jornada de trabalho diária dos profissionais foi de 12 a 24 horas. Em média 20 funcionários participaram dos cursos de suporte básico de vida (BLS), seis do curso de suporte avançado de vida (ACLS), 18 do suporte de vida ao traumatizado préhospitalar (PHTLS) e 17 do suporte avançado de vida ao traumatizado (ATLS). Os itens: central de regulação, telefone gratuito e rádio de monitoramento estavam presentes em todas as Concessionárias. A frota de veículos é constituída, em média, por nove viaturas de atendimento básico e uma de suporte avançado, por concessionária. Todas as concessionárias da malha rodoviária de Campinas fazem registros dos atendimentos, em duas vias, arquivando a primeira via na empresa. Conclusão: As equipes de atuação nos serviços de atendimento móvel de urgência das rodovias da região de Campinas são constituídas por médicos, enfermeiros, técnicos e auxiliares de enfermagem e profissionais denominados resgatistas. Os recursos materiais presentes nas viaturas atendem ao disposto na Portaria 2048 de 5 de novembro de 2002, para o atendimento das ocorrências. Os impressos para registros dos atendimentos contem os itens que descrevem a situação do atendimento; são realizados pelos membros das equipes do APH das concessionárias e por ocasião do encaminhamento uma cópia é entregue no local de destino da vítima / Abstract: Introduction: The logistics of the structure existing in pre-hospital care services of the highway service companies should offer basic support for procedure to the victims in emergency situations, regardless of place of occurrence. The appropriate structure of the Mobile Emergency Medical Service in the highways leads to on how the victims will be assisted that determine the sequence of care to the victims by providing better quality of survival. Objectives: to discribe the composition of the staff in the mobile emergency medical service in highways the surrounding areas of Campinas, check up the materials and equipment which should be found in the vehicles in order to attend the emergency cases; then check the contents of the report issued by the staff and also identify how is performed the transference of pre-hospital emergency care to the local where the victim will be assisted. Method: A descriptive / exploratory survey which used a pre-developed and assigned by emergency care experts, submitted to the coordinators(responsible) of the highway service companies, total of four companies in the surrounding areas of Campinas. The interviewed members were given by the heads of the companies who answered the questionnaires. The companies were called A, B, C and D in order to maintain them confidentiality. The data were stored in a database computer, using software MSExcel ® 2000 and so, performed and descriptive analysis. Results: The sample consisted of four coordinators of the mobile emergency medical service providers. Most professionals who worked in these services were male, average age 34.75 ± 6.9 years, with training experience based on three to nineteen years, which is between three and nine years experience in the company. The average number of professionals in the companies was of ten doctors, seven nurses, 38 nursing technicians and Company D had 40 professionals rescuers hired as rescuers. The distribution of daily working schedule of the professionals was 12 to 24 hours. On average 20 professionals participated in the courses of basic life support (BLS), six of the advanced course life support (ACLS), 18 pre hospital trauma life support (PHTLS) and 17 advanced life support to traumatized (ATLS). The checked items of the regulation center ,toll- free telephone and radio monitoring were present in all concessionaries. The vehicle fleet consists the average of nine vehicles from primary care and an advanced support for each concessionaries. All of the highway concessionaires surrounding the area of Campinas make two copy records of the attendance, filing the first page in the company. Conclusion: The staff in the mobile emergency care of the roads in the region of Campinas consist of doctors, nurses, technicians and nursing assistants and professional rescuers. Material resources found in the vehicles is in accordance to the provisions of the federal law nr 2048 dated November 5, 2002 as to the emergency care. The issued records of attendance include all items which must be described in the assistance, and it is done by the staff of the Mobile Emergency Medical Service and in this occasion a copy of the pre-hospital emergency care should delivered to the local in which the victim was assisted / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Myndigheten för samhälle och beredskap (MSB) är den myndighet som på central nivå ska verka för och utveckla förmågan till effektiva räddningsinsatser. I dess uppgift ingår att stödja räddningstjänsterna med information, utbildning och övningsverksamhet. På kommunal nivå svarar kommunerna inom sitt geografiska område och insatserna utförs av räddningstjänsten. Anställda inom räddningstjänsten består av både heltidsanställda brandmän och räddningspersonal i beredskap (RiB), det som tidigare kallades för deltidsbrandmän. RiB är den vanligaste typen av anställningar på mindre tätorter. Att rekrytera in RiB har blivit ett problem och en utmaning för kommunerna då människor inte längre bor och arbetar på samma ort. Kan kommunerna inte rekrytera in personal får de svårt att upprätthålla den beredskap som de enligt lag är skyldiga att ha. De personer som väljer att bli RiB är beroende av att huvudarbetsgivare godkänner detta. Här kan man se att det skett en minskning inte bara bland de privata företagarna utan även bland de offentliga arbetsgivarna. Syftet med vår undersökning är att få RiB:s perspektiv på hur kompetensförsörjningen till räddningstjänsten ska se ut i framtiden. Vi har valt att använda oss av en kvalitativ undersökning i form av intervjuer. Våra respondenter är 13 RiB-anställda som har arbetat i räddningstjänsten mellan 1 och 30 år och är i åldrarna 20-58 år. De arbetar på fyra olika brandstationer någonstans i Sverige och det gemensamma för alla fyra stationer är att de är belägna på mindre orter. Vi har analyserat vårt intervjumaterial och kopplat det till våra teorier. Resultatet visar att respondenterna är medvetna om problemet med att bemanna upp brandstationer på mindre orter och de har många idéer kring en möjlig lösning på problemet. De ser dock fortfarande ljust på framtiden, att RiB på ett eller annat sätt kommer att finnas kvar. / The Swedish Rescue Agency is the central authority body that shall promote and develop the capacity for effective emergency and rescue work. Within its responsibility is support to the rescue crews with information, education and training development. The council is responsible for rescue and emergency services within council boundaries. Employees with emergency services consist of both of full-time firemen and standby rescue crew. They used to be called part-time firemen and are known today as standby rescue crew. The standby crews are most commonly employed in smaller villages.  Recruiting standby rescue crew has always been a problem and a challenge for small councils due to the fact that there are less people to choose from that work and live in the same place. This creates a problem of having enough staff there required by law. People who choose to become part-time firemen are dependent on their main employees to approve their needs as part-time firemen. Due to private and public employees being less tolerant to the needs required to be part-time firemen there has been a reduction in their numbers. Our main purpose is to get the standby rescue crews perspective on how the emergency services can recruit employees in the future.  We have chosen to use a qualitative study in the form of interviews. Our respondents are 13 part-time firemen that have worked as rescue crews between 1 and 30 years and are aged between 20 to 58. They work in four different fire stations throughout Sweden and have in common that they are all placed in small communities. We have analyzed our interviews and linked them to our theories. The result shows that the respondents are aware of the problems of having enough crew at the stations in smaller communities and they have many ideas for a possible solution to the problems. They are feeling positive that standby crews will be around in the future in one form or another.

Despite high levels of exposure, firefighter posttraumatic stress disorder (PTSD) rates are unclear. Likewise, questions remain regarding how social interactions and beliefs about emotion might interact to influence PTSD in firefighters. In this study, U.S. urban firefighters (N = 225) completed measures of social support, negative social interactions, and fear of emotion which were then used via regression analyses to predict PTSD symptoms. Each independent variable predicted PTSD beyond variance accounted for by demographic variables. Additionally, fear of emotion emerged as the strongest individual predictor of PTSD and a moderator of the relation between social interactions and PTSD symptoms. These findings emphasize the importance of beliefs about emotion; both in how these beliefs might influence the expression of PTSD symptoms, and in how the social networks of trauma survivors might buffer distress.

Räddningstjänsters behov av frivilliga värn för att bekämpa skogsbränder undersöktes och en enkät skickades ut till skogsägare i Småland för att undersöka deras vilja och förmåga att bidra till skogsbrandvärn. Räddningstjänsterna ansåg att de hade ett behov av värn vid sidan av sin ordinarie personal och beskrev förutom ett antal kriterier för att värnet skulle fungera bra också ett antal kompetenser samt maskiner som kunde komma till användning vid bekämpning av skogsbränder. Resultaten visar att 42 % av skogsägarna var villiga att ingå i lokala skogsbrandvärn samt 89 % kunde se en styrka i att skogsägare gick samman för att stötta varandra och avlasta räddningstjänsten vid skogsbränder eller andra större händelser i närområdet. 91% utav skogsägarna hade någon av de fordon, maskiner eller redskap som räddningstjänsterna såg som användbara. Vidare så uppgav 70 % utav dessa att de skulle vara villiga att använda de här fordonen, maskinerna eller redskapen vid insatser med skogsbrandvärnen.

Queueing theory has often been applied to study communication and service queueing systems such as call centers, hospital emergency departments and ride-sharing platforms. Unfortunately, it is complicated to analyze queueing systems. That is largely because the arrival and service processes that mainly determine a queueing system are uncertain and must be represented as stochastic processes that are difficult to analyze. In response, service providers might be able to partially capture the main characteristics of systems given partial data information and limited domain knowledge. An effective engineering response is to develop tractable approximations to approximate queueing characteristics of interest that depend on critical partial information. In this thesis, we contribute to developing high-quality approximations by studying tight bounds for the transient and the steady-state mean waiting time given partial information. We focus on single-server queues and multi-server queues with the unlimited waiting room, the first-come-first-served service discipline, and independent sequences of independent and identically distributed sequences of interarrival times and service times. We assume some partial information is known, e.g., the first two moments of inter-arrival and service time distributions. For the single-server GI/GI/1 model, we first study the tight upper bounds for the mean and higher moments of the steady-state waiting time given the first two moments of the inter-arrival time and service-time distributions. We apply the theory of Tchebycheff systems to obtain sufficient conditions for classical two-point distributions to yield the extreme values. For the tight upper bound of the transient mean waiting time, we formulate the problem as a non-convex non-linear program, derive the gradient of the transient mean waiting time over distributions with finite support, and apply classical non-linear programming theory to characterize stationary points. We then develop and apply a stochastic variant of the conditional gradient algorithm to find a stationary point for any given service-time distribution. We also establish necessary conditions and sufficient conditions for stationary points to be three-point distributions or special two-point distributions. Our studies indicate that the tight upper bound for the steady-state mean waiting time is attained asymptotically by two-point distributions as the upper mass point of the service-time distribution increases and the probability decreases, while one mass of the inter-arrival time distribution is fixed at 0. We then develop effective numerical and simulation algorithms to compute the tight upper bound. The algorithms are aided by reductions of the special queues with extremal inter-arrival time and extremal service-time distributions to D/GI/1 and GI/D/1 models. Combining these reductions yields an overall representation in terms of a D/RS(D)/1 discrete-time model involving a geometric random sum of deterministic random variables, where the two deterministic random variables have different values, so that the extremal waiting times need not have a lattice distribution. We finally evaluate the tight upper bound to show that it offers a significant improvement over established bounds. In order to understand queueing performance given only partial information, we propose determining intervals of likely performance measures given that limited information. We illustrate this approach for the steady-state waiting time distribution in the GI/GI/K queue given the first two moments of the inter-arrival time and service time distributions plus additional information about these underlying distributions, including support bounds, higher moments, and Laplace transform values. As a theoretical basis, we apply the theory of Tchebycheff systems to determine extremal models (yielding tight upper and lower bounds) on the asymptotic decay rate of the steady-state waiting-time tail probability, as in the Kingman-Lundberg bound and large deviations asymptotics. We then can use these extremal models to indicate likely intervals of other performance measures. We illustrate by constructing such intervals of likely mean waiting times. Without extra information, the extremal models involve two-point distributions, which yield a wide range for the mean. Adding constraints on the third moment and a transform value produces three-point extremal distributions, which significantly reduce the range, yielding practical levels of accuracy.

Bakgrund: Akutsjukvårdens syfte är att tillgodose personer som drabbats av akut skada eller sjukdom en god och säker vård genom hela den akuta vårdkedjan. Brister inom hälso- och sjukvården leder årligen till att patienter skadas. Förutom stort lidande hos patienter och anhöriga belastar detta ett redan hårt pressat vårdsystem. I vårdövergångarna kan misstag eller missförstånd ske som gör att information som ges tolkas olika eller helt går förlorad. För att kunna arbeta förebyggande och minimera antalet vårdskador för patienterna måste risker samt vart dessa uppstår synliggöras. Syfte: Syftet var att belysa patientsäkerhetsrisker vid patientens övergång från ambulanssjukvård till akutmottagning. Metod: En litteraturöversikt med en systematiskt ansats där 15 vetenskapliga artiklar användes. Artiklarna kvalitetsgranskades innan inkludering för att säkerställa ett resultat av god kvalitét. Resultatet sammanställdes genom en integrerad analys. Resultat: Det framkom patientsäkerhetsrisker kopplades till brister i organisationen och bristande förvaltande av vårdrelationen. Organisatoriska brister var förlust av information om patientens tillstånd, bristande fokus på patienten och dennes omvårdnadsbehov. Avsaknad av tydlighet kring vem som bar ansvaret för patienten och dennes vård i vårdövergången samt risker för patienten kopplade till personalens kompetens. Bristande förvaltande av vårdrelationen manifesteras genom avsaknad av samsyn kring patientens situation och sjukdomsförlopp samt bristande bemötande gentemot patienter som ofta besökte akutmottagningen och/eller var i behov av ambulans. Slutsats: För att kunna säkerställa en patientsäker vård förutsätter det att det finns organisatoriska förutsättningar samt att patienten sätts i fokus. Idag ses flera patientsäkerhetsrisker och det behöver ske en förändring i akutsjukvårdens organisation och förhållningssätt för att kunna säkra en god vård för patienten. / Background: The purpose of emergency healthcare is providing people who have suffered an acute injury or illness a good and safe care throughout the emergency care chain. Deficiencies in healthcare lead to patients being injured annually. In addition to suffering patients and relatives, this burdens an already hard-pressed healthcare system. In care transitions, mistakes or misunderstandings can occur, which means information given is interpreted differently or is lost. To be able to work preventively and minimize the number of care injuries for patients, risks and where they occur must be made visible. Aim: The aim was to highlight patient safety risks during the patients transfer from ambulance care to the emergency department. Method: A literary review using a systematic approach including 15 research articles was used. The articles were quality checked before being included to secure a result with a good quality. The result was concluded through an integrated analysis. Results: Patient safety risks were identified linked to deficiencies in the organization and lack of management of the care relationship. Organizational deficiencies were lost of information about the patient’s condition, lack of focus on the patient and their care needs. Lack of clarity of who was responsible for the patient and patients care during the care transition and risks for the patient linked to staff competence. Lack of management of the care relationship manifested through lack of consensus for the patient’s situation and course of disease and lack of treatment toward patients that often visited the emergency department and/or needed an ambulance. Conclusion: To ensure patient safety, there needs to be organizational prerequisites and focus on the patient. Today, major patient safety risks are seen and there needs to be a change in the organization and the approach of emergency healthcare to ensure good care for the patient.

Electronic health records (EHRs) led to improvements in patient safety, care delivery, and efficiency; however, they have also resulted in significant increases in documentation time. EHR documentation burden, defined as “added work (e.g., documentation) or extraneous actions (e.g., clicks) performed in the EHR beyond that which is required for good clinical care”, has been linked to increased medical errors, poorer patient outcomes, reduced care quality, cognitive overload, and ultimately, burnout among clinicians. Relative to other clinical practice settings where patient flows are more predictable and of lower intensity, emergency department (ED) clinicians report markedly higher workload. Furthermore, EHR implementation research in the ED indicates that incongruities between EHR design and usability and the clinical workflow may intensify clinician workflow fragmentation. In our prior work, we identified workflow fragmentation, which we define as task switching, as one potential approach for evaluating documentation burden in ED practice settings. Yet, no standardized, scalable measures of documentation burden have been developed. Despite shortcomings, there have been increasing efforts to leverage information from EHR event logs as an alternative to direct clinical observation methods in evaluating user-centric behaviors and interactions with health information technology systems. Using EHR event logs, this dissertation aims to advance the study of evaluating burden by investigating EHR-mediated workflow fragmentation as a measure of EHR documentation burden among physicians and registered nurses (hereinafter interchangeably referred to as “clinicians”) in the ED. First, I review the literature on the existing quantitative approaches employed for measuring clinician documentation burden in clinical practice settings. Next, I explore EHR factors perceived to contribute to clinician documentation burden as well as the perceived role of workflow fragmentation on clinician documentation burden in the ED. Lastly, I investigate data-driven approaches to abstract clinically relevant concepts from EHR event logs for studying EHR documentation burden—culminating into a computational framework to evaluate ED clinician documentation burden in the context of cognitive burden. Collectively, the work conducted in this dissertation contributes computational methods that are foundational for investigating clinician documentation burden measurement at scale using EHR event logs, informed by current evidence and clinician perspectives, and grounded in theory.

[ES] Según la Organización Mundial de la Salud, la esperanza de vida ha aumentado en seis años en las últimas dos décadas. Esto ha llevado a un aumento de las enfermedades crónicas entre la población. Como consecuencia, los sistemas de salud se han visto obligados a buscar medidas preventivas y de mejora de los procesos de atención para garantizar su sostenibilidad. Factores clave para esta mejora son la seguridad, la eficacia, la eficiencia, la atención centrada en el paciente, la puntualidad y la equidad, los cuales buscan minimizar riesgos y brindar una atención óptima. Asimismo, los Servicios de Urgencias se enfrentan a grandes desafíos debido a la alta demanda a la que están sometidos, lo que resulta en Servicios de Urgencias saturados y errores que pueden derivar en eventos adversos. Por lo tanto, mejorar la seguridad del paciente es crucial para obtener una mejor atención en el Servicio de Urgencias. Paradigmas como el Cuidado de la Salud Basado en el Valor abogan por medir la calidad de la atención, optimizar la asignación de recursos y lograr mejores resultados a través de una mejora continua. Siendo los indicadores de rendimiento tradicionales los que han desempeñado un papel crucial en este proceso, al alinear actividades y objetivos, brindar información sobre las experiencias del paciente y su estado de salud, así como contribuir en la evaluación del rendimiento, la eficacia clínica y la mejora de la calidad. Sin embargo, estos indicadores pueden presentar limitaciones debido a su naturaleza abstracta y la propia complejidad de los datos. Por lo tanto, es posible que el uso de indicadores clave no represente en su totalidad la complejidad de estos procesos. Además, la adaptación de estos indicadores a continuos cambios puede ser un desafío, lo que dificulta la comprensión de los sistemas. Técnicas como la Inteligencia Artificial pueden ofrecer una información valiosa al procesar grandes conjuntos de datos, que son de especialmente interés en el sector de la salud. De esta forma, la Minería de Procesos, un paradigma emergente y que está ganando popularidad en varios dominios incluido salud, ofrece la oportunidad de analizar y mejorar los procesos, contribuyendo a aliviar la crisis a la que se enfrentan los sistemas de salud hoy en día. Esta tesis doctoral introduce nuevos indicadores de proceso basados en técnicas de Minería de Procesos para el proceso de urgencias como solución a cuestiones no cubiertas por las técnicas de medición tradicionales o nuevas tecnologías como la Inteligencia Artificial. Además, esta tesis presenta un método novedoso para medir la Calidad de la Atención, así como comprender el proceso de atención del ictus en los Servicios de Urgencias. Este enfoque ofrece una forma más dinámica e interactiva de analizar los procesos de atención de la salud, lo que permite un mejor entendimiento, además de medir la cadena de valor, lo que ayuda a identificar especificidades en el proceso de atención en urgencias y así descubrir el comportamiento del proceso de la enfermedad de ictus. Por último, en esta tesis se presenta una aplicación basada en Minería de Procesos para soportar este método diseñada e implementada para tal fin. / [CA] Segons l'Organització Mundial de la Salut, l'esperança de vida ha augmentat en sis anys en les últimes dues dècades. Això ha portat a un augment de les malalties cròniques entre la població. Com a conseqüència, els sistemes de salut s'han vist obligats a buscar mesures preventives i de millora dels processos d'atenció per a garantir la seua sostenibilitat. Factors clau per a aquesta millora són la seguretat, l'eficàcia, l'eficiència, l'atenció centrada en el pacient, la puntualitat i l'equitat, els quals busquen minimitzar riscos i brindar una atenció òptima. Així mateix, els Serveis d'Urgències s'enfronten a grans desafiaments a causa de l'alta demanda a la qual estan sotmesos, la qual cosa resulta en Serveis d'Urgències saturats i errors que poden derivar en esdeveniments adversos. Per tant, millorar la seguretat del pacient és crucial per a obtindre una millor atenció en el Servei d'Urgències. Paradigmes com la Cura de la Salut Basat en el Valor advoquen per mesurar la qualitat de l'atenció, optimitzar l'assignació de recursos i aconseguir millors resultats a través d'una millora contínua. Sent els indicadors de rendiment tradicionals els que han exercit un paper crucial en aquest procés, en alinear activitats i objectius, brindar informació sobre les experiències del pacient i el seu estat de salut, així com contribuir en l'avaluació del rendiment, l'eficàcia clínica i la millora de la qualitat. No obstant això, aquests indicadors poden presentar limitacions a causa de la seua naturalesa abstracta i a la pròpia complexitat de les dades. Per tant, és possible que els indicadors clau no representen íntegrament la complexitat d'aquests processos. A més, l'adaptació d'aquests indicadors a canvis continus pot ser un desafiament, la qual cosa dificulta la comprensió dels sistemes. Tècniques com la Intel·ligència Artificial poden oferir una informació valuosa en processar grans conjunts de dades, que són d'especialment interés en el sector de la salut. D'aquesta manera, la Mineria de Processos, un paradigma emergent i que està guanyant popularitat en diversos dominis inclòs salut, ofereix l'oportunitat d'analitzar i millorar els processos, contribuint a alleujar la crisi a la qual s'enfronten els sistemes de salut hui dia. Aquesta tesi doctoral introdueix nous indicadors de procés basats en tècniques de Mineria de Processos per al procés d'urgències com a solució a qüestions no cobertes per les tècniques de mesurament tradicionals o noves tecnologies com la Intel·ligència Artificial. A més, aquesta tesi presenta un mètode nou per a mesurar la Qualitat de l'Atenció, així com comprendre el procés d'atenció del ictus en els Serveis d'Urgències. Aquest enfocament ofereix una forma més dinàmica i interactiva d'analitzar els processos d'atenció de la salut, la qual cosa permet un millor enteniment, a més de mesurar la cadena de valor, la qual cosa ajuda a identificar especificitats en el procés d'atenció en urgències i així descobrir el comportament del procés de la malaltia de ictus. Finalment, en aquesta tesi es presenta una aplicació basada en Mineria de Processos per a suportar aquest mètode dissenyada i implementada per a tal fi. / [EN] According to the World Health Organization, life expectancy has increased by six years in the last two decades. This has led to an increase in chronic diseases among the population. Consequently, health systems have been forced to look for preventive measures and improvement of care processes to guarantee sustainability. Key factors for this improvement are safety, efficacy, efficiency, patient-centred care, timeliness, and equity, all of which pursue to minimize risks and provide optimal care. Likewise, Emergency Services face significant challenges due to the high demand to which they are subjected, which results in saturated Emergency Departments and errors that can lead to adverse events. Therefore, improving patient safety is crucial to obtain better care in the Emergency Department. Paradigms such as Value-Based Healthcare advocate measuring the Quality of Care, optimizing the allocation of resources, and achieving better results through continuous improvement being the traditional performance indicators, those that have played a crucial role in this process by aligning activities and objectives, providing information on the patient's experiences and their state of health, as well as contributing to the evaluation of performance, clinical efficacy and quality improvement. However, these indicators may present limitations due to their abstract nature and the complexity of the data. Therefore, the key indicators may not fully represent the complexity of these processes. Furthermore, adapting these indicators to continuous changes can be challenging, making it difficult to understand the systems. Techniques such as Artificial Intelligence can offer valuable information when processing large data sets, which are particularly interesting in the health sector. In this way, Process Mining, an emerging paradigm gaining popularity in several domains, including health, offers the opportunity to analyze and improve processes, contributing to alleviating the crisis that health systems face today. This doctoral thesis presents a new way to measure the value of the emergency process with interactive process indicators based on Process Mining techniques as a solution to issues not covered by traditional measurement techniques or new technologies such as Artificial Intelligence. In addition, this thesis proposes a novel method to measure the Quality of Care in addition to understanding the stroke care process in Emergency Services. This approach offers a more dynamic and interactive way of analyzing healthcare processes, which allows for a better understanding and measuring of the value chain, which helps identify specificities in the emergency care process and thus discover the behaviour of the stroke disease process. Finally, this thesis presents an application based on Process Mining to support this method, designed and implemented for this purpose. / Ibáñez Sánchez, G. (2023). Interactive Process Mining Techniques to Co-create Interactive Process Indicators to Evaluate and Characterize the Clinical Practice in Emergency Departments [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/202611

Collaboration between small municipalities has become a necessity in order to cope with municipal difficulties such as emergency services. Collaboration has also been mentioned as a possible solution to the challenges facing the public sector in light of economic and demographic developments that will continuously increase the demands on these municipalities. Inter-municipal collaboration is therefore something that is sought after and strived for. This essay will analyse the process surrounding the formation of this inter-municipal association, and to help understand and explain this process I will use the following theories: framing theory and public choice theory. The results show that the primary motivation for establishing Räddningstjänsten Väst was to create a robust and efficient emergency service, not just an economical one. A significant factor in its success was the tradition of trust and cooperation between these two municipalities. Another factor was the hiring of an experienced and objective consultant. The analysis indicates that those responsible for the process acted rationally based on the set goals, with shared ideas and values serving as a framework for their collaboration. Thus the focus of the essay is on municipal collaboration structures, particularly inter-municipal associations, highlighting the process and ideas behind the formation of these associations, as well as who has taken the initiative for their establishment.  In 2011 the municipalities Falkenberg and Varberg began planning their municipality association, Räddningstjänsten Väst, and in 2013 it began its operations.