[Quality as management tool. Actions to improve efficiency in neurological care].
BACKGROUND
Quality of care involves meeting the needs and expectations of patients with the lowest consumption of resources and in accordance with scientific knowledge. In this context it is important to know if the changes in medical care procedures based on scientific and technical aspects of the quality positively impacts both efficiency measures and perceived quality.


METHODS
Prospective study carried out during the 2000-2006 period at the neurology department of a public hospital with has 1303 beds. Changes in medical care introduced: adequacy of a high resolution hospitalization zone, setting up of three care pathways (transient ischemic attach [TIA], multiple sclerosis exacerbation and first epileptic seizure) and practice guidelines for stroke, and implementation of neurological care at the emergency department.


RESULTS
There has been an increase in the number of patients treated in the emergency department of the hospital (17%), although the number of admissions has stabilized. In the neurology department, the number of admissions has decreased by 20%, especially those arising from TIA (decrease by 47%), the average stay has been reduced by 30% (especially in demyelinating and vascular disease, which has fallen by 50%). Adjusted average length of stay has remained below 1 and the complexity index above 1. Satisfaction with the information and health care has undergone little change.


CONCLUSIONS
The changes in clinical practice to improve the quality of care have been associated with improvements in the efficiency indicators but not in patient satisfaction. The improvement in the perceived quality probably requires specific actions.
Ara
J R
JR
Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza. jrara@salud.aragon.es
García-Mata
J R
JR
Capablo
J L
JL
Martín
J
J
López-Gastón
J I
JI
Bertol
V
V
Alarcia
R
R
Marta
J
J
D003695:Delivery of Health Care / Q000592:standards*; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D009462:Neurology / Q000592:standards*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care