Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.

The overall rating of the patients on responsiveness of the HIO system is low, especially when compared with the private sector. The results emphasize the importance of establishment of systems for monitoring the performance of the providers and discontinuation of the services for the nonperformers.

Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system. RÉSUMÉ Les données disponibles sur la mise en oeuvre de systèmes de dossiers électroniques en soins de santé primaires dans les pays en développement sont limitées. La présente étude visait à évaluer la qualité de la documentation des dossiers médicaux électroniques dans des unités de soins de santé primaires à Alexandrie (Égypte) et à recueillir les commentaires des médecins sur les obstacles et les leviers ayant un impact sur le système. Des données ont été recueillies au sein de sept unités sélectionnées aléatoirement dans chaque région administrative ; puis dans chaque unité, 50 dossiers au format papier et leurs dossiers électroniques correspondants ont été sélectionnés aléatoirement pour les patients qui avaient consulté dans l'unité de soins au cours de trois premiers mois de l'année 2011. Les données administratives étaient presque complètes dans les dossiers au format papier et au format électronique, mais l'exhaustivité des données cliniques variait entre 60 % et 100 % en fonction des unités de soins et du type de dossiers. Le taux d'exactitude du diagnostic principal dans les dossiers électroniques par rapport aux dossiers papiers était compris entre 44,0 % et 82,0 %. Une lourde charge de travail et la complexité du système étaient les obstacles les plus fréquemment cités à la mise en oeuvre du système de dossiers électroniques.

Background Missed nursing care (MNC) has been linked to patient harm in a growing body of literature. However, this issue is still not adequately investigated in developing countries. The aim of the study is to measure the extent of missed nursing care, to identify its types, and to determine factors contributing to missed nursing care. Methods A cross-sectional design was used. The study was conducted among 50 units at 1762-beds teaching Hospital in Alexandria that employs 1211 nurses in inpatient areas. A sample of 553 nurses were interviewed using the MISSCARE and the N4CAST survey. The MISSCARE survey measured the amount of missed nursing care (MNC) that was experienced on the last worked shift by each nurse. The N4CAST survey was used to collect data about level of non-nursing work carried out by nurses and the nurses’ job satisfaction. Results The overall mean score for the missed nursing care was 2.26 ± 0.96 out of 5, with highest mean score attributed to “Planning” and lowest mean score attributed to “Assessment and Vital Signs” (2.64 and 1.96, respectively). Missed nursing care was significantly associated with number of patients admitted and cared for in the last shift and perceived staffing adequacy. Almost all non-nursing care tasks and most of satisfaction elements showed negative weak correlation with overall missed nursing care. Conclusion Missed Nursing Care is common in study hospital which may endanger patient safety. MNC Missed Nursing Care is positively associated with nursing adequacy. There is no association between MNC and neither nurses’ job satisfaction nor non-nursing tasks. Nursing leaders should monitor missed nursing care and the environmental and staffing conditions associated with it in order to design strategies to reduce such phenomena.

Critical value policies and practices showed interinstitutional variation with deficiencies in some reporting practices. Selection of critical assays for notification and setting the limits of notification exhibited wide variation as well.