scholarly journals The impact of inpatient bed capacity on length of stay

2021 ◽  
Author(s):  
Brendan Walsh ◽  
Samantha Smith ◽  
Maev-Ann Wren ◽  
James Eighan ◽  
Seán Lyons
Keyword(s):  
Length Of Stay ◽  
Fixed Effects ◽  
Public Hospital ◽  
Negative Binomial ◽  
Average Length ◽  
Average Length Of Stay ◽  
Bed Capacity ◽  
Direction Of Causation ◽  
The Impact ◽  
Inpatient Length Of Stay

Abstract Objective Large reductions in inpatient length of stay and inpatient bed supply have occurred across health systems in recent years. However, the direction of causation between length of stay and bed supply is often overlooked. This study examines the impact of changes to inpatient bed supply, as a result of recession-induced healthcare expenditure changes, on emergency inpatient length of stay in Ireland between 2010 and 2015. Study design We analyse all public hospital emergency inpatient discharges in Ireland from 2010 to 2015 using the administrative Hospital In-Patient Enquiry dataset. We use changes to inpatient bed supply across hospitals over time to examine the impact of bed supply on length of stay. Linear, negative binomial, and hospital–month-level fixed effects models are estimated. Results U-shaped trends are observed for both average length of stay and inpatient bed supply between 2010 and 2015. A consistently large positive relationship is found between bed supply and length of stay across all regression analyses. Between 2010 and 2012 while length of stay fell by 6.4%, our analyses estimate that approximately 42% (2.7% points) of this reduction was associated with declines in bed supply. Conclusion Changes in emergency inpatient length of stay in Ireland between 2010 and 2015 were closely related to changes in bed supply during those years. The use of length of stay as an efficiency measure should be understood in the contextual basis of other health system changes. Lower length of stay may be indicative of the lack of resources or available bed supply as opposed to reduced demand for care or the shifting of care to other settings.

scholarly journals Times of change in complex environments - Evaluating hospital co-payments in Palestine refugee camps

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S V Valente de Almeida ◽  
H Ghattas ◽  
G Paolucci ◽  
A Seita
Keyword(s):  
Length Of Stay ◽  
Policy Change ◽  
Negative Binomial ◽  
Negative Impact ◽  
Average Length ◽  
Lessons Learned ◽  
Policy Impact ◽  
Average Length Of Stay ◽  
Ex Post ◽  
The Impact

Abstract We measure the impact introducing a of 10% co-payment component on hospitalisation costs for Palestine refugees from Lebanon in public and private hospitals. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand and supply for healthcare. The data was collected by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and include episode level information from all public, private and Red Crescent Hospitals in Lebanon, between April 2016 and October 2017. This is a complete population episode level dataset with information from before and after the policy change. We use multinomial logit, negative binomial and linear models to estimate the policy impact on demand by type of hospital, average length of stay and treatment costs for the patient and the provider. After the new policy was implemented patients were 18% more likely to choose a (free-of-charge) PRCS hospital for secondary care, instead of a Private or Public hospital, where the co-payment was introduced. This impact was stronger for episodes with longer stays, which are also the more severe and more expensive cases. Average length of stay decreased in general for all hospitals and we could not find a statistically significant impact on costs for the provider nor the patient. We find evidence that the introduction of co-payments is hospital costs led to a shift in demand, but it is not clear to what extent the hospitals receiving this demand shift were prepared for having more patients than before, also because these are typically of less quality then the others. Regarding costs, there is no evidence that the provider managed to contain costs with the new policy, as the demand adapted to the changes. Our findings provide important information on hospitalisation expenses and the consequences of a policy change from a lessons learned perspective that should be taken into account for future policy decision making. Key messages We show that in a context of poverty, the introduction of payment for specific hospital types can be efficient for shifting demand, but has doubtable impact on costs containment for the provider. The co-payment policy can have a negative impact on patients' health since after its implementation demand increased at free-of-charge hospitals, which typically have less resources to treat patients.

Impact of Length of Stay on Functional Outcomes of TBI Patients

2005 ◽  
Vol 71 (11) ◽  
pp. 920-930 ◽  
Author(s):  
M.L. Hawkins ◽  
F.D. Lewis ◽  
R.S. Medeiros
Keyword(s):  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Care ◽  
Average Length ◽  
Functional Independence ◽  
Average Length Of Stay ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

Predicting the impact of new health technologies on average length of stay: Development of a prediction framework

2005 ◽  
Vol 21 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Sue Simpson ◽  
Claire Packer ◽  
Andrew Stevens ◽  
James Raftery
Keyword(s):  
Length Of Stay ◽  
Health Management ◽  
Average Length ◽  
New Technology ◽  
Length Of Hospital Stay ◽  
Health Technologies ◽  
Average Length Of Stay ◽  
Admission Policies ◽  
Mechanism Of Impact ◽  
The Impact

Objectives: The aim of this study was to develop a framework to predict the impact of new health technologies on average length of hospital stay.Methods: A literature search of EMBASE, MEDLINE, Web of Science, and the Health Management Information Consortium databases was conducted to identify papers that discuss the impact of new technology on length of stay or report the impact with a proposed mechanism of impact of specific technologies on length of stay. The mechanisms of impact were categorized into those relating to patients, the technology, or the organization of health care and clinical practice.Results: New health technologies have a variable impact on length of stay. Technologies that lead to an increase in the proportion of sicker patients or increase the average age of patients remaining in the hospital lead to an increase in individual and average length of stay. Technologies that do not affect or improve the inpatient case mix, or reduce adverse effects and complications, or speed up the diagnostic or treatment process should lead to a reduction in individual length of stay and, if applied to all patients with the condition, will reduce average length of stay.Conclusions: The prediction framework we have developed will ensure that the characteristics of a new technology that may influence length of stay can be consistently taken into consideration by assessment agencies. It is recognized that the influence of technology on length of stay will change as a technology diffuses and that length of stay is highly sensitive to changes in admission policies and organization of care.

scholarly journals The evaluation of a highly specialist inpatient psychologist working with patients with high risk presentations in an acute mental health inpatient setting

2021 ◽  
Vol 17 (1) ◽  
pp. 29-40
Author(s):  
Lisa Wood ◽  
Claudia Alonso ◽  
Tirma Morera ◽  
Claire Williams
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Length Of Stay ◽  
Clinical Data ◽  
Average Length ◽  
Inpatient Setting ◽  
Slight Reduction ◽  
Average Length Of Stay ◽  
Restrictive Practice ◽  
The Impact

Objective: To evaluate the function and impact of a highly specialist psychologist working with high risk patients in an acute mental health inpatient setting. The impact was examined on outcomes such as risk related incidents, re-admission, average length of stay, and use of restrictive practice.<br/> Method: A mixed methods service evaluation of a pilot project was undertaken to examine the impact of the specialist psychologist role on these outcomes over a 17-month period. Demographic and clinical data was collected for 18 patients who were seen by the psychologist. Routinely collected clinical data examining risk incidents, re-admission rates, average length of stay, and use of restrictive practice, were also used to evaluate outcome across the evaluation period (at baseline and six-month follow-up).<br/> Results: The specialist psychologist provided input to patients' care and undertook a variety of direct and indirect work and training. Examination of descriptive routine clinical data indicated a slight reduction in risk related incidents, readmissions, and average length of stay after the introduction of the psychologist role, however these were not statistically significant.<br/> Conclusion: These initial findings suggest the potential for outcome improvement, but further, more robust research is required to see if such a role can have a significant impact on outcomes.

scholarly journals Internações, óbitos e custos hospitalares por diabetes mellitus

2019 ◽  
Vol 13 ◽  
Author(s):  
Edison Vitório de Souza Júnior ◽  
Mariana Alves Soledade de Jesus ◽  
Poliana Souza Lapa ◽  
Jamille Sales da Cruz ◽  
Tayná Freitas Maia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Public Hospital ◽  
Average Length ◽  
Hospital Costs ◽  
Northeastern Brazil ◽  
Slight Reduction ◽  
The Public ◽  
Average Length Of Stay ◽  
Public Health Epidemiology

Objetivo: descrever as internações, óbitos e custos públicos hospitalares por Diabetes Mellitus no Nordeste brasileiro entre 2013 e 2017. Método: trata-se de estudo quantitativo, descritivo e ecológico com levantamento de dados secundários do Sistema de Informações Hospitalares. Coletaram-se os dados referentes às internações, óbitos, custos hospitalares, valor médio de internação e média de permanência. Analisaram-se os dados mediante estatística descritiva simples, apresentando-os por meio de tabelas elaboradas no software Excel. Resultados: registraram-se 136.504 internações e 7.424 óbitos por Diabetes Mellitus no Nordeste brasileiro. Destacaram-se, além disso, os custos públicos hospitalares superiores a R$ 65 milhões, com valor médio de internação de R$ 545,08 e média de permanência de 5,4 dias. Conclusão: conclui-se que as internações, óbitos e os custos públicos hospitalares por Diabetes Mellitus apresentaram discreta redução e, mesmo assim, implicaram, de maneira expressiva, o orçamento público, além das repercussões pessoais e familiares impostas pela doença. Descritores: Saúde Pública; Epidemiologia; Endocrinologia; Custos de Cuidados de Saúde; Doenças do Sistema Endócrino; Indicadores Básicos de Saúde.Abstract Objective: to describe hospitalizations, deaths and public hospital costs for Diabetes Mellitus in Northeastern Brazil between 2013 and 2017. Method: this is a quantitative, descriptive and ecological study with secondary data collection from the Hospital Information System. Data was collected regarding hospitalizations, deaths, hospital costs, average hospitalization value and average length of stay. Data was analyzed using simple descriptive statistics, presenting them using tables prepared using Excel software. Results: 136,504 hospitalizations and 7,424 deaths from diabetes mellitus were recorded in the Brazilian Northeast. Also noteworthy were the public hospital costs over R$ 65 million, with an average hospitalization value of R$ 545.08 and an average length of stay of 5.4 days. Conclusion: it can be concluded that hospitalizations, deaths and public hospital costs for Diabetes Mellitus showed a slight reduction and, even so, they significantly implied the public budget, in addition to the personal and family repercussions imposed by the disease. Descriptors: Public Health; Epidemiology; Endocrinology; Health Care Costs;ResumenObjetivo: describir las hospitalizaciones, muertes y costos hospitalarios por diabetes mellitus en el noreste de Brasil, entre 2013 y 2017. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, con la recopilación de datos secundarios del Sistema de Informaciones Hospitalarias. Se recopilaron los datos de hospitalizaciones, muertes, costos hospitalarios, valor promedio y tiempo de permanencia de la hospitalización. Los datos se analizaron mediante estadísticas descriptivas simples y se presentaron a través de tablas elaboradas en el software Excel. Resultados: se registraron 136,504 hospitalizaciones y 7,424 muertes por diabetes mellitus en el noreste de Brasil. Además, se destacaron los costos hospitalarios públicos superiores a R $ 65 millones, con un valor promedio de hospitalización de R$ 545.08 y una permanencia con promedio de 5,4 días. Conclusión: se concluye que las hospitalizaciones, las muertes y los costos hospitalarios debidos a la diabetes mellitus presentaron una ligera reducción, y aun así, estaban significativamente implicados en el presupuesto público, además de las repercusiones personales y familiares impuestas por la enfermedad. Descriptores: Salud Pública; Epidemiología; Endocrinología; Costos de la Atención en Salud; Enfermedades del Sistema Endocrino; Indicadores de Salud.

scholarly journals The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy

2021 ◽  
Vol 18 (13) ◽  
pp. 6722
Author(s):  
Daniel Adrian Lungu ◽  
Elisa Foresi ◽  
Paolo Belardi ◽  
Sabina Nuti ◽  
Andrea Giannini ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Geographical Variation ◽  
Average Length ◽  
Surgical Techniques ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Invasive Approach ◽  
Average Length Of Stay ◽  
The Impact

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.

scholarly journals Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions

2014 ◽  
Vol 52 (195) ◽  
pp. 878-885 ◽  
Author(s):  
Oya Durmus Cakir ◽  
Sebnem Eren Cevik ◽  
Mehtap Bulut ◽  
Ozlem Guneyses ◽  
Sule Akkose Aydin
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Waiting Times ◽  
Pediatric Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Average Length Of Stay ◽  
Bed Capacity

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.  Keywords: bed capacity; crowding; emergency department; length of stay.  

scholarly journals 208 Assessment of The Impact Of COVID-19 On the Management of Patients with Neck of Femur Fractures in A Major Trauma Center In Wales

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Solari ◽  
Z Ansar
Keyword(s):  
Length Of Stay ◽  
Operative Treatment ◽  
Major Trauma ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Neck Of Femur ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
The Impact

Abstract Introduction Neck of femur (NOF) fractures form a significant proportion of trauma. Especially since they do not benefit from COVID-19 social isolation policies. Surgery and hospital admissions present risks to patients during the COVID-19 pandemic. Method Retrospective analysis of all NOF fractures from 24/3/20 to 26/6/20 in Morriston Hospital. Directly compared with 2019, allowing assessment of COVID-19’s impact. Results 179 NOF fractures were admitted, 158 had an operation. Increased from 127 patients in 2019. Average time to surgery increased from 39 to 67 hours. There were operation delays for 98 patients, and non-operative treatment increased from 2 to 21 patients. Prompt orthogeriatric reviews completed in 80.4% patients in 2020, up from 72.5%. Prompt physiotherapy review increased from 66.9% to 74.6%. Mortality remained similar at 8.6% (2019) and 8.5% (2020). Average length of stay reduced; 17.4 to 11 days in 2020. Conclusions 2020 saw increased waits for operations. There was reduction in length of stay and improved promptness of orthogeriatric and physiotherapy reviews. Increased non-operative treatment in 2020, reflecting decisions about risks and benefits of surgery in the pandemic. Mortality remained stable. This department improved some aspects of care, potentially due to pressures of COVID-19 heightening awareness of patient's needs.

scholarly journals Emergency Surgery in A Tertiary Hospital: The Covid-19 Experience

2020 ◽  
Author(s):  
Gennaro Perrone ◽  
Mario Giuffrida ◽  
Elena Bonati ◽  
Paolo Del Rio ◽  
Vittoria Pattonieri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Acute Cholecystitis ◽  
Emergency Surgery ◽  
Average Length ◽  
Medical Science ◽  
University Hospital ◽  
Average Length Of Stay ◽  
The Impact

Objective: Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in an Emergency Department of a tertiary COVID-Hospital. Methods: We reported and compared the surgical procedures performed for acute appendicitis and acute cholecystitis between two periods (March and April 2019 and March and April 2020) at Emergency Surgery Department of Parma University Hospital, a tertiary COVID-Hospital. Results: A total of 72 patients underwent surgery between March and April 2019 and 36 between March and April 2020 for acute appendicitis and cholecystitis. The average length of stay was comparable in the two considered years for LA (4.23±1.69 days in 2019 versus 4.5±2.33 days in 2020). The average length of stay in patients with acute cholecystitis was 5.9±3.8 days in 2019 and 8.23±5.5 days in 2020(P=0.038). The average hospitalization was comparable with 2019 data (5.62±3.77 days)n March 2020;whereas, April 2020 was statistically significantly longer 10.5±6 days (P= 0.023). Conclusions: Half of the emergency centers reported a drop in the overall number of urgent cases as confirmed in our department, where the number of total appendicectomy and cholecystectomy was halved comparing the two months in 2019 and 2020, 72 operations in 2019 versus 36 operations in 2020.During the pandemic, the confidence of the population to the healthcare systems was poor, and this can explain the delayed access to the emergency department of patients who suffered from an acute illness. Bangladesh Journal of Medical Science Vol.19(0) 2020 p. S 66-S 68

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