scholarly journals Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service

2019 ◽  
Vol 43 ◽  
pp. 17-24
Author(s):  
M.A. Kazem ◽  
C. Hopley ◽  
D.J. Corless
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tayebeh Baniasadi ◽  
Kobra Kahnouji ◽  
Nasrin Davaridolatabadi ◽  
Saeed Hosseini Teshnizi

Abstract Background One of the effective indicators for determining the efficiency and optimal use of hospital resources is the length of stay (LOS). This study aimed to determine the patients’ length of stay and the factors affecting the LOS in the Children’s hospital. Method A cross-sectional study was performed on Children Hospital medical record database including 350 records (April 2015 to Dec 2015). Records were selected by stratified random sampling with proportional allocation. Then the predetermined demographic and hospital variables were extracted through the study of patients’ medical records. All statistical analysis were performed using SPSS software. Results The overall median of the LOS in the studied hospital was 3 days (IQR =3). The results showed that in this hospital the LOS has a significant relationship with the variables of time of admission, the place of residence, type of admission, and the degree of attending physician. Also, with the increasing number of visits, ultrasonography, counseling and laboratory test, LOS was increased. Conclusion Improving processes related to diagnostic procedures, providing adequate staffing for specialized services in all hours of the day, preventing unnecessary and non-emergency admissions in the evening and night, will be effective in optimizing patient LOS.


2007 ◽  
Vol 31 (4) ◽  
pp. 633 ◽  
Author(s):  
Andrew W Dent ◽  
Tracey J Weiland ◽  
Lisa Vallender ◽  
Nicola E Oettel

Objectives: To determine the accuracy of predictions of the need for hospital admission and, if admitted, length of stay (LOS) made early in an emergency attendance by emergency department (ED) doctors, nurses, patients and relatives, and the characteristics of ED presentations predictive of admission and short stays (~3 days). Methods: Prospective collection of predictions by medical and nursing staff, patients and relatives of ED departure status and LOS (1 day, 2-3 days, 4- 7 days or longer) of a convenience sample of adults presenting with medical symptoms. Predictions were made before full medical assessment and matched against actual departure status and LOS. Vital signs and demographics were recorded. Results: Seventy five percent (2159/2904; CI 73%?77%) of all admission predictions in 704 patients were correct with 85% (575/673; CI 81%- 88%) of doctors? predictions correct. Thirty-five percent (361/1024) of all LOS predictions for 331 patients were correct with 46% (122/268; CI 40%- 52%) of doctors? predictions correct. Risk factors for short-stay over longer admission included age less than 65, normal oxygen saturations and selfreferral. Conclusion: Emergency admissions can be predicted with reasonable accuracy but LOS is difficult to predict. Development of a prediction tool may facilitate streaming and appropriate use of short-stay units.


Author(s):  
C Dandurand ◽  
MN Hindi ◽  
T Ailon ◽  
M Boyd ◽  
R Charest-Morin ◽  
...  

Background: Length of stay (LOS) is a surrogate for care complexity and a determinant of occupancy and service provision. Our primary goal was to assess changes in and determinants of LOS at a quaternary spinal care center. Secondary goals included identifying opportunities for improvement and determinants of future service planning. Methods: This is a prospective study of patients admitted from 2006 to 2019. Data included demographics, diagnostic category (degenerative, oncology, deformity, trauma, other), LOS (mean, median, interquartile range, standard deviation) and in-hospital adverse events (AEs). Results: 13,493 admissions were included. Mean age has increased from 48.4 (2006) to 58.1 years (2019) (p=<0.001). Mean age increased overtime for patients treated for deformity (p=<0.001), degenerative pathology (p=<0.001) and trauma (p=<0.001), but not oncology (p=0.702). Overall LOS has not changed over time (p=0.451). LOS increased in patients with degenerative pathology (p=0.019) but not deformity (p=0.411), oncology (p=0.051) or trauma (p=0.582). Emergency admissions increased overtime for degenerative pathologies (p=<0.001). AEs and SSIs have decreased temporally (p=<0.001). Conclusions: This is the first North American study to analyze temporal trends in LOS for spine surgery in an academic center. Understanding temporal trends in LOS and patient epidemiology can provide opportunities for intervention, targeted at the geriatric populations, to reduce LOS.


Author(s):  
A. Viljoen ◽  
M.N. Saulez ◽  
C.M. Donnellan ◽  
L. Bester ◽  
B. Gummow

Medical records of equine after-hours admissions from 1998 to 2007 are reviewed. Data extracted from the medical records included signalment, reason for admission, pre-admission treatment, clinical presentation, procedures performed, final diagnoses, complications occurring in hospital, length of stay and outcome. Eight hundred and twenty after-hours admissions were available of which 75 % were classified as emergencies. Most horses originated from Gauteng province (82 %), with Thoroughbred, Arabian, and Warmbloods representing 46 %, 10 % and 7 % of horses. Horses had a median age of 7 years and were predominantly male (60 %). Gastrointestinal (64 %) and musculoskeletal (19 %) disorders were the primary reasons for admission. Anti-inflammatories, sedation and antibiotics were given in 51 %, 20 % and 15 % of cases respectively prior to referral. On admission, 23 % of horses had surgical intervention. Intravenous catheterisation (64 %), rectal examination (61 %), nasogastric intubation (56 %), abdominocentesis (33 %) and ultrasonography (19 %) were the procedures performed most frequently. Surgical and medical colics constituted 28 % and 27 % respectively of the overall diagnoses, while piroplasmosis was diagnosed in 5 % of horses. Post-admission complications occurred in <2 % of horses. The median length of stay was 4 days (95 % CI: 1 to 21 days). Overall survival to discharge was 74 %. This study demonstrates that the majority of after-hours equine admissions to a university referral hospital required medical intervention and were mostly due to gastrointestinal disorders. Information obtained from this study can be used in emergency referral planning.


1989 ◽  
Vol 34 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Brian Baker ◽  
James Rochon

Length of stay information was collected from 1,364 individuals over a one year period for five general hospitals in a major metropolitan area. The current set of data represents homogeneity in the nature of admissions and the type of facilities examined. Three of the hospitals operated short stay units. Significant differences in the total length of stay were observed according to age, sex and presence of psychosis but there were no unequivocal distinctions between short stay and conventional hospitals.


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