Hospital Bed Occupancy due to Drug-Related Problems1

1980 ◽  
Vol 73 (12) ◽  
pp. 853-856 ◽  
Author(s):  
Karabi Ghose

The number of patients admitted for drug-related problems and the duration of inpatient treatment required primarily for drug reactions and/or related problems during the period 1 October to 31 December 1979 were studied in one of the three general medical units of a district general hospital. 93% of all patients were admitted as emergencies either through the casualty department or at the their own general practitioner's request. Acute self-poisoning (9.9%) and other drug-related problems (8.8%) were, respectively, the third and fifth most common causes of hospital admission. These two conditions jointly (all drug-related problems) appeared to be the second most common cause and accounted for 18.7% of hospital admissions. The mean duration of hospitalization in patients with drug-related problems, excluding self-poisoning, was approximately 8 days. This was almost identical to hospital bed occupancy due to bronchopulmonary diseases (8.3 days) and complications of diabetes mellitus (8.4 days).

1995 ◽  
Vol 19 (5) ◽  
pp. 276-280 ◽  
Author(s):  
◽  
Bernard Audini ◽  
Michael Crowe ◽  
Joan Feldman ◽  
Anna Higgitt ◽  
...  

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.


2015 ◽  
Vol 39 (5) ◽  
pp. 533 ◽  
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Rob Eley ◽  
Alan Scanlon ◽  
Judy Flores ◽  
...  

Background Movement of emergency patients across the emergency department (ED)–inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface. Objective To compare the association of NEAT with new and traditional markers of patient flow across the ED–inpatient interface and to investigate new markers of mortality and NEAT compliance across this interface. Methods Retrospective study of consecutive emergency admissions to a tertiary hospital (January 2012 to June 2014) using routinely collected hospital data. The practical access number for emergency (PANE) and inpatient cubicles in emergency (ICE) are new measures reflecting boarding of inpatients in ED; traditional markers were hospital bed occupancy and ED attendance numbers. The Hospital Standardised Mortality Ratio (HSMR) for patients admitted via ED (eHSMR) was correlated with inpatient NEAT compliance rates. Linear regression analyses assessed for statistically significant associations (expressed as Pearson R coefficient) between all measures and inpatient NEAT compliance rates. Results PANE and ICE were inversely related to inpatient NEAT compliance rates (r = 0.698 and 0.734 respectively, P < 0.003 for both); no significant relation was seen with traditional patient flow markers. Inpatient NEAT compliance rates were inversely related to both eHSMR (r = 0.914, P = 0.0006) and all-patient HSMR (r = 0.943, P = 0.0001). Conclusions Traditional markers of patient flow do not correlate with inpatient NEAT compliance in contrast to two new markers of inpatient boarding in ED (PANE and ICE). Standardised mortality rates for both emergency and all patients show a strong inverse relation with inpatient NEAT compliance. What is known about the topic? Impaired flow of emergency admissions across the interface between ED and inpatient wards retards achievement of NEAT-compliance rates and adversely affects patient outcomes. Uncertainty exists as to which measures of patient flow and mortality outcomes correlate closely with NEAT-compliance rates for patients admitted from emergency departments. What does this paper add? This study investigates the utility of two new markers of patient flow from ED to inpatient wards. The Practical Access Number for Emergency (PANE) is the number of patients in ED who have had their episode of ED care completed and are awaiting an inpatient bed at a particular point in time. The Inpatient Cubicles in Emergency (ICE) represents the theoretical number of ED cubicles blocked by boarding patients over a specified time interval (in this study 5 weekdays, Monday–Friday), based on the mean time boarders spent in ED during that interval. Both measures were shown to be significantly inversely related to inpatient NEAT compliance rates (i.e. as PANE and ICE increased, NEAT compliance decreased). In contrast, no relation was seen with traditional markers of patient flow (i.e. hospital bed occupancy and ED attendance numbers). HSMR for both all patients and emergency patients only demonstrated a strong inverse relation with inpatient NEAT compliance. What are the implications for practitioners? When pursuing higher NEAT compliance rates, traditional markers of patient flow across the ED–inpatient interface may be misleading and adversely impact bed-management strategies and patient safety. Identifying when hospitals may be at risk of developing, or already in, a state of reduced access to emergency care may be performed more accurately using new flow markers such as PANE and ICE. The inverse relationship between inpatient NEAT compliance and HSMR, whether calculated for all patients or for emergency patients only, underscores the dependence of inpatient mortality on the swift flow of large volumes of emergency admissions across the ED–inpatient interface. This flow may be compromised by imposing additional demands on a limited number of commissionable beds by way of increasing ED demand and/or use of more beds for elective admissions.


2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Watson ◽  
L Ralston

Abstract Introduction Delirium is a common cause and complication of hospital admissions. DVLA1, and Consensus guidelines2 exist for driving with dementia or mild cognitive impairment, but there are no specific guidelines pertaining to delirium. This audit set out to find the prevalence of delirium in a district general hospital prior to implementation of a standard screening tool. It was noteworthy that a significant number of patients with delirium were drivers. Methods The notes of 114 patients under the care of nine specialties, both medical and surgical were prospectively reviewed. Of those with risk factors for delirium, data was collected on the number of patients who had a diagnosis of delirium made during their admission. For patients at risk with no documented screening already completed a Confusion Assessment Method (CAM) screening test was performed by the lead author. In patients identified with delirium it was also established if they were current drivers via clerking documentation or by discussion with the patient/family. Drivers with delirium were highlighted in the medical notes and where possible discussions were had with the patient and their families regarding driving advice until the delirium had resolved. Results The prevalence of delirium in this group was 23% (n = 26/114). 20 patients had documented evidence of delirium and a further 6 patients were diagnosed as a result of this project. 15.4% (n = 4/26) of patients with delirium were current drivers. For this group there was no documented evidence that driving advice had been given to the patient or family. Conclusion This baseline audit has identified that delirium is not consistently screened for and identified. In patients with delirium, driving history is not being sought and consequently the opportunity for driving advice is being missed. Clear guidance from the DVLA on driving for patients with a resolving delirium is needed. References 1. DVLA, 2018. 2. RCPsych, 2019.


Author(s):  
R.E Field ◽  
I. Afzal ◽  
J. Dixon ◽  
V.R Patel ◽  
P Sarkar ◽  
...  

AbstractThis retrospective cohort analysis, reports the demographic data and early outcome of the first 500 patients who were admitted to a District General Hospital in South West London, UK and tested positive to COVID-19. The patients were admitted between 10 January and 10 April 2020; with the first COVID-19 positive diagnosis on 6 March. A surge in admissions started around the 15 March and peaked at the beginning of April.56.8% of the admissions were male and 43.2% were female. The average age of the 500 admissions was 69.32 years (SD 19.23 years, range 1 week to 99.21 years). By the morning of 14 April 2020, 199 patients had been discharged (Female 89, Male 111), 163 patients had died (female 61, male 102) and 131 remained as in-patients (female 66, male 71).Fewer than one in twenty deaths occurred in patients below the age of 50 years, in either gender. Mortality rose dramatically, for both genders, after the age of sixty with males being almost twice as vulnerable to dying, as females, during the 7th decade. Males older than their mid-fifties were more likely to die than leave hospital. The same applied to females beyond their mid seventies. We did not see any evidence of a poorer outcome associated with a lower decile for Index of Multiple Deprivation or convincing evidence that any Ethnic minority groups were more likely to die than the White subgroups. When compared to the equivalent medical conditions, normally treated in the early spring, COVID-19 has an increased mortality, adversely affecting more men and an older population.The mean duration from admission to discharge was 11.29 days (SD 11.50 days). For admission to death, the mean interval was 11.72 days (SD 11.05 days). 62 of the 500 admissions required ventilator support. Of this subgroup, 71% were male and 29% were female. By the morning of the 14 April, no female over the age of 60 had left the intensive care unit alive and no male over the age of 50 had left the intensive care unit alive. At this time-point, 1.2% of the 500 admitted patients had returned alive from the intensive care units, following a period of ventilator support. This figure will rise if prolonged ventilator and renal support proves effective.While only providing a snapshot of a relatively small number of patients, reviewed over a short time period, from a small geographic area, the data supports the view that the younger members of society are less vulnerable to the adverse sequelae of COVID-19 infection and that any return to normal work and social activities should be considered initially for the individuals who are less than 40-50 years of age. There is an ongoing need for analyses on larger patient cohorts using both demographic and detailed clinical data.


2019 ◽  
Vol 11 (1) ◽  
pp. 9-18
Author(s):  
Abdul Wakhid ◽  
Ana Puji Astuti ◽  
Maya Kurnia Dewi

Logoterapi merupakan terapi untuk menemukan makna positif dibalik sebuah kejadian yang tidak diharapkan. Logoterapi dilaksanakan secara individu maupun berkelompok dalam bentuk konseling dan berorientasi pada pencarian makna hidup individu. Tujuan logoterapi meningkatkan makna pengalaman hidup individu yang diarahkan kepada pengambilan keputusan yang bertanggung jawab. Penelitian ini dilakukan dengan menggunakan rancangan pre-experiment dengan metode pre and post test group, artinya pengumpulan data dilakukan terhadap responden untuk membandingkan kualitas hidup sebelum dan sesudah dilakukan intervensi. Teknik pengambilan sampel dilakukan dengan metode total sampling yaitu pengambilan seluruh sampel dengan tetap memperhatikan kriteria yang telah ditetapkan. Jumlah pasien yang menjalani hemodialisis di RSUD Ungaran sebanyak 21 orang dan di RSUD Ambarawa sebanyak 25 pasien. Analisis data dilakukan dengan menggunakan uji t test dependent. Hasil penelitian didapatkan bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 60.22 dengan skor terrendah 55 dan skor tertinggi 69. Bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 88.72 dengan skor terrendah 79 dan skor tertinggi 103. Hasil uji statistik dengan uji t test dependent diketahui ada pengaruh logoterapi terhadap kemampuan memaknai hidup pada klien yang menjalani hemodialisis di RSUD Kabupaten Semarang (p value: 0,0001). Saran perlunya peningkatan kemampuan perawat dalam memberikan layanan kesehatan termasuk pemberian atau pemanduan penemuan makna hidup bagi pasien hemodialysis, agar selain dengan hemodialysis, ada faktor internal dari pasien yang dapat dijadikan sebagai motivasi untuk sembuh dari penyakit.   Kata Kunci: Logoterapi, kualitas hidup   IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH RENAL FAILURE WHO UNDERWENT HEMODIALYSIS   ABSTRACT Logotherapy is a therapy to discover the positive meaning behind an unexpected event. Logotherapy is carried out individually or in groups in the form of counseling and oriented to the search for the meaning of individual life. This study aims to improve the quality of life of patients with renal failure who underwent hemodialysis. This research was conducted by using pre-experiment with pre-post test study. The sampling technique was done by the convenience sampling. The number of patients undergoing hemodialysis as many as 46 respondents. Data analysis was done by using test t test dependent. The result showed that from 46 respondents got the mean of quality of life of patients who had hemodialysis 60.22 with lowest score 55 and highest score 69. Whereas from 46 respondents got the mean score of life quality of patients who had hemodialysis 88.72 with score the lowest score 79 and the highest score 103. The result of statistical test with t test dependent is known there is influence of logoterapi to the ability of meaningful life on client who undergo hemodialysis at Semarang Regency hospitals (p value: 0.0001). Advice on the need to improve the nurse's ability to provide health services, including the provision or guidance of the discovery of the meaning of life for hemodialysis patients, in addition to hemodialysis, there are internal factors of the patient that can be used as a motivation to recover from illness.   Keywords: Logotherapy, quality of life, kidney failure.  


2011 ◽  
Vol 152 (20) ◽  
pp. 797-801 ◽  
Author(s):  
Miklós Gresz

In the past decades the bed occupancy of hospitals in Hungary has been calculated from the average of in-patient days and the number of beds during a given period of time. This is the only measure being currently looked at when evaluating the performance of hospitals and changing their bed capacity. The author outlines how limited is the use of this indicator and what other statistical indicators may characterize the occupancy of hospital beds. Since adjustment of capacity to patient needs becomes increasingly important, it is essential to find indicator(s) that can be easily applied in practice and can assist medical personal and funders who do not work with statistics. Author recommends the use of daily bed occupancy as a base for all these statistical indicators. Orv. Hetil., 2011, 152, 797–801.


2020 ◽  
Author(s):  
Kanan Shah ◽  
Akarsh Sharma ◽  
Chris Moulton ◽  
Simon Swift ◽  
Clifford Mann ◽  
...  

BACKGROUND From 2006/2007 to 2017/2018, there was a 26% increase in emergency department (ED) attendances and 32% increase in total admissions in the National Health Service in England (NHS). Growing demand puts severe strain on hospitals, resulting in bed, nursing, clinical and equipment shortages. Nevertheless, scheduling issues can still result in significant under-utilization of beds. It is imperative to optimize the allocation of existing healthcare resources, including hospital beds. More accurate and reliable long-term hospital bed occupancy rate prediction would help managers plan ahead for their population’s hospital requirements, ultimately resulting in greater efficiencies and better patient care. OBJECTIVE This study aimed to compare widely used automated time series forecasting techniques to predict short-term daily non-elective bed occupancy at all trusts in the NHS. METHODS Bed occupancy models that accounted for patterns in occupancy were created for each trust in the NHS. Daily non-elective midnight trust occupancy data from April 2011 to March 2017 for 121 NHS trusts were utilized to generate these models. Forecasts were generated using the three most widely used automated forecasting techniques: Exponential Smoothing (ES); Seasonal Autoregressive Integrated Moving Average (SARIMA); Trigonometric, Box-Cox transform, ARMA errors, Trend and Seasonal components (TBATS). The NHS Modernization Agency’s recommended forecasting method prior to 2020, was also replicated. A comparative analysis of forecast accuracy was conducted by comparing forecasted daily non-elective occupancy with actual non-elective occupancy in the out-of-sample dataset for each week forecasted. Percentage root mean squared error (RMSE) was reported. RESULTS The accuracy of the models varied based on the season during which occupancy was forecasted. For the summer season, percent RMSE values for each model remained relatively stable across six forecasted weeks. However, only the TBATS model (median error 2.45% for six weeks) outperformed the NHS Modernization Agency’s recommended method (median error 2.63% for six weeks). In contrast, during the winter season, percent RMSE values increased as we forecasted further into the future. ES generated the most accurate forecasts (median error 4.91% over four weeks), but all models outperformed the NHS Modernization Agency’s recommended method prior to 2020 (median 8.5% error over four weeks). CONCLUSIONS It is possible to create automated models, similar to those recently published by the NHS, that can be used at a hospital level for a large, national healthcare system in order to predict non-elective bed admissions and thus schedule elective procedures. CLINICALTRIAL N/A


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.


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