scholarly journals Impact of a One-Stop Rapid Access Venous Ulcer Clinic on Inpatient Admissions

2021 ◽  
Author(s):  
Colum Keohane ◽  
Momhammed Alagha ◽  
Marie O'Shaughnessy ◽  
Doireann Joyce ◽  
Wael Tawfick ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Control Period ◽  
Public Hospitals ◽  
Hospital Inpatient ◽  
Venous Leg Ulcer ◽  
Venous Ulceration ◽  
Rapid Access ◽  
One Stop ◽  
Bed Days ◽  
Unplanned Admissions

Abstract Objective To determine whether the introduction of a one-stop see and treat clinic offering early reflux ablation for Venous Leg Ulcer (VLU) patients in July 2016 has affected rates of unplanned inpatient admissions due to venous ulceration. Design Review of inpatient admission data and analysis of related costs. Materials The Hospital Inpatient Enquiry collects data from acute public hospitals in Ireland on admissions and discharges, coded by diagnosis and acuity. This was the primary source of all data relating to admissions and length of stay. Costs were calculated from data published by the Health Service Executive in Ireland on average costs per inpatient stay for given diagnosis codes. Methods Data were collected on admission rates, length of stay, overall bed day usage, and costs across a four-year period; the two years since the introduction of the rapid access clinic, and the two years immediately prior as a control. Results 218 patients admitted with VLUs accounted for a total of 2,529 inpatient bed-days, with 4.5(2-6) unplanned admissions, and a median hospital stay of 7(4-13) days per month. Median unplanned admissions per month decreased from 6(2.5-8.5) in the control period, to 3.5(2-5) after introduction of the clinic p=.040. Bed-day usage was significantly reduced from median 62.5(27-92.5), to 36.5(21-44) bed-days per month (p=.035), though length of stay remained unchanged (p=.57). Cost of unplanned inpatient admissions fell from median \euro33,336.25(\euro14,401.26-\euro49,337.65) per month to \euro19,468.37(\euro11,200.98-\euro22,401.96) (p=.03). Conclusions Admissions for inpatient management of VLUs have fallen after beginning aggressive endovenous treatment of venous reflux in a dedicated one-stop see-and-treat clinic for these patients. As a result, bed-day usage has also fallen, leading to cost savings.

scholarly journals Projected acute inpatient activity in New South Wales — aIM2005

2008 ◽  
Vol 32 (3) ◽  
pp. 528 ◽  
Author(s):  
Neill Jones ◽  
Greg Hardes ◽  
Stephen Ryan ◽  
Jennifer Sheehan ◽  
Cathryn Cox ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
New South ◽  
New South Wales ◽  
Age Groups ◽  
Public Hospitals ◽  
Population Projections ◽  
Age Group ◽  
South Wales ◽  
Bed Days

Objectives: To describe the statewide projections of acute inpatient activity in New South Wales. Methods: Data on acute inpatient activity in NSW for the period 1998?1999 to 2003?04 were derived from the Admitted Patient Data Collection. Regression analysis was used to project trends in utilisation and length of stay by age group, clinical specialty groups and stay type (day-only and overnight). The projected separation rates and length of stay were subject to clinical review. Projected separation rates (by age group, clinical speciality and stay type) were applied to NSW population projections to derive the projected number of separations. Bed-days were calculated by applying projected overnight average length of stay. Results: Total acute inpatient activity in NSW public hospitals is projected to increase from around 1.05 million separations in 2004 to around 1.3 million separations by 2017 (24%). Same-day separations are projected to increase from around 368 000 to around 514 000 (40%). Overnight separations are projected to rise from around 690 000 in 2003?04 to around 798 000 in 2016?17 (18%). Overnight bed-days are projected to increase from around 3.7 million in 2003?04 to around 4.1 million bed-days in 2017 (12%). Differences across age groups and clinical specialties are also evident from the modelling.

Increased allied health services to general and acute medical units decreases length of stay: comparison with a historical cohort

2018 ◽  
Vol 42 (3) ◽  
pp. 327 ◽  
Author(s):  
Ellen Mills ◽  
Vicki Hume ◽  
Kathy Stiller
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Allied Health ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Tertiary Referral ◽  
Historical Cohort ◽  
Historical Comparison ◽  
Hospitalised Patients ◽  
Bed Days

Objective The present study evaluated the effect of an initiative to fund increased allied health (AH) services, enabling increased days and both volume and scope of AH services, for general medical in-patients in the Central Adelaide Local Health Network for a 6-month trial period. Methods A quasi-experimental mixed-methods study was undertaken involving general medical in-patients at two acute tertiary-referral public hospitals with a prospective (December 2015–May 2016) and historical comparison (December 2014–May 2015) cohort. Outcome measures compared between the two cohorts included hospital length of stay (LOS), occupied bed-days, adverse events and AH service data. Results After implementation of increased AH services, there were significant decreases in the median (interquartile range) of both hospital LOS (from 7.2 (7.0–8.0) to 6.5 (6.1-6.7) days; P = 0.006) and occupied bed-days (from 5295.0 (5200.0–5622.3) to 4662.5 (4335.8–4744.3) bed-days per month; P = 0.004). There was no significant change in weekend discharges or adverse events. AH services increased, with the median number of referrals seen by AH professionals per month, occasions of AH service and AH intervention time per month increasing by 17%, 45% and 43% respectively after implementation, along with a faster response time to referrals. Conclusions Increased levels of AH staffing to general medical in-patients were associated with a significant reduction in hospital LOS and occupied bed-days. What is known about the topic? AH services are an important component in the delivery of safe, effective and efficient health care to hospitalised patients. There is little evidence specifically investigating the effect of increased AH services for general medical patients in an acute hospital setting. What does this paper add? This study provides new evidence demonstrating that increasing AH services to general medical in-patients within two acute tertiary-referral public hospitals decreased hospital LOS and occupied bed-days, without an increase in adverse events. What are the implications for practitioners? A funding initiative to enable increased AH services to general medical in-patients significantly reduced hospital LOS and occupied bed-days. These findings will be of considerable interest to other healthcare centres, particularly those where AH levels are below benchmark figures.

scholarly journals Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ladjane Santos Wolmer de Melo ◽  
Maria Verônica Monteiro de Abreu ◽  
Bernuarda Roberta de Oliveira Santos ◽  
Maria das Graças Washington Casimiro Carr ◽  
Maria Fernanda Aparecida Moura de Souza ◽  
...  
Keyword(s):  
Experimental Study ◽  
Length Of Stay ◽  
Public Hospitals ◽  
Incidence Density ◽  
Healthcare Associated Infections ◽  
Collaborative Project ◽  
Quasi Experimental ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Over Time

Abstract Background Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. Methods A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI “Improvement Model”, during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). Result A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. Conclusions Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.

scholarly journals Severity variations within DRGs:Measurement of hospital effects by use of data on significant secondary diagnoses

1998 ◽  
Vol 21 (1) ◽  
pp. 37 ◽  
Author(s):  
Don Hindle ◽  
Pieter Degeling ◽  
Ono Van Der Wel
Keyword(s):  
Resource Allocation ◽  
Length Of Stay ◽  
Group Classification ◽  
Public Hospitals ◽  
Diagnosis Related Group ◽  
Use Of Data ◽  
Acute Hospitals ◽  
Related Group

The Diagnosis Related Group classification has provided an excellent basis forenhancing the equity of resource allocation between public acute hospitals. However,it underestimates the higher levels of severity and consequent costliness of referralhospitals.This paper describes a practical way of measuring within-DRG variations in severity,which can be used to increase the precision of casemix-based funding. It involves theregression of length of stay against the numbers of significant diagnoses and procedures,and hence the prediction of additional justified costs. An example is given of itsapplication to data from South Australian public hospitals.

The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic

2008 ◽  
Vol 17 (2) ◽  
pp. 163-170 ◽  
Author(s):  
A. Fairchild ◽  
E. Pituskin ◽  
B. Rose ◽  
S. Ghosh ◽  
J. Dutka ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Palliative Radiotherapy ◽  
Rapid Access ◽  
One Stop

scholarly journals A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

2015 ◽  
Vol 21 (1) ◽  
pp. 5 ◽  
Author(s):  
Eileen Thomas ◽  
Karen Jacqueline Cloete ◽  
Martin Kidd ◽  
Helena Lategan
Keyword(s):  
Length Of Stay ◽  
Public Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Care ◽  
Tertiary Care ◽  
Mental Healthcare ◽  
District Level ◽  
Public Hospitals ◽  
Western Cape ◽  
Entry Level

<p><strong>Background. </strong>There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care.</p><p><strong>Objective.</strong><em> </em>To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape. </p><p><strong>Method.</strong><em> </em>Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (<em>N</em>=487) admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected. </p><p><strong>Results. </strong>Psychotic disorders were the most prevalent (<em>n</em>=287, 59%) diagnoses, while 228 (47%) of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38%) of admission episodes, 37 (57%) of readmissions and 19 (61%) of abscondments. Most admission episodes (<em>n</em>=372, 76%) were discharged without referral to specialist/tertiary care. </p><p><strong>Conclusion. </strong>Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.</p>

scholarly journals Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward

2018 ◽  
Vol 7 (4) ◽  
pp. e000149 ◽  
Author(s):  
Katherine Adlington ◽  
Juliette Brown ◽  
Laura Ralph ◽  
Alan Clarke ◽  
Tim Bhoyroo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Older Adult ◽  
Average Length ◽  
Psychiatric Ward ◽  
Bed Occupancy ◽  
Care Needs ◽  
Bed Days ◽  
Community Team ◽  
The Impact

BackgroundLength of stay and bed occupancy are important indicators of quality of care. Admissions are longer on older adult psychiatric wards as a result of physical comorbidity and complex care needs. The recommended bed occupancy is 85%; levels of 95% or higher are associated with violent incidents on inpatient wards.MethodsWe aimed to reduce length of stay and bed occupancy on Leadenhall ward, a functional older adult psychiatric ward serving a population of just under 40 000 older adults in two of the most deprived areas of the UK.At baseline in October 2015, the average length of stay was 47 days, and bed occupancy was at 77%. We approached the problem using quality improvement methods, established a project team and proceeded to test a number of changes over time in line with the driver diagram we produced.ResultsIn 12 months, length of stay was reduced from an average 47 to an average 30 days and bed occupancy from 77% to 54%.At the end of 2016, the closure of some beds effected this calculation and we added an additional outcome measure of occupied bed days (OBD) better to assess the impact of the work. OBD data show a decrease over the course of the project from 251 to 194 bed days (a reduction of 23%).ConclusionThe most effective interventions to address length of stay and bed occupancy on an older adult functional mental health ward were the daily management round and the high-level management focus on longer-stay patients. The work depended on an effective community team and on the support of the quality improvement programme in the trust, which have led to sustained improvements.

scholarly journals Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yuri Choi ◽  
Jinwoo Jeong ◽  
Byoung-Gwon Kim
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Policy Change ◽  
Control Period ◽  
Medical Patients ◽  
Emergency Physicians ◽  
Before And After ◽  
Negative Effect ◽  
Admission Decisions ◽  
The Impact

Background. Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing treatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and are associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by emergency physicians without consultations on the ED LOS and other quality indicators. Methods. The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions that was implemented in October 2016. During and after the policy change, emergency physicians decided how to arrange for and treat medical patients by processing their admission and providing follow-up care without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared between the study period (January to June 2017) and the control period (January to June 2016). Results. The median ED LOS of patients admitted to the IM department decreased from 673 (IQR: 347–1,369) minutes in the control period to 237 (IQR: 166–364) minutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality between the two periods. Conclusions. The admission decisions regarding medical patients made by emergency physicians without specialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS.

scholarly journals Impact of point-of-care testing on patients' length of stay in a large emergency department

1996 ◽  
Vol 42 (5) ◽  
pp. 711-717 ◽  
Author(s):  
C A Parvin ◽  
S F Lo ◽  
S M Deuser ◽  
L G Weaver ◽  
L M Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Point Of Care ◽  
Control Period ◽  
Experimental Period ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Acceptable Accuracy ◽  
Patient Interview ◽  
Combined Control

Abstract We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.

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