Duration of Hospital Stay and Influence on the Period between Hospitalizations of Patients

The purpose of the study. The article presents and substantiates the possibilities of reducing the risk of rehospitalization on the basis of a specially developed econometric model of behavior of the hospital doctor in conditions of different workload of patients using the schedule according to Slutsky. Materials and methods. The effects of the model showed that the growth of the competitive environment leads to: a) a decrease in the number of services provided by the hospital doctor; b) switching to perform functions that help improve the quality of the treatment process; c) an increase in the average duration of treatment. Modern tendencies are shown: a) reduction of the number of doctors of inpatient departments; b) increasing the workload of the hospital doctor with patients and bed-days; c) reducing the average length of stay in the hospital. Results and discussion. The economic mechanisms of reducing the risk of re-hospitalizations are substantiated, namely: a) compensation of the turn of the profit curve through compensatory mechanisms of payment for the quality of work of the hospital doctor; b) increasing the price elasticity of consumer demand for stationary services. That is, we chose the length of the period between regular hospitalizations of patients as a criterion for the quality of inpatient treatment. This criterion is essentially equivalent to the risk of re-hospitalization, in which hospitalization in a department of the same profile, which confirms the failure of the previous treatment. Thus, a link is expected between a longer stay of the patient in the hospital and a lower risk of re-hospitalization, provided that a longer stay will provide additional quality of treatment. Therefore, the discovery of such a connection is a confirmation of the hypothesis, which is based on the theoretical econometric model of physician behavior and relates to the reorientation to the additional quality of inpatient care in a competitive environment. That is, due to the increased load, the doctor reduces the length of the patient's stay in the hospital and therefore the quality of care deteriorates. Due to the fact that the discharge of the patient involves achieving a stable condition, doctors are sometimes forced to give an objective assessment of the condition at the time of discharge. The timeliness of evaluating effectiveness is the possibility of temporary relief when in fact the case of treatment is not over. It should be noted that in countries with a private health care system, reimbursement of hospital care costs is related to the number of bed-days spent by the patient in the hospital, where "day" is defined as the period from one midnight to the next, medical staff can manipulate the time of hospital discharge, as patients who are kept until midnight will have an additional day to reimburse. Conclusion. It follows from the research results that a reduction in the length of hospital stay in the existing situation significantly worsens the prognosis, increasing the risks of an uncontrolled course of the disease and, accordingly, subsequent hospitalizations

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An assessment of the effects of casemix funding on hospital utilisation: A Northern Territory perspective

Australian Health Review ◽

10.1071/ah000122 ◽

2000 ◽

Vol 23 (1) ◽

pp. 122 ◽

Cited By ~ 3

Author(s):

Jianguo Xiao ◽

Andy Lee ◽

Siva Ram Vemuri

Keyword(s):

Average Length ◽

Community Health Services ◽

Long Term Effects ◽

Cost Shifting ◽

Average Length Of Stay ◽

Casemix Funding ◽

Bed Days ◽

Hospital Utilisation

This article is concerned with the methodological issues of assessing the effects of casemixfunding on hospital utilisation. Time-series analysis and intervention analysis are proposedto ascertain the effects. It was found there had been a decline in average length of stay andnumber of bed-days, an increase in weighted separations for teaching and non-teachinghospitals, and no apparent increase of costliness in terms of a comprehensive casemix index.No evidence of decline in quality of care can be established in terms of readmission rates.The long-term effects of casemix funding, and specific issues in terms of the funding modelused, patients and cost shifting between hospital services and community health services,remain to be studied.

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An innovative and cost-effective way of managing ankle fractures prior to surgery – home therapy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12699663904358 ◽

2010 ◽

Vol 92 (7) ◽

pp. 615-618 ◽

Cited By ~ 20

Author(s):

John M Lloyd ◽

Rachel Martin ◽

Senthil Rajagopolan ◽

Nedal Zieneh ◽

Richard Hartley

Keyword(s):

Emergency Department ◽

Hospital Stay ◽

Average Length ◽

Length Of Hospital Stay ◽

Cost Effective ◽

Ankle Fractures ◽

Home Therapy ◽

Surgical Fixation ◽

Bed Days ◽

Therapy Programme

INTRODUCTION Ankle fractures are common injuries affecting all age groups and constitute a large proportion of the orthopaedic trauma case load. Patients are usually admitted directly to the ward from the emergency department and a large number of bed-days are spent waiting for the ankle swelling to subside prior to surgery. We audited current practice and then implemented a home therapy programme (HTP). The purpose of the study was to assess the pioneering HTP with respect to cost effectiveness, length of stay and patient satisfaction. PATIENTS AND METHODS If HTP criteria were met, patients with reduced, unstable ankle fractures were taught safe mobilisation by physiotherapists in the emergency department. They were then discharged home to ice and elevate their ankle in a plaster backslab. A provisional operation date was allocated on discharge. They were admitted to hospital the day of surgery and then discharged home when safe and comfortable. RESULTS Forty-three consecutive patients met our inclusion criteria and underwent surgical fixation of unstable ankle fractures over a 3-month period (February–April 2008). The average length of hospital stay was 8 days (range, 1–18 days), 4.5 days pre-operatively and 3.5 days postoperatively. Patients were frustrated and dissatisfied with the whole process. In total, 177 patients underwent surgical fixation of unstable ankle fractures over an 11-month period (November 2008 to October 2009) and, of these, 59 met the home therapy criteria. The average length of hospital stay was 2.4 days, 1 day pre-operatively (range, 0–4 days) and 1.4 days postoperatively (range, 0–5 days). All HTP patients expressed satisfaction with the process. Over the course of the HTP, 354 bed-days were saved which equates to a saving of £81,774. The annual estimated cost saving is £90,000. CONCLUSIONS The home therapy programme has proved effective in reducing hospital stay both pre- and postoperatively. It is cost-effective and well received by patients.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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The objective assessment of the quality of hospital care: dream or reality?

Orvosi Hetilap ◽

10.1556/oh.2007.28107 ◽

2007 ◽

Vol 148 (43) ◽

pp. 2033-2041

Author(s):

Éva Belicza ◽

Erika Takács

Keyword(s):

Hospital Care ◽

Objective Assessment

A nemzetközi szakirodalom egyre gyakrabban foglalkozik azzal a kérdéssel, hogy a minőségi indikátorokra támaszkodó nyilvános minőségértékelésnek mi a hatása az ellátás minőségére és az érintettek döntésére vonatkozóan, illetve melyek azok a kritériumok, amelyek mentén nyilvános minőségértékelési rendszereket célszerű kialakítani. A nemzetközi szakirodalom alapján a dolgozat hat témakört mutat be: (1) az indikátorok képessége a szolgáltatók megkülönböztetésére; (2) az eredményindikátorok alkalmassága a szolgáltatók megítélésére; (3) a bajnoki tabellák képessége a szolgáltatók rangsorolására; (4) a lakosság viselkedése a szolgáltatók választása során; (5) az indikátorokra támaszkodó nyilvános minősítések hatásai; (6) ajánlások minősítési rendszerek kidolgozására. A szakirodalmi kutatások szerint elsősorban a kockázatkiegyenlítési problémák miatt az indikátorok képessége a szolgáltatók megkülönböztetésére a nyújtott ellátás minősége szempontjából kérdéses; az elért ellátási eredmények nem feltétlenül utalnak vissza az ellátási folyamatok minőségére; a több indikátorból komponált intézményi sorrendek (bajnoki tabellák) nem megbízhatóak; a lakosság a szolgáltatók kiválasztásakor elsősorban a környezet véleményét és a távolságot veszi figyelembe; és a nyilvános közlések hatására igazoltan romlik az ellátás átfogó minősége. A szolgáltatók értékelésében alkalmazott mérési eredmények közzétételét eszköznek kell tekinteni. A lakosság intézményválasztásának elősegítésére az ő preferenciáik mentén végzett betegelégedettségi vizsgálatok nyilvánossá tétele hozhatja meg a kívánt eredményt. A minőségfejlesztési célokat igazoltan segítik a szolgáltatói körben végzett közvetlen visszajelzések az indikátorok mért értékeiről, illetve pontosabb kép kapható az ellátási és szervezési folyamatok, standardok egységes felülvizsgálatára alapozott eljárások külső értékelési rendszerekbe történő beemelésével.

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Comparison of the effects of intravenous propofol and inhalational desflurane on the quality of early recovery after hand-assisted laparoscopic donor nephrectomy: a prospective, randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-039881 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039881

Author(s):

Jaesik Park ◽

Minhee Kim ◽

Yong Hyun Park ◽

Jung-Woo Shim ◽

Hyung Mook Lee ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Hospital Stay ◽

Controlled Trial ◽

Early Recovery ◽

Total Hospital ◽

Kidney Donors ◽

Living Kidney Donors ◽

Total Hospital Stay ◽

Randomised Controlled

ObjectivesWe compared early recovery outcomes between living kidney donors who received total intravenous (IV) propofol versus inhalational desflurane during hand-assisted laparoscopic nephrectomy.DesignA single-centre, prospective randomised controlled trial.SettingUniversity hospital.ParticipantsStudy participants were enrolled between October 2019 and February 2020. A total of 80 living donors were randomly assigned to an intravenous propofol group (n=40) or a desflurane group (n=40).InterventionPropofol group received intravenous propofol and desflurane group received desflurane, as a maintenance anaesthetic.Primary and secondary outcome measuresThe quality of postoperative functional recovery was primarily assessed using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire on postoperative day 1. Secondarily, ambulation, pain score, rescue analgesics, complications and total hospital stay were assessed postoperatively.ResultsOur study population included 35 males and 45 females. The mean age was 46±13 years. The global QoR-40K score (161 (154–173) vs 152 (136–161) points, respectively, p=0.001) and all five subdimension scores (physical comfort, 49 (45–53) vs 45 (42–48) points, respectively, p=0.003; emotional state, 39 (37–41) vs 37 (33–41) points, respectively, p=0.005; psychological support, 30 (26–34) vs 28 (26–32) points, respectively, p=0.04; physical independence, 16 (11–18) vs 12 (8-14) points, respectively, p=0.004; and pain, 31 (28–33) vs 29 (25-31) points, respectively, p=0.021) were significantly higher in the intravenous propofol group than the desflurane group. The early ambulation success rate and numbers of early and total steps were higher, but the incidence of nausea/vomiting was lower, in the intravenous propofol group than the desflurane group. The total hospital stay after surgery was shorter in the intravenous propofol group than the desflurane group.ConclusionsIntravenous propofol may enhance the quality of postoperative recovery in comparison to desflurane in living kidney donors.Trial registration numberKCT0004365.

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Effectiveness of comprehensive geriatric assessment intervention on quality of life, caregiver burden and length of hospital stay: a systematic review and meta-analysis of randomised controlled trials

BMC Geriatrics ◽

10.1186/s12877-021-02319-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhongyi Chen ◽

Zhaosheng Ding ◽

Caixia Chen ◽

Yangfan Sun ◽

Yuyu Jiang ◽

...

Keyword(s):

Quality Of Life ◽

Hospital Stay ◽

Usual Care ◽

Caregiver Burden ◽

Length Of Hospital Stay ◽

Sf 36 ◽

Subgroup Analyses ◽

Randomised Controlled ◽

Meta Analyses

Abstract Background Comprehensive geriatric assessment (CGA) interventions can improve functional ability and reduce mortality in older adults, but the effectiveness of CGA intervention on the quality of life, caregiver burden, and length of hospital stay remains unclear. The study aimed to determine the effectiveness of CGA intervention on the quality of life, length of hospital stay, and caregiver burden in older adults by conducting meta-analyses of randomised controlled trials (RCTs). Methods A literature search in PubMed, Embase, and Cochrane Library was conducted for papers published before February 29, 2020, based on inclusion criteria. Standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) was calculated using the random-effects model. Subgroup analyses, sensitivity analyses, and publication bias analyses were also conducted. Results A total of 28 RCTs were included. Overall, the intervention components common in different CGA intervention models were interdisciplinary assessments and team meetings. Meta-analyses showed that CGA interventions improved the quality of life of older people (SMD = 0.12; 95% CI = 0.03 to 0.21; P = 0.009) compared to usual care, and subgroup analyses showed that CGA interventions improved the quality of life only in participants’ age > 80 years and at follow-up ≤3 months. The change value of quality of life in the CGA intervention group was better than that in the usual care group on six dimensions of the 36-Item Short-Form Health Survey questionnaire (SF-36). Also, compared to usual care, the CGA intervention reduced the caregiver burden (SMD = − 0.56; 95% CI = − 0.97 to − 0.15, P = 0.007), but had no significant effect on the length of hospital stay. Conclusions CGA intervention was effective in improving the quality of life and reducing caregiver burden, but did not affect the length of hospital stay. It is recommended that future studies apply the SF-36 to evaluate the impact of CGA interventions on the quality of life and provide supportive strategies for caregivers as an essential part of the CGA intervention, to find additional benefits of CGA interventions.

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Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty

The American Surgeon ◽

10.1177/0003134821989051 ◽

2021 ◽

pp. 000313482198905

Author(s):

John A. Perrone ◽

Stephanie Yee ◽

Manrique Guerrero ◽

Antai Wang ◽

Brian Hanley ◽

...

Keyword(s):

Quality Of Life ◽

Statistical Analysis ◽

Hospital Stay ◽

Hiatal Hernia ◽

Collis Gastroplasty ◽

Significant Difference ◽

Related Quality

Introduction After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. Methods This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. Results Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups ( P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions ( P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) ( P = .01). The LOH stay was not significantly different ( P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. Conclusion Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

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Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand

SAGE Open Medicine ◽

10.1177/2050312121989631 ◽

2021 ◽

Vol 9 ◽

pp. 205031212198963

Author(s):

Artit Sangkakam ◽

Pasin Hemachudha ◽

Abhinbhen W Saraya ◽

Benjamard Thaweethee-Sukjai ◽

Thaniwan Cheun-Arom ◽

...

Keyword(s):

Influenza Virus ◽

Gastrointestinal Tract ◽

Hospital Stay ◽

Rectal Swab ◽

Average Length ◽

Gastrointestinal Symptoms ◽

Virus Detection ◽

Length Of Hospital Stay ◽

Nasopharyngeal Swab ◽

Influenza Virus Detection

Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of three of them. Gastrointestinal symptoms were observed for 28.2% patients with a negative rectal swab negative and 25.0% patients with a positive rectal swab. Average length of hospital stay was 4.2 days for rectal swab positive group and 3.7 days for rectal swab negative group. This difference was not statistically significant (p = 0.288). Conclusions: There is no correlation between influenza virus detection in rectal swab and gastrointestinal disturbances or disease severity, and there is currently insufficient evidence to support replicative ability in the gastrointestinal tract.

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