Are hospital admissions reduced by Acute Medicine consultant telephone triage of medical referrals?

2015 ◽  
Vol 14 (1) ◽  
pp. 10-13
Author(s):  
Christopher Westall ◽  
◽  
Robert Spackman ◽  
Channa Vasanth Nadarajah ◽  
Nicola Trepte ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cost Effective ◽  
Acute Hospital ◽  
Full Time ◽  
Telephone Triage ◽  
Full Time Equivalent ◽  
Acute Medicine ◽  
General Management ◽  
Nurse Coordinator ◽  
The Impact

The NHS in England is facing well-documented pressures related to increasing acute hospital admissions at a time when the acute medical bed-base is shrinking, doctors working patterns are increasingly fragmented and many acute hospital trusts are operating a financial deficit. Novel strategies are required to reduce pressure on the acute medical take. We conducted a prospective cohort study to assess the impact of acute medicine consultant triage of referrals to the acute medical take on the number of acute hospital admissions as compared to a historical control cohort. The introduction of an acute medicine consultant telephone triage service was associated with a 21% reduction in acute medical admissions during whole the study period. True admission avoidance was achieved for 28.5% of referrals triaged by an acute medicine consultant. The greatest benefit was seen for consultant-triage of GP referrals; 43% of all GP referrals resulted in a decision not to admit and in 25% the referral was avoided by giving advice alone. Consultant telephone triage of referrals to the acute medical take substantially reduces the number of acute medical admissions as compared to triage by a trained band 6 or higher nurse coordinator. Our service is cost effective and can be job-planned using 6 full-time equivalent acute medicine consultants. The telephone triage service also provides additional benefits to admission numbers beyond its hours of operation and the general management of the acute medical take.

scholarly journals Diuretic lounge and the impact on hospital admissions for treatment of decompensated heart failure

QJM ◽  
2020 ◽  
Vol 113 (9) ◽  
pp. 651-656 ◽  
Author(s):  
A Ioannou ◽  
T Browne ◽  
S Jordan ◽  
S Metaxa ◽  
A K J Mandal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Decompensated Heart Failure ◽  
Acute Hospital ◽  
Readmission Rates ◽  
Emergency Admissions ◽  
Heart Failure Patients ◽  
The Cost ◽  
The Impact

Abstract Background Heart failure is a prevalent condition associated with frequent and costly hospital admissions. Hospitalizations are primarily related to worsening fluid retention and often require admission for decongestion with intravenous diuretics. Objective To assess the safety of an outpatient intravenous diuresis service for heart failure patients, and its impact on emergency admissions and the cost of treatment. Methods We conducted a prospective observational cohort registry study on patients referred to the diuretic lounge at our acute hospital between May 2017 and April 2018. Results We analysed 245 patients treated in the diuretic lounge, of which 190 (77.6%) avoided hospitalization or any adverse events during the 60 days of follow up (77.6% vs. 22.4%; P < 0.001). The diuretic lounge service resulted in a significant decrease in emergency heart failure admissions compared to the previous 12 months (823 vs. 715 per annum; 68.6 ± 10.1 vs. 59.6 ± 14 per month; P = 0.04), and a numerical reduction in readmission rates (17.3% vs. 16.2%). The 13.1% decrease in admissions lead to financial savings of £315 497 per annum and £2921 per admission avoided. During the same time period, at the other acute hospital site in our trust, where no diuretic lounge service is available, the number of admissions did not significantly change (457 vs. 450 per annum; 37.5 ± 7.0 vs. 38.1 ± 7.6 per month; P = 0.81). Conclusion Ambulatory administration of intravenous diuretics reduces emergency admissions and is a safe and cost-effective alternative to treat acute decomposition in heart failure patients.

An evaluation of opioid use during acute hospital admissions

2022 ◽  
Vol 4 (1) ◽  
pp. 24-31
Author(s):  
Alison Blackburn
Keyword(s):  
Acute Pain ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Opioid Use ◽  
Opioid Medication ◽  
Age Range ◽  
The Impact ◽  
Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

Measuring impact of telephone triage in Acute Medicine

2017 ◽  
Vol 16 (3) ◽  
pp. 104-106
Author(s):  
Huma Asmat ◽  
◽  
Shah Khalid Shinwari ◽  
Timothy Cooksley ◽  
Roger Duckitt ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Emergency Departments ◽  
Local Context ◽  
Telephone Triage ◽  
Time Data ◽  
Acute Medicine ◽  
The Impact ◽  
First Time

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.

Adjusting College Costs for Noncredit Enrollments: An Issue for Data Geeks or Policy Makers?

2019 ◽  
Vol 47 (2) ◽  
pp. 159-177
Author(s):  
Richard M. Romano ◽  
Rita J. Kirshstein ◽  
Mark D’Amico ◽  
Willard Hom ◽  
Michelle Van Noy
Keyword(s):  
New York ◽  
Community Colleges ◽  
Postsecondary Education ◽  
Full Time ◽  
Full Time Equivalent ◽  
Policy Makers ◽  
College Costs ◽  
Education Data ◽  
Project Data ◽  
The Impact

Objective: In the first study of its kind, the impact of excluding noncredit enrollments in calculations of spending in community colleges is explored. Noncredit enrollments are not reported to Integrated Postsecondary Education Data System (IPEDS), but expenditures for these efforts are. This study corrects for this omission and provides new estimates of spending on community college students in four states. Method: Data on noncredit enrollments were made available from four states—New York, New Jersey, California, and North Carolina. Interviews with campus and state officials within each state helped us verify the findings. In addition, Delta Cost Project data were analyzed and adjusted to account for noncredit enrollments. Results: Our analysis indicates that the expenditure per full-time equivalent (FTE) student measure, which researchers typically use, seriously overstates the resources that community colleges have to spend on educating students; however, great variations exist within and across states. Conclusion: Community colleges are underfunded to an even greater extent than standard IPEDS analyses indicate.

scholarly journals Predicting the Impact of COVID-19 on Australian Universities

2020 ◽  
Vol 13 (9) ◽  
pp. 188 ◽  
Author(s):  
Arran Thatcher ◽  
Mona Zhang ◽  
Hayden Todoroski ◽  
Anthony Chau ◽  
Joanna Wang ◽  
...  
Keyword(s):  
International Student ◽  
Department Of Education ◽  
Full Time ◽  
The Novel ◽  
Full Time Equivalent ◽  
Policy Makers ◽  
Education Industry ◽  
Novel Coronavirus ◽  
The Impact ◽  
Australian Universities

This article explores the impact of the novel coronavirus (COVID-19) upon Australia’s education industry with a particular focus on universities. With the high dependence that the revenue structures of Australian universities have on international student tuition fees, they are particularly prone to the economic challenges presented by COVID-19. As such, this study considers the impact to total Australian university revenue and employment caused by the significant decline in the number of international students continuing their studies in Australia during the current pandemic. We use a linear regression model calculated from data published by the Australian Government’s Department of Education, Skills, and Employment (DESE) to predict the impact of COVID-19 on total Australian university revenue, the number of international student enrolments in Australian universities, and the number of full-time equivalent (FTE) positions at Australian universities. Our results have implications for both policy makers and university decision makers, who should consider the need for revenue diversification in order to reduce the risk exposure of Australian universities.

The Government-Industrial Complex

2018 ◽  
Author(s):  
Paul C. Light
Keyword(s):  
Ronald Reagan ◽  
Industrial Complex ◽  
Full Time ◽  
Size Of Government ◽  
Full Time Equivalent ◽  
The Government ◽  
Sorting System ◽  
The Right ◽  
The Military ◽  
The Impact

The Government-Industrial Complex explores the recent history and impact of the federal government’s blended workforce of federal, contract, and grant employees. Drawing upon Dwight D. Eisenhower’s description of the military-industrial complex, government-reform expert Paul Light argues that the federal government now depends on seven-nine million full-time-equivalent government-industry employees. Light’s analysis examines changes in the size of the government-industrial complex, explains the federal government’s dependence on contract and grant employees, and explores potential reforms to protect the nation against what Eisenhower called the potential for the disastrous rise of misplaced power. Light chronicles the role of hiring caps, cuts, and freezes in promoting the use of contract and grant employees and shows the impact of war and peace on the changing size of government. Light offers short histories of the role that Ronald Reagan, George H. W. Bush, Bill Clinton, George W. Bush, and Barack Obama played in the changing number and distribution of the federal government’s federal, contract, and grant employees. Light also discusses the Trump administration’s early strategies on downsizing and deconstructing government while describing the demographic, bureaucratic, and political problems that explain the federal government’s dependence on contract and grant employees. He then describes a sorting system for assuring that the right employees are in the right jobs to assure the greatest value and accountability, and he concludes with a description of the “next gen” public service needed to achieve the more perfect union and blessings of liberty promised in the Constitution’s preamble.

Impact of a central review oncology clinical pharmacist in a community oncology practice.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 68-68
Author(s):  
Julianna Kula ◽  
Shannon Hough ◽  
Josh Howell
Keyword(s):  
Clinical Pharmacist ◽  
Cost Effective ◽  
Cost Of Care ◽  
Financial Impact ◽  
Full Time ◽  
Community Oncology ◽  
Medication Dose ◽  
Oncology Practice ◽  
Clinical Changes ◽  
The Impact

68 Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]

scholarly journals Evaluating the Economic Impact of Farmers' Markets Using an Opportunity Cost Framework

2008 ◽  
Vol 40 (01) ◽  
pp. 253-265 ◽  
Author(s):  
David W. Hughes ◽  
Cheryl Brown ◽  
Stacy Miller ◽  
Tom McConnell
Keyword(s):  
Farmers Markets ◽  
Grocery Stores ◽  
Full Time ◽  
Full Time Equivalent ◽  
The West ◽  
Local Economies ◽  
Direct Sales ◽  
Gross State Product ◽  
Survey Results ◽  
The Impact

Farmers' markets presumably benefit local economies through enhanced retention of local dollars. Unlike other studies, the net impact of farmers' markets on the West Virginia economy is examined. Producer survey results are used in estimating annual direct sales ($1,725 million). Using an IMPLAN-based input-output model, gross impacts are 119 jobs (69 full-time equivalent jobs) and $2,389 million in output including $1.48 million in gross state product (GSP). When the effect of direct revenue losses are included (primarily for grocery stores), the impact is reduced to 82 jobs (43 full-time equivalent jobs), $1,075 million in output, and $0,653 million in GSP.

scholarly journals A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. Hurley ◽  
S. McHugh ◽  
J. Browne ◽  
L. Vaughan ◽  
C. Normand
Keyword(s):  
Mixed Methods ◽  
Hospital Stay ◽  
Patient Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Comparative Case Study ◽  
Medical Patients ◽  
Acute Medicine ◽  
The Impact

Abstract Background To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. Methods We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme’s outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme’s implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme’s outcomes can be explained by the level of implementation. Discussion This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

Education and devices to prevent blood and body fluid exposures

2019 ◽  
Vol 70 (1) ◽  
pp. 38-44 ◽  
Author(s):  
S Cheetham ◽  
H Ngo ◽  
J Liira ◽  
E Lee ◽  
C Pethrick ◽  
...  
Keyword(s):  
Body Fluid ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Incidence Rates ◽  
Full Time ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
The Impact

Abstract Background Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. Aims To assess the impact of an education and SEDs workplace programme on rates of reported exposures. Methods A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. Results A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7–17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6–4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18–20) incidents per 1000 FTE pre-intervention to 11 (CI 10–12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. Conclusions The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

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