Bed Occupancy Rate Research Articles

Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

BackgroundUnplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate.MethodsThis was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals’ information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM).ResultsThe average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was first explored in this study. Thursday had the lowest re-attendance rate, while Sunday has the highest re-attendance rate. The patients who visited at ED on the dates with higher BOR were more likely to re-attend the ED within 3 days for hospitals A and B. There was no significant association between BOR and ED re-attendance rate in hospital C.ConclusionsA study using time series data has been conducted to explore the factors associated with the unplanned 3-day ED re-attendance rate. Strong day-of-week effect was first reported. The association between BOR and the ED re-attendance rate varied with hospital.

Evolución de la cirugía mayor ambulatoria en Cataluña, 2001-2011

ObjectiveTo analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. MethodsA descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. DiscussionThe percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units

Measuring Hospital Efficiency Through Pabon Lasso Analysis: An Empirical Study in Kemang Medical Care (KMC)

Introduction: Hospital is most costly in health care system. Provisions of optimal service require that hospital administrators identify hospital efficient performance based on relevant indicator. This study used the Pabon Lasso Analysis to access the efficiency of KMC and to identify strategies toward an improving efficiency KMC.Methods: This cross-sectional descriptive study involved all the four years performance of KMC Hospital. Data on Average Length Of Stay (ALOS), Bed Occupancy Rate (BOR) and Bed Turn Over (BTO). Data collected from 2011-2014 based on medical record.Result: The overall average length of stay and bed turn over represents a satisfactory level of efficiency. ALOS 2-3 days and BTO 42-47 times. KMC hospital located in Zone II because BOR only 28-31%. This study represents good satisfactory level of efficiency KMC demonstrated, short stay, high turnover but low occupancy.Discussion: This study showed the KMC hospital has generally high performance as indicated by Pabon Lasso Analysis. The administrator should find a strategy for measuring bed occupation rate for increasing hospital efficiency.

A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care.

BackgroundOrganizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.MethodsIn a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs.ResultsWe analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62–1.27) or compared to control group (OR 0.67; 95 % CI 0.39–1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41–1.26 compared to baseline and OR 0.65; 95 % CI 0.35–1.19 compared to control group).ConclusionsA multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up.Trial registrationISRCTN: ISRCTN50542146

AN EVALUATION OF HEALTH CENTERS AND HOSPITAL EFFICIENCY IN KAMPALA CAPITAL CITY AUTHORITY UGANDA; USING PABON LASSO TECHNIQUE

The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.

Consommation d’antibiotiques au Centre Hospitalier Universitaire d’Antananarivo : prévalence et défis stratégiques

Introduction : À Madagascar, très peu d’études ont été réalisées concernant la consommation d’antibiotiques. Notre objectif était de décrire la consommation d’antibiotiques dans l’un des centres hospitaliers universitaires de troisième référence d’Antananarivo-Madagascar en vue de mieux cibler les stratégies de bon usage des antibiotiques. Matériels et méthodes : Il s’agissait d’une enquête de prévalence un jour donné réalisée le 5 avril 2011 au Centre Hospitalier de Befelatanana qui comptait 339 lits d’hospitalisation avec un taux d’occupation de lits de 65,5 %. Résultats : Sur les 222 patients présents le jour de l’enquête, la prévalence de l’antibiothérapie a été de 57,2 %. Près de la moitié (49,6 %) des patients a reçu au moins l’association de deux antibiotiques. Les familles d’antibiotiques prescrites ont été les bétalactamines (55,3 %), les imidazolés (14,9 %), les aminosides (14,9 %), les quinolones (7,9 %) et les macrolides avec 7 % des prescriptions. Les pénicillines avec 55,5 % de l’ensemble des prescriptions de bétalactamines, suivies par les céphalosporines de troisième génération ont été les plus prescrites. Les enfants de moins de 14 ans (p < 0,019) et les patients avec du dispositif invasif (p < 10 -6 ) ont reçu plus d’antibiotiques. La prescription d’antibiotiques dans le service de Réanimation-Urgence a été significativement plus élevée par rapport à celle des autres services (p < 0,01). Conclusion : La consommation d’antibiotiques est élevée au Centre Hospitalier Universitaire de Befelatanana. Les bétalactamines sont les plus prescrits et le service de Réanimation-Urgence occupe la première place en matière de consommation d’antibiotiques. La mise en place d’une politique de bon usage des antibiotiques serait indispensable.

Five-Year Trend Analysis of Capacity Utilization Measures in a Teaching Hospital 2008-2012

Background: Evaluation of hospitals performance determines what hospitals really do, and define deficiencies with regard to the original standards and identify opportunities for improvement. Objectives: We investigated trends in the performance of a hospital with capacity utilization measures used in Pabon Lasso (PL) model. Materials and Methods: In this cross-sectional descriptive study from March 2008 to March 2012, we retrieved all performance data from the Hospital Information System of Shahid Faghihi Hospital, a public teaching hospital in Shiraz, Iran. Measurements included changes in the trend of three indices: bed turnover, bed occupancy rate, and average length of stay. Results: The trends in hospital performance showed a decrease in mean (median) hospital stay from 6.77 (± 3.11) days in 2008 to 4.25 (± 2.70) days in 2012. In 2008, bed turnover was 50.03 times/year, bed occupancy rate was 92.9% and turnover interval was 0.51 days. In 2012, these indices were 60.8 times/year, 70.9%, and 1.74 days, respectively. These measures in PL model showed that Shahid Faghihi Hospital was located in zone 4 during 2008-2009, zone 1 during 2010-2011, and zone 3 during 2012, indicating an acceptable degree of efficiency and an optimal level of performance. Conclusions: This hospital showed relative improvements in all capacity utilization measures in 2012. Future efforts should examine new interventions to further increase the hospital’s performance capacity.

English

INTRODUCTION: The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up at different levels Health Care Delivery System to provide quality newborn-care services in several hospitals to meet this challenge. Many units are located in the districts where the burden of neonatal deaths is high, and access to special newborn care is poor. MATERIALS AND METHODS: The study was conducted to assess the functioning of SCNUs in six centers of India. The evaluation was based on an analysis of secondary data from the six units that had been functioning for at least three year. A cross-sectional survey was conducted to assess the availability of infrastructure, equipment’s and human resources and assessment of the beneficiaries. Descriptive statistics were used for analyzing the inputs (Resources) and outcomes (Assessment of the beneficiaries). Correlation coefficients were estimated to understand the possible association of satisfaction rate of beneficiaries with factors, such as bed: doctor ratio, bed: nurse ratio, average duration of stay, and bed occupancy rate. RESULTS: The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. Likart’s Analysis is used to analyze Beneficiaries Assessment. Beneficiaries were not found at Level I NBSUs at the time of evaluation. The units had a varying nurse: bed ratio (1:1-1:2.14). The bed occupancy rate ranged from 83% to 121% (median 115%), and the average duration of stay ranged from three days to 8 days (median 5 days). Repair and maintenance of equipment were a major concern. CONCLUSION: It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to infrastructure, human resources and maintenance of equipment remain.

Sepsis in fatal pelvic trauma patients: report from a level-1 Indian Trauma Centre

data, duration of survival, type of pelvic injury and any associated injuries, if any, were noted and analysed. The profile of infections developing in these patients was recorded and analysed as per the predisposing factors, infection, response, organ dysfunction (PIRO) grading system [6, 7]. Causes of death were acquired from the autopsy reports from the Department of Forensic Pathology at the hospital and were cross checked with the clinical data. The National Capital Region (NCR) of Delhi has an estimated population of 17.8 million currently with 21.7 million residing in its NCR areas. The JPNA Trauma Centre, AIIMS, New Delhi is a level-1 trauma centre which also serves as a national referral centre for trauma care. With bed strength of 186, the average total admissions per year during the study were 4,094 during the study period; the hospital bed occupancy rate was 83 % with an average bed turnover rate per day of 24. A total of 50,137 emergency visits and 4,850 surgical procedures were performed during the study period per year. Among these, 964 were admitted for pelvic injuries out of a total of 4,820 orthopaedic patients admitted for trauma care during the study period. During the study, a total of 213 consecutive fatal cases with pelvic injuries alone or with other associated injuries were included. The mean of the ages in this group was 36 years (range 3–95 years, SD 17.6). Although age did not meet the requirements for a significant predictor of mortality (P = 0.099), patients more than 45 years had >50 % mortality. Of the total 213 cases, male (196, 92 %) patients exceed females (17, 8 %). Road traffic accident was the most common cause of injury (182, 85 %), followed by fall from height (21, 10 %), train accidents (5, 2 %), firearm injuries (2, 1 %), fall in well (1, 0.5 %), assault (1, 0.5 %) and fall of wall (1, 0.5 %). Abdominal injuries (30 %, 94) were the most common associated injury, followed by limbs (65, 21 %), chest (53, 17 %), head injuries Sir,

Performance evaluation of hospitals that provide care in the public health system, Brazil.

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimento s de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Model of Allocating Public Financial Resources to Brazilian Hospital Organizations that Provide Highly Complex Health Care Services

The general objective of this paper was to propose a model of allocating public financial resources to Brazilian hospital organizations that provide highly complex health care services on behalf of the Brazilian Unified Health System (SUS). The main theoretical background was built on Carr-Hill et al. [1] Focusing on the highly complex health care services provided by the hospitals, the study underscored factors such as supply (or productivity and accessibility/availability of services/beds), demand (or need for health care), use (or utilization/consumption of services/beds), and complexity segmentation of the service in Brazil. The sample comprised 251 organizations offering at least type-II adult and type-II newborn Intensive Care Units in 23 Brazilian states and classified as general and/or specialized hospitals. The Carr-Hill et al. [1] model was adapted to propose a simplified theoretical model of supply that could represent the relationship between the variables included in the final equation of the model, namely: mean inpatient cost, availability of basic health care services, bed occupancy rate, organization type, and organization nature. The results pointed out that the significant determinants empirically confirm the arguments that are rejected by sanitarians in the theoretical field – that the model of resource allocation is based on productivity.

Psychiatric admissions fall following the Christchurch earthquakes: an audit of inpatient data.

Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services. We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake. After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period. The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake.

Hospital bed occupancy for rotavirus and all cause acute gastroenteritis in two Finnish hospitals before and after the implementation of the national rotavirus vaccination program with RotaTeq®.

BackgroundVaccination-impact studies of the live-attenuated pentavalent oral vaccine Rotateq® have demonstrated that the burden of rotavirus gastroenteritis has been reduced significantly after the introduction of RotaTeq® vaccination, but less is known about the benefit of this vaccination on hospital overcrowding.MethodsAs part of an observational surveillance conducted during the RV seasons 2000/2001 to 2011/2012, we analysed hospital discharge data collected retrospectively from two Finnish hospitals (Oulu and Tampere), concerning ICD 10 codes A00-09 (acute gastroenteritis, AGE) and A08.0 (rotaviral acute gastroenteritis RV AGE). We estimated the reduction in the number of beds occupied and analysed the bed occupancy rate, for RV AGE and all cause AGE, among 0–16 year-old children, before and after the implementation of the RV immunisation program.ResultsThe rate of bed days occupied for RV AGE was reduced by 86% (95% CI 66%-94%) in Tampere and 79% (95% CI 47%-92%) in Oulu after RV vaccination implementation. For all cause AGE, reduction was 50% (95% CI 29% to 65%) in Tampere and 70% (95% CI 58% to 79%) in Oulu. Results were similar among 0–2 year-old children. This effect was also observed on overcrowding in both hospitals, with a bed occupancy rate for all cause AGE >25% in only 1% of the time in Tampere and 9% in Oulu after the implementation of the immunisation program, compared to 13% and 48% in the pre-vaccination period respectively. After extrapolation to the whole country, the annual number of prevented hospitalizations for all cause AGE in the post-vaccination period in Finland was estimated at 1,646 and 2,303 admissions for 0–2 and 0–16 year-old children respectively.ConclusionsThis study demonstrated that universal RV vaccination is associated with a clear decrease in the number of bed days and occupancy rates for RV AGE and all cause AGE. Positive consequences include increase in quality of care and a better healthcare management during winter epidemics.

Patient Flow from Emergency Department to Inpatient Wards: Empirical Observations from a Singaporean Hospital

This document presents a comprehensive empirical study on the inpatient flow management in a Singaporean hospital. The empirical study uses high resolution patient flow data from 2008 to 2010. This document details the statistics of waiting times for patients admitted from the emergence department (ED) to inpatient wards, bed occupancy rate of the inpatient wards, and overflow proportions (proportions of patients that are admitted to a non-primary ward). The document also reports various statistics related to patient arrival, inpatient discharge, length of stay (LOS), and pre- and post-allocation delays incurred during the bed-assignment process.

High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages.

ABSTRACT 980

Background and aims: In context of evolving health care, the focus on quality and safety of medical care is increasing because of the high cost of health care and potential for harm. Aims: To study outcome of care provided in Neonatal Surgery Intensive Care Unit (NSICU) at All India Institute of Medical Sciences, New Delhi, India. Methods: Descriptive and observational study was done and records of all patients admitted from January to June 2011 were analyzed. Demographic, morbidity and mortality parameters were studied. Results: In NSICU from January to June 2011, 85 patients were admitted and 78.3% of them were referred with 69.9% admitted from emergency department. 69.9% of admitted patients were male. Mean age of the patients was 6.31 days. 87.95% patients underwent surgical intervention within a day of admission in NSICU. 34.25% developed post-operative complications with most common being wound infection/discharge/dehiscence. 56.6% required mechanical ventilation with 3.57 days of mean mechanical ventilation. 15.7% patients were reintubated within 48 hours of their extubation. Only two patients were readmitted within 72 hours of their discharge/ transfer out. Mean hospital and NSICU length of stay in admitted patients was 16.41 and 13.78 days respectively. Bed occupancy rate of NSICU was calculated to be 72.5%. Conclusions: Most common presentation at NSICU was oesophageal atresia with tracheo-oesophageal fistula. 15.7% patients died and all deaths were observed in age group of 1 to <7 days. Most of death was observed among males (61.5%). Sepsis with septic shock was the major reason for mortality in NSICU

The dynamics of psychiatric bed use in general hospitals.

This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N=7,831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100% occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events.

Global analysis of critical care burden

Care of critically ill patients is a specialised task that demands high human and financial resources. In the USA, each day of critical care costs about US$3500 and accounts for 13% of hospital costs, amounting to 1% of GDP. 1 Halpern NA Pastores SM Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010; 38: 65-71 Crossref PubMed Scopus (610) Google Scholar Neill Adhikari and Gordon Rubenfeld 2 Adhikari NK Rubenfeld GD Worldwide demand for critical care. Curr Opin Crit Care. 2011; 17: 620-625 Crossref PubMed Scopus (46) Google Scholar estimated that worldwide in 2004 there were 13–20 million mechanically ventilated patients, 1·2–5·5 million patients with acute respiratory distress syndrome, and 15–19 million patients with sepsis. However, despite the rapid expansion of critical care medicine and rising costs associated with treatment of the critically ill worldwide, there is a dearth of information on the epidemiology of critical care, particularly in low-income and middle-income countries. 3 Adhikari NK Fowler RA Bhagwanjee S Rubenfeld GD Critical care and the global burden of critical illness in adults. Lancet. 2010; 376: 1339-1346 Summary Full Text Full Text PDF PubMed Scopus (718) Google Scholar Data on the organisational structure and staffing of intensive care units (ICUs) across different worldwide settings remain scarce, which makes it difficult to estimate current global critical care capacity. 3 Adhikari NK Fowler RA Bhagwanjee S Rubenfeld GD Critical care and the global burden of critical illness in adults. Lancet. 2010; 376: 1339-1346 Summary Full Text Full Text PDF PubMed Scopus (718) Google Scholar This is even more relevant in low-income and middle-income countries where the availability of critical care services is limited and resources have to be used judiciously. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) auditThis large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death. Full-Text PDF

A prospective evaluation of interventions to reduce the MDRO rate in ICU

Background: Carbapenem resistance among the Gram negative rods is on the increase. Poor infection control practices are a major cause of these bugs becoming “endemic” in various ICUs. Hypothesis: Providing the nurses with target based incentives is an effective method for implementation of infection control principles. Methods & Materials: All admissions to the MDICU during the 18 months (January 1st 2012 to June 30th 2013) were included. Only Carbapenem Resistant Isolates among Gram Negative Bacilli were included in the surveillance. MDRO rates were calculated every month as Number of Carbapenem Resistant Isolates among Gram Negative bugs per 100 ICU admissions. Average Length of Stay in the ICU was calculated. Hand Hygiene compliance rates were calculated using the WHO Five Moments format every month. Interventions were introduced in sequential manner (every 6 months). The first intervention bundle comprised of cohorting of patients, enhanced training, evaluation of cleaning with ATP based monitoring and feedback, and a Restrictive policy on Carbapenem use. (only for hemodynamically unstable/immuno-compromised patients or based on culture results). After 6 months the incentives for target achievement were introduced.The nurses were provided with a target–to reduce Carbapenem Resistant isolates by 25% of the baseline (preceding 6 months average) within 3 months–and an incentive on achieving this target–cash awards & Letter of Appreciation from the Hospital Management followed by 15% increase over the regular yearly increment in pay if the rates stayed low (sustained effect) over next one year. Results: The MDRO rate came down from 15.5% in January 2012 (baseline) to 6% in June 2013 (end of 18 months)The hand hygiene compliance rates increased from 49% to 77% during the study period.The Average Length of Stay in the MDICU decreased from 5.7 days to 4.7 days during the study period.There was no significant change in the bed occupancy rate (97% to 95%)There was no significant change in Meropenem consumption during the study period. Conclusion: The preliminary results do suggest that incentives for achieving reasonable targets would be very effective in improving compliance to infection control practices as evidenced by the fall in MDRO rates.

Various indicators for the assessment of hospitals' performance status: differences and similarities.

Background:Hospitals are the most costly operational and really important units of health system because they consume about 50%-89% of total health resources. Therefore efficient use of resources could help in saving and reallocating the financial and physical resources.Objectives:The aim of this study was to obtain an overview of hospitals' performance status by applying different techniques, to compare similarities and differences between these methods and suggest the most comprehensive and practical method of appraisal for managers and policy makers.Patients and Methods:This is a cross sectional study conducted in all hospitals of Ahvaz (eight hospitals affiliated with Jundishapur University of Medical Sciences and eight non-affiliated hospitals) during 2007 to 2011. Two kinds of data were collected through separate special checklists. Excel 2007 and Windeap 2.1 software were applied for data analysis.Results:The present findings show that the average of bed occupancy rate (BOR) in the studied hospitals was about 65.91 ± 1.16. The maximum number of inefficient hospitals in the present study happened in the years 2007, 2008 and 2010 (four hospitals) but there were two hospitals in the third part of the present graph which had maximum level of efficiency and optimal level of productivity in the years 2007 and 2009. Data Envelopment Analysis (DEA) showed that the mean score of technical efficiency for the studied hospitals is 0.924 ± 0.105 with the minimum of 0.585 ± 0.905 for hospital number 1. Furthermore It shows that only five hospitals (31.25%) reach complete technical efficiency (TE) scores across all five years of 2007-11 (TE = 1).Conclusions:Results of the present and similar studies should be considered for the future planning and resource allocation of Iranian public hospitals. At the same time it is very important to consider need assessment results for each region according to its potentials, population under the coverage and other geographical and cultural indices. Furthermore because of potential limitations of each of the above models it is highly recommended to apply different methods of performance evaluation to reach a complete and real status view of the hospitals for future planning.