Belgian General Hospitals Research Articles

Profile of hospitalised elderly patients in Belgium—Analysis of factors affecting hospital costs

Abstract Introduction The objectives of this research are (i) to describe the medicoadministrative profiles of inpatients aged 65 and over and (ii) to determine the main hospitalisation-related diseases in order (iii) to assess and identify predictors influencing hospital costs and lengths of stay thanks to data collected in hospital administrative databases. Methods The study is based on 45,469 hospital stays of inpatients aged 65 and over, with data collected among ten Belgian general hospitals in 2014. We conduct a linear regression in order to isolate factors influencing hospital costs and length of stay. Results The mean length of stay (SD) for older patients (65+) is 11 days (18.17) and the mean hospitalisation cost (SD) €6706 (9422). The main predictor of hospital costs is the length of stay. A linear regression (n = 41,348, R2 = 0.4520) reveals that predictors of a longer LOS for hospitalised older patients are: to be a male, to come from another hospital, to be sent to hospital by a general practitioner, to be admitted through the emergency department, to undergo a surgical procedure, to suffer from a major or extreme SOI or run a major or extreme mortality risk, to have a high score on the Charlson Comorbidity Index (CCI), to stay in an ICU, to belong to older age categories (85+), and to be institutionalised after discharge. Conclusion Advanced age is by itself only a weak predictor of hospital cost, but it is a good predictor of a longer hospital stay.

Impact of shortened length of stay for delivery on the required bed capacity in maternity services: results from forecast analysis on administrative data

BackgroundWe examine the implications of reducing the average length of stay (ALOS) for a delivery on the required capacity in terms of service volume and maternity beds in Belgium, using administrative data covering all inpatient stays in Belgian general hospitals over the period 2003–2014.MethodsA projection model generates forecasts of all inpatient and day-care services with a time horizon of 2025. It adjusts the observed hospital use in 2014 to the combined effect of three evolutions: the change in population size and composition, the time trend evolution of ALOS, and the time trend evolution of the admission rates. In addition, we develop an alternative scenario to evaluate the impact of an accelerated reduction of ALOS.ResultsBetween 2014 and 2025, we expect the number of deliveries to increase by 4.41%, and the number of stays in maternity services by 3.38%. At the same time, a reduction in ALOS is projected for all types of deliveries. The required capacity for maternity beds will decrease by 17%. In case of an accelerated reduction of the ALOS to reach international standards, this required capacity for maternity beds will decrease by more than 30%.ConclusionsDespite an expected increase in the number of deliveries, future hospital capacity in terms of maternity beds can be considerably reduced in Belgium, due to the continuing reduction of ALOS.

Patients with dementia in hospitals: a nation-wide analysis of administrative data 2010-2014.

Considering the limited information available, the aim of the study was to examine the prevalence and characteristics of inpatients with dementia in Belgian general hospitals. All admissions of inpatients aged at least 40years with or without dementia were retrieved from the nationwide administrative hospital discharges database for the period 2010-2014. Admissions of inpatients aged 40years or more with dementia have increased to reach 83,017 out of 1,285,593 admissions (6.46%) in general hospitals in 2014, mostly admitted through the emergency department (79.7%) and for another reason than dementia (85.9%). These patients stayed longer [19.2days, standard deviation (sd) = 23.6, median = 13] than the average length of stay of patients of the same age (7.9days, sd = 14.1, median = 17). Considering patients aged 75years or more falling into the 20 most common pathology groups (of patients with dementia), the group with dementia spent 5days more than the group without dementia. Patients admitted from home spent more time in hospital when they were discharged to a residential care facility than when they returned home (27.2days versus 15.8days). The in-hospital mortality was high in the first days of admission. The growing prevalence of patients with dementia in inpatient setting puts a high pressure on the hospital capacity planning and geriatric expertise. Moreover, as patients with dementia should be kept outside hospitals when possible for safety and quality matters, long-term organizational investments are required inside hospital and residential care settings as well as in community care.

The hospital cost of hip replacement for old inpatients in Belgium.

The objectives of this research are (i) to describe the medico-administrative characteristics of inpatients aged 65 and more who are hospitalized for hip joint replacement, (ii) to evaluate the complete hospital cost into costs of medical procedures, drugs costs, prostheses costs, and the administrative costs, and (iii) to identify and to evaluate from administrative database predictors influencing the complete hospital costs. The study was based on 961 inpatient stays aged 65 and more, with the APR-DRG 301 "Hip joint replacement". The sample for this study was based on data collected in 2014 among nine Belgian general hospitals. We used the linear regression method for isolating predictors of hospital cost. The study highlights three different types of patients hospitalized for hip replacement, depending on the primary diagnosis: osteoarthritis problems (57%), femur neck fracture (30%), or other reasons (13%) (complications, infections, or problems with the existing hip prosthesis). The median length of stay (P25-P75) was 9days (6.29-20.91). The median cost (P25-P75) was 8,023.91 EUR (6678.32-13,670.78). The total cost was composed of the direct hospital cost (30%), the cost of medical procedures (31%), cost of drugs (4%), the cost of hip prosthesis (18%), and other costs (17%). The linear regression reveals that an extreme SOI or risk of mortality, an ICU stay, an in-hospital death, an index of Charlson comorbidities of 4 or 5, to be hospitalized for a hip replacement because of complications, infections, or problems with the existing hip prosthesis, and the length of stay, were predictors of an increase in hospital cost. The cost is not increasing with the age of the patient, but mainly with the length of stay and the comorbidities linked to the age which are considered in the severity of illness and the Charlson comorbidities index. The hospital cost is higher for patients hospitalized for complications linked to an existing hip prosthesis than for a hip replacement linked to osteoarthritis problems.

Causes and consequences of occupational stress in emergency nurses, a longitudinal study

This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions.

The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey

BackgroundEmergency Nurses are routinely confronted with work related traumatic events and hectic work conditions. Several studies report a high prevalence of post-traumatic stress disorder (PTSD) in these nurses. Coping and social support seem to play an important role in the development of PTSD. ObjectivesThis study examines (1) the frequency of exposure to and the nature of traumatic events in Emergency Nurses, (2) the percentage of nurses that report symptoms of PTSD, anxiety, depression, somatic complaints and fatigue at a sub-clinical level, and (3) the contribution of traumatic events, coping and social support to PTSD symptoms, psychological distress, somatic complaints, fatigue and sleep disturbances. DesignCross-sectional data from 248 Emergency Nurses, from 15 Flemish (Belgian) general hospitals, were analyzed. ResultsEmergency Nurses were found to be confronted frequently with work related traumatic events. Death or serious injury of a child/adolescent was perceived as the most traumatizing event. Almost one out of three nurses met sub-clinical levels of anxiety, depression and somatic complaints and 8.5% met clinical levels of PTSD. Levels of fatigue were high but not directly related to the frequency of exposure to traumatic events. Emotional coping was related to an increase in all outcomes; avoidant coping was related to more somatic complaints; problem focused coping was related to a decrease in psychological distress and perceived fatigue. Social support from colleagues and supervisor (head nurse) was found to have a protective effect on the occurrence of PTSD symptoms. ConclusionEmergency Nurses are especially vulnerable to post-traumatic stress reactions due to repetitive exposure to work related traumatic incidents. This not only personally affects the nurses, but can also impact quality of care. Hospital management should act on the findings of this study and invest in supportive, communicative, empathic and anticipatory leadership, and provide time-out facilities, cognitive-behavioral interventions and psychological counseling for Emergency Nurses on demand.

Exploring the burden of emergency care: predictors of stress‐health outcomes in emergency nurses

This paper is a report of a study that examines (1) whether emergency nurses differ from a general hospital nursing comparison group in terms of job and organizational characteristics and (2) to what extent these characteristics predict job satisfaction, turnover intention, work engagement, fatigue and psychosomatic distress in emergency nurses. The work environment and job characteristics of nurses are important predictors of stress-health outcomes. Emergency nurses are particularly exposed to stressful events and unpredictable work conditions. This cross-sectional study (N = 254) was carried out in 15 emergency departments of Belgian general hospitals in 2007-2008 by means of the Leiden Quality of Work Questionnaire for Nurses, the Checklist Individual Strength, the Utrecht Work Engagement Scale and the Brief Symptom Inventory. Emergency nurses report more time pressure and physical demands, lower decision authority, less adequate work procedures and less reward than a general hospital nursing population. They report, however, more opportunity for skill discretion and better social support by colleagues. Work-time demands appear to be important determinants of psychosomatic complaints and fatigue in emergency nurses. Apart from personal characteristics, decision authority, skill discretion, adequate work procedures, perceived reward and social support by supervisors prove to be strong determinants of job satisfaction, work engagement and lower turnover intention in emergency nurses. Emergency departments should be screened regularly on job and organizational characteristics to identify determinants of stress-health outcomes that can be the target of preventive interventions.

Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study

BackgroundIn-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement.MethodsHospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital.ResultsWe identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (ORadj 23.0; 95% CI [20.9;25.2]), and five-year age groups ORadj 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter-type of hospital differences {(ORcomunity vs tertiary hospitals1.36; 95% CI [1.34;1.39]) and (ORintermediary vs tertiary hospitals1.36; 95% CI [1.34;1.39])}, and nonconformities to guidelines for treatment were observed.ConclusionsDespite established data quality shortcomings, the magnitude of the observed differences and the nonconformities constitute leads to quality improvement. However, to measure progress, ways to improve and routinely monitor data quality should be developed.

The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma.

BackgroundThe use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.MethodsNine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.ResultsThe most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists.ConclusionsDespite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.

Development and validation of nursing resource weights for the Belgian Nursing Minimum Dataset in general hospitals: A Delphi questionnaire survey approach

Background Internationally, nursing is not well represented in hospital financing systems. In Belgium a nursing weight system exists to adjust budget allocation for differences in nurse staffing requirements, but there is a need for revision. Arguments include the availability of a nursing minimum dataset and the adverse consequences of the current historically based nursing weight system. Objectives The development and validation of nursing resource weights for the revised Belgium nursing minimum dataset (NMDS). Design Two independent cross sectional Delphi—surveys. Setting and participants A convenience sample of 222 head nurses from 69 Belgian hospitals participated in the cross sectional survey methods. To assess validity 112 patient case records from 61 nursing wards of 35 Belgian general hospitals representing general, surgical, pediatric, geriatric and intensive care were selected. Methods Nursing resource weights were constructed based on Delphi survey results by NMDSII intervention. The patient case Delphi survey results were used as the primary source for validation. A series of additional validation measures were calculated, based on the different patient classification systems. Finally, three validated nursing resource weighting systems were compared to the constructed NMDSII weighting system: the use of ‘Closon’, ‘Ghent’ and WIN weights. Results A coherent set of nursing resource weights was developed. The comparison of nurse resource weights, based on the survey per NMDS intervention versus the survey on patient cases, yielded high correlations: r = 0.74 to r = 0.97 ( p < 0.01) between three case rating questions, as an indication of reliability in terms of internal consistency, and r = 0.90 ( p < 0.01) between summed intervention weights and patient case weights, as an indication of criterion validity in terms of concurrent validity. Other concurrent validity measures based on summed intervention weights versus patient classification dependency weights showed a correlation ranging from r = 0.14 to r = 0.74. The correlation of summed intervention weights with the Closon, Ghent and WIN weights ranged from r = 0.93 to r = 0.96 ( p < 0.01), as a third indication of concurrent validity. Conclusions A system of valid nursing resource weights has been developed. The system should be further validated within an international context.

Financial consequences of hospital-acquired bacteraemia in three Belgian hospitals in 2003 and 2004

The financial and human costs of hospital-acquired infections are increasingly recognised in many healthcare systems. This study seeks to quantify excess expenditures on hospital-acquired bacteraemia (HAB) in three Belgian general hospitals in 2003 and 2004. Patients with HAB were compared with patients in the same All Patient Refined Diagnosis Related Groups (APR-DRGs) without HAB. Patient level costs were estimated using a hospital costing system developed by the 'Université Libre de Bruxelles', and compared with DRG-based funding for the three hospitals. HAB incidence was consistent with the national rate for two of the three hospitals, but considerably higher for the third. Both severity of illness and mortality were higher in the HAB group. Nosocomial bacteraemia was associated with an increased length of stay of 30 days and of 6.1 days in intensive care units. When compared with uninfected patients in the same DRG, treatment of HAB patients cost an additional euro 16,709. At current funding rates, hospitals made a mean profit of euro 446 for uninfected patients, but a mean loss of euro 2,431 for patients with HAB. Our findings suggest that hospitals have a financial interest in reducing the rate of HAB, even in a system which funds such complications through severity adjustments in the APR-DRG system. Growing international interest in pay for performance and other funding schemes will only strengthen these financial incentives.

Challenging patient safety culture: survey results

The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores were expressed as the percentage of positive answers towards patient safety for each dimension. The survey was conducted from March through November 2005. In total, 3,940 individuals responded (overall response rate = 77 per cent), including 2,813 nurses and assistants, 462 physicians, 397 physiotherapists, laboratory and radiology assistants, social workers and 64 pharmacists and pharmacy assistants. The dimensional positive scores were found to be low to average in all the hospitals. The lowest scores were "hospital management support for patient safety" (35 per cent), "non-punitive response to error" (36 per cent), "hospital transfers and transitions" (36 per cent), "staffing" (38 per cent), and "teamwork across hospital units" (40 per cent). The dimension "teamwork within hospital units" generated the highest score (70 per cent). Although the same dimensions were considered problematic in the different hospitals, important variations between the five hospitals were observed. A comprehensive and tailor-made plan to improve patient safety culture in these hospitals can now be developed. Results indicate that important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge to all stakeholders wishing to improve patient safety.

In response to T. Defloor, A. Van Hecke, S. Verhaeghe, M. Gobert, E. Darras &amp; M. Grypdonck (2006) The clinical nursing competences and their complexity in Belgian general hospitals. Journal of Advanced Nursing56(6), 669–678.

In response to T. Defloor, A. Van Hecke, S. Verhaeghe, M. Gobert, E. Darras &amp; M. Grypdonck (2006) The clinical nursing competences and their complexity in Belgian general hospitals. <i>Journal of Advanced Nursing</i><b>56</b>(6), 669–678.

Measuring performance in the presence of stochastic demand for hospital services: an analysis of Belgian general care hospitals

Since demand for hospital services is subject to substantial variability, the relationship between uncertain demand, excess capacity, hospital costs and performance should be investigated thoroughly. In this paper a waiting time indicator to proxy hospital standby capacity is incorporated into a multi-product translog cost function for Belgian general care hospitals. The indicator is derived from queuing theory and improves on the conventionally used (inverse of the) occupancy rate. The multi-product stochastic frontier specification allows calculation of cost elasticities and marginal cost of seven hospital departments, as well as the degree of economies of scale and scope and enables identification of differences in efficiency.

The clinical nursing competences and their complexity in Belgian general hospitals

This paper reports a study whose aim was to chart clinical nursing competences and their complexity in Belgian general hospitals. Competence is an essential factor for assuring quality, safety and cost-effective health care. As clinical competence cannot be evaluated separately from the clinical context in which decisions are made, competence is defined as functional adequacy and the capacity to integrate knowledge and skills with attitudes and values into the specific contexts of practice. The study took place in 2003 and focused on basic care, specialized care and elder care. Head nurses of 176 departments processed 521 patient situations. Experts selected 50 situations per area. In a Delphi procedure 100 experts described the nursing competences required in each situation necessary to provide quality acceptable care. The experts determined the global complexity of each of these competences as well as the complexity of the cognitive, psychomotor and affective aspects. The global complexity of the various care areas was similar. Cognitive and affective aspects of competences scored higher than psychomotor aspects. Simple and average situations did not show any significant difference with regard to complexity and were less complex than difficult situations, which obtained the highest complexity score. The complexity of emergency situations did not differ from that of difficult situations. Emergency and difficult situations require more competences than offered by basic nursing education. The continuous presence of care providers with additional education is necessary for each care area to respond adequately to emergency and difficult situations. Nurses with additional academic qualifications need to be available for consultation. There are only a few possibilities of employing lower qualified staff in direct care, with the exception of support with regard to administrative tasks. Cognitive and affective aspects of the competences require particular attention during the education programme.

Impact of organizational structure on nurses’ job satisfaction: A questionnaire survey

Background Nurses’ job satisfaction is an important issue because of its impact on the quality of the nursing job. Therefore, it receives a lot of attention in the international nursing literature but insight into the sources of nurses’ job satisfaction is yet insufficient, in particular for sources related to organizational structure. Objectives We contribute by investigating the relationship between the organizational structure variables, formalization, centralization and specialization, and nurses’ job satisfaction. This allows us to learn whether structural changes can help to improve satisfaction, and therefore nurses’ work quality. Design Data were collected by questionnaires in a random sample of 764 non-managing nurses in three Belgian general care hospitals. We measured satisfaction by Stamps and Piedmont's work satisfaction index. Structure was also measured by an existing scale. Results The results support the negative effect of centralization and the clearly positive effects of specialization and formalization on nurses’ job satisfaction. These effects differ according to the different dimensions of satisfaction. Furthermore, pay is the most important dimension of nurses job satisfaction but the dimension least influenced by organizational structure. Conclusions The importance of the dimension pay in nurses’ job satisfaction, which is not a function of organizational structure, is limiting hospitals in improving nurses’ job satisfaction. However, organizational structure is related to the other dimensions of satisfaction. Especially, the fact that specialization and formalization are, contrary to our hypotheses, only positively related to satisfaction is important from a practice perspective and for further research. Furthermore, our data indicates that there is a need to refine one of the dimensions of Stamps and Piedmont index.

Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals

This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High resource use outliers were selected according to the following rule: 75th percentile +1.5 xinter-quartile range. The frequency of cost outliers varied from 7% to 8% across hospitals. Explanatory factors were: major or extreme severity of illness, longer length of stay, and intensive care unit stay. Cost outliers account for 22-30% of hospital costs. One-third of length-of-stay outliers are not cost outliers, and nearly one-quarter of charges outliers are not cost outliers. The current funding system in Belgium does not penalize hospitals having a high percentage of outliers. The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers.

The professional self-image of nurses in Belgian hospitals: A cross-sectional questionnaire survey

This paper reports data on the professional self-image of 9638 nurses employed in 22 Belgian general hospitals with the goal of identifying problems affecting recruitment and retention. Nurses reported having a positive self-image. Most were proud to be a nurse and considered themselves competent health professionals having great responsibility. Although they reported that an ideal practice requires effective teamwork, supportive management, societal recognition, and sufficient time to perform their duties, they also felt that these essential conditions were absent in daily practice.

Multi-product costs and standby capacity derived from queuing theory: the case of Belgian hospitals

Empirical hospital cost function studies can be divided into two categories: studies estimating traditional multi-product cost functions and studies including demand uncertainty (assuming that hospitals provide standby capacity to cope with uncertain demand and stressing that the relationship between the uncertain demand, excess capacity and costs should be investigated). Most studies include (the inverse of) the occupancy rate in a relatively basic cost function. The first contribution of this paper is to incorporate an indicator of reserve capacity into a genuine multi-product cost function. The second contribution is to propose an alternative indicator to proxy the reserve margin. The often used occupancy rate has an important shortcoming: the same occupancy rate can hide different turnaway probabilities and waiting times, obscuring the true degree of reservation quality. Since turnaway probabilities and waiting times are typical queuing theory indicators, an indicator for average waiting time (derived from queuing theory) is incorporated into a proper multi-product cost function to capture the degree of standby capacity into a proper multi-product cost function. The study uses 1997 data on Belgian general care hospitals to estimate a multi-product cost function and calculate cost elasticities, marginal costs and the degree of economies of scale. The results further show that providing standby capacity has a significant impact on total costs.

COMPARATIVE IN VITRO ACTIVITY OF ISEPAMICIN AND OTHER ANTIBIOTICS AGAINST GRAM-NEGATIVE BACILLI FROM INTENSIVE CARE UNITS (ICU) IN BELGIUM

The in vitro activity of isepamicin was compared to that of amikacin, gentamicin, cefepime, ciprofloxacin and meropenem against Gram-negative bacilli isolated from patients hospitalized in the intensive care unit (ICU) of 11 Belgian university or general hospitals between November 1998 and July 1999. The minimal inhibitory concentrations (MIC) for 1087 non-duplicate, consecutive aerobic Gram-negative isolates, including 798 Enterobacteriaceae and 289 non-fermenters, were determined by E-test for each antibiotic. Overall, isepamicin was active against 91% of all isolates and was found more active than ciprofloxacin (84% susceptibility), gentamicin (88% susceptibility), cefepime and amikacin (89% susceptibility each), but less active than meropenem (94% susceptibility). Enterobacter aerogenes isolates exhibited the highest resistance rate to ciprofloxacin (72%) while P. aeruginosa appeared the most resistant (frequently multi-resistant) pathogen. Compared to amikacin, MIC values for isepamicin were usually two- to fourfold lower for most inducible Enterobacteriacieae species and for Klebsiella spp., while they were identical for P. aeruginosa and other non-fermenters. Complete cross-susceptibility or crossresistance between amikacin and isepamicin was observed in more than 95% of all tested isolates. On the other hand, 12% of all E. aerogenes isolates appeared resistant to amikacin and susceptible to isepamicin, while 6% of the P. aeruginosa were found to be resistant (or intermediate) to isepamicin and intermediate (or susceptible) to amikacin. No significant differences in pathogen distribution nor in resistance rates were observed between hospitals except for P. aeruginosa.Taking into account the species distribution and the prevalence of resistance to the different antibiotics tested, isepamicin appears as a suitable agent for empiric therapeutic use in severe ICU-acquired Gram-negative infections in Belgium.