Hospital Bed Utilization Research Articles

Utilisation of beds on the general medical unit by ‘non‐acute medical’ patients: a retrospective study of incidence and cost in two Tasmanian regional medical hospital units

Demand for healthcare services threatens to overwhelm the Australian healthcare system. Public hospitals have the largest component of expenditure growth and as such represent the largest opportunity for efficiency gains. Utilisation of inpatient hospital beds and in particular those on general medical units has not been studied in Australia. To undertake a retrospective patient medical record review of 200 sequential admissions to the medical wards in two regional Tasmanian hospitals to determine the incidence of non-acute medical patient admission to the medical unit, and the subsequent days in hospital that were not required for medical reasons. The cost of these days was estimated. Sixteen patient admissions (8%) could not be justified on medical grounds. Forty-eight (24%) patient admissions had at least one day hospital day that could not be justified on medical grounds. Of the 1438 total bed days, 475 (33%) were for non-medical reasons. The estimated cost of those non-medical bed days for this cohort was $764 800. The incidence of non-acute medical admissions and non-acute medical bed days to the medical unit and associated cost was significant. Further research is needed to design alternative care provision for such patients particularly in regional Australia. The potential savings to the Australian healthcare system could be significant.

Health Service Management Study for Stroke: A Randomized Controlled Trial to Evaluate Two Models of Stroke Care

The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days postdischarge included functional independence measure, length of hospital stay, and functional independence measure efficiency (change in functional independence measure score ÷ total length of hospital stay). Among 41 patients randomized, 20 were allocated co-located acute/rehabilitation stroke care and 21 traditionally separated acute/rehabilitation stroke care. Baseline measurements showed no significant difference. There was no significant difference in functional independence measure scores between the two groups at discharge and again at 90 days postdischarge (co-located acute/rehabilitation stroke care: 103.6 ± 22.2 vs. traditionally separated acute/rehabilitation stroke care: 99.5 ± 27.7; P = 0.77 at discharge; co-located acute/rehabilitation stroke care: 109.5 ± 21.7 vs. traditionally separated acute/rehabilitation stroke care: 104.4 ± 27.9; P = 0.8875 at 90 days post-discharge). Total length of hospital stay was 5.28 days less in co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (24.15 ± 3.18 vs. 29.42 ± 4.5, P = 0.35). There was significant improvement in functional independence measure efficiency score among participants assigned to co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (co-located acute/rehabilitation stroke care: median 1.60, interquartile range: 0.87-2.81; traditionally separated acute/rehabilitation stroke care: median 0.82, interquartile range: 0.27-1.57, P = 0.0393). Linear regression analysis revealed a high inverse correlation (R(2) = 0.89) between functional independence measure efficiency and time spent in the acute stroke unit. This proof-of-concept study has shown that co-located acute/rehabilitation stroke care was just as effective as traditionally separated acute/rehabilitation stroke care as reflected in functional independence measure scores, but significantly more efficient as shown in greater functional independence measure efficiency. Co-located acute/rehabilitation stroke care has potential for significantly improved hospital bed utilization with no patient disadvantage.

AB0282 Increased prescription of tumour necrosis factor alpha antagonists is strongly associated with a reduction in myocardial infarctions in rheumatoid arthritis patients based on a 16 year analysis of nationwide data.

BackgroundPatients with rheumatoid arthritis (RA) die prematurely from cardiovascular disease (CVD) with persistent inflammation likely playing an important role in the development of atherosclerosis. Conversely, induction of remission reduces CVD...

Hospital Bed Utilization by Teaching and Nonteaching Medical Services

A study was undertaken to determine whether hospital bed utilization is different between teaching and nonteaching hospitalist services. During a 2-year period, the average length of stay (ALOS), case-mix index, readmissions within 30 days of discharge, and percentage of 1-day stays were compared between these services. To ameliorate confounders, the ALOS was recalculated (ALOS revised) after excluding patients with length of stay of more than 20 days and those originally admitted to the intensive care unit. Six thousand ninety-nine patients were discharged by the teaching service (group 1), 14 348 by the corporate hospitalist (group 2), and 2634 by the community-based practitioner group (group 3). The mean ALOS revised was significantly lower for the teaching service (3.64 ± 2.22 days) compared with the other 2 services (4.53 ± 1.48 and 4.73 ± 1.02, respectively [P < .001]), although the mean case-mix index was significantly higher for the teaching service compared with the other services. The mean percentage of readmissions within 30 days of discharge and 1-day stays were not significantly different between group 1 and groups 2 and 3. Hospital bed utilization in the teaching service was superior to the nonteaching hospitalist services. Further research should explore the reasons for the differences between these models of care.

21st century health services for an ageing population: 10 challenges for general practice

![][1] When Queen Elizabeth II was crowned in 1952, life expectancy was 66 years for males and 71 years for females. By 2001, these figures were 77 and 81 respectively. Average life expectancy at 70 is already 17 years for males and 19 years for females. Old age is often caricatured as a time of ill-health, loneliness, unhappiness, and dependence, but life satisfaction peaks in the 70s and most over-80s rate their health as being good or excellent and say they do not live with life-limiting long-term conditions (LTCs). Most over 65s are neither disabled nor dependent.1 Despite this good news, ageing does pose significant challenges to health and social care systems, which need to change to meet radically different patterns of demand. I believe there are at least 10 key challenges for general practice in providing care for an ageing population. Several are well-illustrated by articles in this welcome themed issue of the BJGP . In England, people over 65 years comprise 46% of spend in acute care, 37% in primary care, 60% in social care, 60% of admissions, and 70% of bed days in hospital. Many older patients have complex needs or use multiple services. There is major unwarranted variation between primary care trusts in rates of emergency hospital admission or bed utilisation in over 65s; and in a range of disease-specific processes and outcomes.2 We need to focus more on older people with multiple morbidities, whose care should be more prominent in plans for service redesign. Older patients often get a poor deal in the NHS and other systems relative to other age-groups.3 Common age-related conditions receive lower priority and older people receive generally lower quality of care than those in midlife with the same diseases. Frailer old people who present with so-called ‘non-specific’ or … [1]: /embed/graphic-1.gif

Improving hospital bed utilisation through simulation and optimisation: With application to a 40% increase in patient volume in a Norwegian general hospital

PurposeThis paper analyses the problem of allocating beds among hospital wards in order to minimise crowding. MethodWe present a generic discrete event simulation model of patient flow through the wards of a hospital. In the generic model, each ward can have separate probability distributions for arrival times and length of stay, which may be time dependent. Output of the model is a matrix, with statistics on the utilisation of different hypothetical numbers of beds for each ward. This matrix is fed into an allocation algorithm, which distributes the available beds among the wards in an optimal way. We define bed utilisation either in terms of how often it is in use (prevalence), or in terms of how often a newly arriving patient is placed in it (incidence). For these classes of utilisation measures we develop efficient allocation algorithms, which we prove to be optimal. ApplicationThe model was applied to Akershus University Hospital in Norway. In 2011, some of the wards of this hospital experienced a high occupancy rate, while others had a lower utilisation. Our model was applied in order to reallocate the hospital beds among the wards. For each ward, acute arrivals were modelled with Poisson-distributions with time-varying intensity, while elective arrivals were programmed to arrive in specific numbers at specific times. The arrival rates were based on empirical data for 2010, scaled up by an expected increase of 40% due to a restructuring of the hospital districts in Oslo and the greater metropolitan area in 2011. Length of stay was modelled as beta-distributions, using a combination of subject matter experts’ evaluations and empirical data from 2010. The model has been verified and validated. ResultsIntuitively, both prevalence (average number of crowding beds in use) and incidence (number of patients placed in crowding beds) might seem like relevant optimisation criteria. However, our experiments show that prevalence optimisation gives more sensible solutions than incidence optimisation, as the latter tends to sacrifice entire wards where length of stay is long and patient turnover is slow. Prevalence optimisation was therefore used. The main results show that when the bed distribution is optimised, the share of crowding patient nights is reduced from 6.5% to 4.2%. ConclusionThis model provides a powerful tool for optimising hospital bed utilisation, and the application showed an important reduction in crowding bed usage. The generic model is flexible, as the level of detail in the modelling of arrivals and length of stay can vary according to the data available and accuracy required.

Burden of Hospitalized Pediatric Morbidity and Utilization of Beds in a Tertiary Care Hospital of Kolkata, India

Background:Childhood morbidity consumes a substantial portion of health care resources in terms of hospital bed utilization, and overload in hospital ward remains a major concern in many countries, including India. A possible way to minimize the problem of scarcities of bed is to analyze the pattern of bed utilization by causes and plan services accordingly.Objectives:To determine the burden of pediatric morbidity and utilization pattern of pediatric beds in a tertiary care hospital.Materials and Methods:A retrospective analysis of pediatric inpatient's records was conducted over a period of 1 year from 1 January 2007 to 31 December 2007.Results:Of 3983 total admitted cases, about one-third were infants, of which neonatal and post-neonatal age group constituted 45% and 55% of the cases, respectively. In terms of bed-day utilization, infants, 1-4 years and 5-11 years age group accounted for 35.10%, 32.58% and 32.32% of total days of admission, respectively. Utilization of pediatric beds by major causes of morbidity was respiratory tract infection (22.23%), convulsive disorder (12.68%), accident and poisoning (6.07%), diarrheal disease (4.97%) and chronic hemolytic anemia (4.42%).Conclusion:A minor change in admission policy through provision of day care unit for management of certain cases would allow efficient use of hospital beds.

Excellent Hospital Care for All: Open and Operating 24/7

Nights and weekends are the times when most people are admitted to the hospital. They are also synonymous with reduced staffing levels and fewer specialized diagnostic, procedural, and treatment options. Indeed, there is increasing evidence suggesting that patient care is compromised during these times. Equally important is the inefficient use of capital investments during nights and weekends, and inappropriate utilization of hospital beds caused by poor weekend discharge flexibility. We believe that these findings should be of concern not just to hospital care providers, but across care settings and to the general public. In this perspective article, we highlight how our current office-hours system of running hospitals threatens the lives of our sickest, most vulnerable patients, describe solutions currently implemented in hospitals that may alleviate this disparity, and discuss challenges to wider scale implementation.

Quick diagnosis units or conventional hospitalisation for the diagnostic evaluation of severe anaemia: A paradigm shift in public health systems?

BackgroundAcute hospital bed utilisation is a growing concern for health care systems in most countries with public health models, as it represents a significant share of health costs. Anaemia with haemoglobin levels below 8g/l has traditionally been a criterion used to hospitalise patients in our centre for diagnosis. MethodsWe conducted a longitudinal study with a prospective and retrospective cohort to investigate the usefulness of a Quick Diagnosis Unit (QDU) for the evaluation of patients with severe anaemia as compared with hospitalisation in a tertiary public hospital. We recorded pretransfusion haemoglobin and haematocrit values, Charlson comorbidity index, waiting time for the first visit, time to diagnosis (length-of-stay in hospitalised patients), final diagnosis, costs, and responses to an opinion survey. ResultsQDU patients were significantly younger [65.63years (17.44)] than hospitalised patients [76.11years (12.68)] (P<.0001). No significant differences were observed regarding time to diagnosis/length-of-stay, haemoglobin concentrations and Charlson index. Iron-deficiency anaemia was the commonest type of anaemia in both cohorts and benign digestive lesions accounted for most cases. The mean cost per process (admission-discharge episode) was 2920.62 Euros in the QDU and 18,278.01 Euros in hospitalised patients. If further diagnostic tests were required, 85% of patients would prefer the QDU care model to conventional hospital admission. ConclusionsFor diagnostic purposes, patients with severe anaemia can be managed similarly in a QDU or in-hospital setting, but the QDU model is more cost-saving than traditional hospitalisation. Most QDU patients preferred the QDU model to hospital admission.

SWOT analysis: The analytical method in the process of planning and its application in the development of orthopaedic hospital department

SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department capacities, inadequate nutrition, low opportunities for expert training of the personnel, outdated equipment, and presence of informal payments. SWOT analysis is a frequently used managerial instrument, which enables the systematic approach in decision making process.

Intra-operative sentinel lymph node biopsy (SNB) using an RT-PCR based assay allows savings in theatre utilisation and hospital stay

Introduction: Theatre times are slightly increased with intra-operative sentinel node analysis (ioaSNB), however node positive patients avoid a second hospital admission and a second operation. It is uncertain if overall this leads to changes in theatre and hospital bed utilisation.

The Impact of Admissions for the Management of End-Stage Renal Disease on Hospital Bed Occupancy

Background: End-stage renal disease (ESRD) is increasingly prevalent but the inpatient costs associated with this condition are poorly defined due to limitations with data extraction and failure to differentiate between hospitalisation for renal and non-renal disease reasons. The impact of admissions primarily for the management of ESRD on hospital bed utilisation was assessed over a 5-year period in a large teaching hospital. Methods: All admission episodes were reviewed and the ESRD group was identified by a primary International Classification of Diseases code for ESRD or a non-specific primary renal failure code with a secondary code for ESRD. The frequency and duration of hospitalisation and contribution to bed day occupancy of this group with ESRD was determined. Results: There were 70,808 patients responsible for a total of 116,915 admissions and 919,212 bed days over the study period. Of these, 988 (1.4%) patients were admitted for the management of ESRD, accounting for 2,387 (2.0%) of admissions and utilisation of 23,011 (2.5%) bed days. After adjustment for age and gender, those admitted for ESRD management were significantly more likely to have a prolonged admission exceeding 30 days (odds ratio 1.46, 95% confidence interval 1.23–1.72, p < 0.001). When the admission was an emergency rather than an elective event, the patient was 4.6 times more likely to be hospitalised for over 30 days. Conclusions: Persons admitted for ESRD management are hospitalised more frequently and for longer than the overall inpatient population, occupying a substantial number of bed days.

Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project

The literature on the dynamics between community- and hospital services concerning utilization of psychiatric beds is inconclusive. The Norwegian VELO-project provides an opportunity to study this in a natural experiment. Two service-systems are compared. The "central-bed system" have mainly outpatient- and day-hospital services locally, with psychiatric beds at a central mental hospital. The "local-bed system" have only one outpatient clinic, with beds at three local inpatient units. Also utilization of sheltered homes was studied. Hypotheses were predicted from Goldberg and Huxley's' stage theory and the Thornicroft and Tansella's' hydraulic model. The case-registries of 2005 were linked across service levels by patients' 11-digit Social Security Number. From 1,865 single treatment episodes, 1,348 continuous courses by 1,253 individual patients were extracted. For overall utilization of psychiatric beds there was only a small difference, were the central-bed system utilized 10% less than the other. For utilization of emergency inpatient admissions and acute hospital beds, the rate was more than twice in the central-bed system compared to the other. For utilization of municipalities sheltered homes, the rate was three times higher in the local-bed system. There may be bedrock of need for psychiatric beds regardless of system-organization. Distance may in general be a minor issue for utilization of psychiatric beds, and may primarily interact with patient- or contextual characteristics associated with acute situations. Activity of day-hospital services rather than outpatient consultations may affect utilization of sheltered homes. The main theoretical models are conceptually useful, although more research is needed to specify mechanisms.

Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning.

BackgroundAdult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of hospital use and SNF discharges in year 2020 in the US.MethodsWe constructed a model estimating the relevant components of hospital utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates.ResultsGiven 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7–4.8) million MV, 5.5 (95% CI 4.3–7.0) million ICU and 10.3 (95% CI 8.1–13.0) million hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268–266,739), compared to 90,928 in 2000.ConclusionOur model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery.

Making the most of routine data in palliative care research – a case study analysis of linked hospital and mortality data on cancer and heart failure patients in Scotland and Oxford

The research base of palliative care is growing rapidly, but despite methodological advances, some of the practical challenges of working with people at the end of life will persist. This means that analysis of routine data is arguably more important in studying palliative care than it is in other aspects of health services research. End-of-life researchers have been using the high-quality linked data from cancer registries for many years. This paper explores the value of a less well-known resource for palliative care research: linked mortality and hospital activity data. Two case studies are presented using information from Scotland (population 5.1 million) and the former Oxford region of England (population 2.5 million). The advantages and limitations of linked hospital and mortality data for research and service planning in palliative care are drawn out through analyses investigating hospital bed utilisation by people with cancer and heart failure and the influence of social deprivation on the use of hospital services in the last year of life. The use of such data deserves a higher profile.

Exploring SWAp's contribution to the efficient allocation and use of resources in the health sector in Zambia

Zambia introduced a sector-wide approach (SWAp) in the health sector in 1993. The goal was to improve efficiency in the use of domestic funds and externally sourced development assistance by integrating these into a joint sectoral framework. Over a decade into its existence, however, the SWAp remains largely unevaluated. This study explores whether the envisaged improvements have been achieved by studying developments in administrative, technical and allocative efficiency in the Zambian health sector from 1990-2006. A case study was conducted using interviews and analysis of secondary data. Respondents represented a cross-section of stakeholders in the Zambian health sector. Secondary data from 1990-2006 were collected for six indicators related to administrative, technical and allocative efficiency. The results showed small improvements in administrative efficiency. Transaction costs still appeared to be high despite the introduction of the SWAp. Indicators for technical efficiency showed a drop in hospital bed utilization rates and government share of funding for drugs. As for allocative efficiency, budget execution did not improve with the SWAp, although there were large variations between both donors and year. Funding levels had apparently improved at district level but declined for hospitals. Finally, the SWAp had not succeeded in bringing all external assistance together under a common framework. Despite strong commitment to implement the SWAp in Zambia, the envisaged efficiency improvements do not seem to have been attained. Possible explanations could be that the SWAp has not been fully developed or that not all parties have completely embraced it. SWAp is not ruled out as a coordination model, but the current setup in Zambia has not proved to be fully effective.

Contemporary outpatient percutaneous coronary intervention: feasible and safe

Outpatient percutaneous coronary intervention (PCI) is safe in selected low risk population. Drug eluting stents (DESs) have expanded the indications of PCI to include more complex anatomies and multivessel disease. Outpatient PCI strategy (transfemoral access with manual sheath removal) is feasible and safe in the era wide utilization of DES. We enrolled 150 consecutive patients (males=82%, smokers=43%, diabetics=40%) referred for elective or semielective PCI. All patients were treated in the catheterization laboratory short-stay area. Procedural success was achieved in 97% of the cases. DESs were used in 88% of patients. Seventy-one percent of patients had single vessel PCI and 29% had multivessel PCI. The majority (n=124, 83%) was discharged within 10 h post-PCI (outpatient group) and 26 patients (17%) were admitted to the hospital for longer observation (hospital group). Of the outpatient group; there were no in-hospital deaths, myocardial infarctions or repeat revascularization. Two patients developed small femoral access site hematoma (treated conservatively). No readmissions or complications within 24 h after discharge were found. Administration of glycoprotein inhibitors and type-C lesion were independent predictors of failed same-day discharge. (i) Transfemoral outpatient PCI with manual sheath removal is feasible and safe in the era of DES. (ii) The majority of patients undergoing single or multivessel PCI can be discharged within 10 h postprocedure. (iii) Out-patient PCI has the potential of decreasing cost and improving hospital bed utilization.

Is P4P Really FFS?

IT IS COMMON FOR SOCIETAL TRENDS AND PREFERENCES TO be recycled. Men’s neckties have varied from thin to wide and back to thin again. Government policies have favored individual responsibility, then social responsibility, and again individual responsibility. In health care, policy makers have swung between concern about access and concern about cost, attempting to increase or decrease medical care supply in response. Until 1980, there was widespread belief in a fairly severe physician shortage in Canada and the United States. By 1990, it was thought that too many physicians were performing too many services. Now, in the 2000s, physician shortages are again the topic of discussion. In the 1960s and 1970s, health policy makers were concerned about access and institutionalized a system that expanded insurance for patients (thus separating them from the true costs of care) and organized a reimbursement system based on fee for service (FFS) and costs incurred. As access expanded, so did health care expenditures. By the 1980s and early 1990s, health care costs in Canada and the United States were thought to be too high. The view that supply created its own demand was common and best epitomized by Roemer’s law: hospital bed utilization reflects supply. In his article on “protecting the commons,” Hiatt criticized the FFS model as having significant negative externalities for society, providing too much health care at the expense of other social services. A solution was to pay physicians and hospitals a flat amount to provide care through prospective case payments, capitation, or global budgets rather than per service. The 1990s were filled with reforms that used 2 mechanisms to correct the problem of rising health care costs and “protecting the commons”: (1) managed care, the insertion of third-party management tools that included incentives for reducing care and (2) competition between health care systems and “plans” for patients on the basis of cost and quality. Together these ideas were known as “managed competition,” an approach originally proposed by Enthoven. The objectives of managed competition, capitation, and global budgets (supply-side constraints) were to reduce unnecessary care without reducing necessary or appropriate care. In managed care, health care administrators would be able to control which patients received which types of care to increase the proportion of care that was deemed appropriate. Theoretically, managed competition made sense, but it quickly fell out of favor in many circles, particularly among the public, precisely because it was successful at achieving its goal; ie, it effectively reduced the provision of care and kept health care costs from continuing to escalate. Restricting only unnecessary care proved to be quite difficult. The RAND Health Insurance Experiment provided an analogous example of the relationship between (consumer) cost sharing (a demand-side intervention) and appropriateness. Increased patient co-payments reduced all health care service use, not just ineffective or unnecessary utilization. It seems that both supply-side and demand-side attempts to control costs provide financial barriers that limit both necessary and unnecessary treatment. Now, as the pendulum appears poised to swing away from cost concerns and back toward improving access, the Institute of Medicine’s Quality Chasm and Rewarding Performance reports have broadened priorities, also focusing attention on improving quality. To improve both quality and access, a new idea has been promoted: pay for performance (P4P).

Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospital

To assess the appropriateness of utilization of beds in the internal medicine department of a university hospital. The appropriateness of hospital stay was evaluated using the Appropriateness Evaluation Protocol. A random sample of 402 days of stay was assessed. One hundred and thirty-nine days of stay (34.6%) were classified as inappropriate. The inappropriate stays were mostly secondary to hospital-related factors. The two major factors for inappropriate stays were 'inappropriate timing/delay in diagnostic procedures/consultations' (27%) and 'delay in obtaining test results' (27%). None of the factors including age, gender, residence and inpatient period was significantly related to inappropriate stay in univariate analysis. This study indicated that a significant portion of stays were inappropriate. Efforts to decrease particularly hospital-related factors associated with inappropriate stay are needed.

Hospice utilization during the SARS outbreak in Taiwan

BackgroundThe severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan.MethodsThe data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic.ResultsOnly 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ.ConclusionHospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.