Lack Of Intensive Care Beds Research Articles

Evaluating demand of High Dependency Unit beds in a hospital with insights on return on capital investment

Abstract Introduction: Hospital administration will have to constantly work around predicting demand of the critical care beds and evaluating the options of expanding the existing capacity. These expansions will be constantly requested by clinicians in private hospitals in India. It becomes imperative to infuse capital into such expansions predicting the utilisation pattern of the new beds. This study concentrates on factors considered for estimating the infrastructure enhancement in step down beds in progression of patient care. Methodology: Retrospective measurement of past bed occupancy rates of existing critical care beds, number of patients denied admissions through emergency department due to lack of intensive care beds was counted during previous 1 year. Cost estimates of building, equipment, manpower was collected. The prices that can be charged per rack basis was estimated, for revenue calculation. Return on investment tool using annual revenues divided by annual investment was used to measure the outputs. Results: For setting up a 34 bed HDU (High Dependency Unit), 4760 square feet of space was utilised, with USD 594,555 as investment, at a revenue of USD 527,425, which is 75% return in first year, provided occupancy is at 100%. At occupancy of 60%, which was seen within 6 months of commissioning new HDU, the breakeven can be achieved at 450 days. At 100% occupancy breakeven can be achieved in 290 days. Conclusion: Demand estimation and Utilisation analysis is valuable tools for administration to make decisions on major capital investments.

Experience in Mechanical Thrombectomy for Acute Stroke Treatment during Pandemic: A Single Center Report

Objective: The COVID-19 disease affected most hospitals with its rapid spread and increased number of severe cases. Thus, delays in acute ischemic stroke care and a decline in hospitalization and interventions, such as endovascular thrombectomy, have been reported. With the present study, we aimed to evaluate baseline patient characteristics and determine the impact of pandemics on MT-related outcomes. Materials and methods: The hospital database was scanned for the patients diagnosed with acute ischemic stroke and treated via mechanical thrombectomy. The patients enrolled in the study were evaluated for their demographic features, infarct characteristics, clinical neurological scores (NIHSS and mRS) on admission and discharge, the TICI results, and the clinical course of the disease. Results: 250 patients were diagnosed with acute ischemic stroke during the Sep.2020-Oct.2021 period. Of the 158 patients were eligible for mechanical thrombectomy. Among the patients who underwent MT, 8 (5.06%) were diagnosed with COVID-19. While the median NIHSS score on admission was 12 (±4.16), the final post-procedural NIHSS score on discharge was 6 (±5.00). The most commonly occluded artery was MCA in 128 (81.01%) patients. While 76 (%48.10) of the patients resulted in procedural success with a TICI 3 score, a post-procedural intracranial hemorrhage was observed in 35 (22%) patients. A total of 90 (%56.96) patients were discharged with a good neurological outcome, while 32 (%20.25) had a lethal result. The outcome data of some patients (32 (%20.25) in particular) could not be obtained. Those patients needed to be referred to another ICU after the MT procedure because of the present hospital's lack of ICU beds. Conclusion: The rate of COVID-19 infection was low among stroke patients who underwent MT. Moreover, all patients who underwent intervention due to a lack of intensive care beds could not be followed up in our hospital and had to be referred to an external center.

The Analysis of the Main Working Parameters of the Head Regional Vascular Center of N.V. Sklifosovsky Research Institute for Emergency Medicine

Introduction. The regional vascular centers (RVC) network was created throughout Russia to manage cardiovascular diseases. On the basis of N.V. Sklifosovsky Research Institute for Emergency Medicine in Moscow, a center was created, which received the status of the head RVC. A comprehensive analysis of its work has not yet been carried out.Aim of study. To assess the main performance indicators and development directions of the head RVC based on the analysis of data for 2012–2019.Results. Analysis of the data obtained showed that by 2019 the flow of patient admissions increased 2.3-fold. At the same time, the use of the hospital bed fund does not exceed 100%, and the use of the intensive care bed fund has increased to 123%. A significant proportion of patients come with not field-specific diagnosis. The mortality, which is the main indicator of the quality of treatment in patients treated at the RVC, remained within 2.33–3%, which turned out to be 3 times lower in similar patients treated in other departments of the Institute.Discussion. Against the background of a constant increase in the number of hospitalizations, resusci-tation provision turned out to be insufficient when the number of hospital beds corre-sponded to the flow of admissions. The general lack of intensive care beds in the center and the lack of specialized intensive care for the department of vascular surgery forces the use of other intensive care units of the Institute. The admission of patients with other (not specific for RVC) diagnosis to the vascular center reduces the volume of highly specialized care for specialized patients.Conclusion. The analysis of the performance indicators of the head regional vascular center on the basis of N.V. Sklifosovsky Research Institute for Emergency Medicine, identified the need to expand the resuscitation bed fund in the existing departments of the center and organize specialized resuscitation for patients of the vascular surgery department. Also, the lack of intensive care beds is aggravated by a large flow of non-core admissions. Their reduction with the existing structure will provide significant savings in resources and will increase the number of treated profile patients and improve the quality of highly specialized care.

External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: a descriptive study

ObjectivesPerforming randomised controlled trials (RCTs) in neonatal intensive care is challenging in many ways. While restrictive inclusion criteria or busy study protocols are obvious barriers, external barriers leading to termination...

Preventing unnecessary interhospital transfers to urban medical centers

ABSTRACT Context: Intensive care interhospital transfers result in longer hospitalization and greater patient mortality and morbidity. Preventing transfers require commitment from providers at all stages of patient’s clinical care to keep care local and maximize limited resources. Purpose: Describe how changes in hospital workflow and inter-departmental communication resulted in a decrease in transfers due to lack of intensive care beds. Methods: Implemented a workflow involving the Intensive Care Unit (ICU), Emergency Department, and hospitalist to anticipate and address shortages in ICU beds in real time to accommodate for new critical care admissions and free up floor beds to allow for timely ICU downgrades. Providers from each department change on a regular basis, but communication occurs across all departments cotinuously to allow all components to work seamlessly. Findings: Implementation of workflow over 2 years resulted in decrease in interhospital transfers due to lack of ICU beds from 11.0 transfers per month to 5.2 (P < 0.01). Hospital CMI went from 1.02 to 1.29 as an indication of greater retention of critically ill patients. Conclusion: A team-approach to managing critically ill patients can lead to a substantial reduction in interhospital transfers, increase case mix index, and improve interdisciplinary communication and continuity of care.

Implementation of a horizontal intensive care team can impact efficiency in an emergency observation unit in Brazil

Emergency department observation units are often used to monitor critical patients in a situation of constant emergency department overcrowding and lack of intensive care beds. However, those units are often understaffed and might not have enough personnel and equipment to provide the same quality of care as a conventional ICU.

SAPS 3 as a predictor admission of surgical patients in the ICU

Owing to lack of intensive care beds, patients undergoing intermediate-risk surgery are usually sent to the ward postoperatively. However, a part from this population evolves with complications requiring intensive care (ICU). The aim of the study was to evaluate the characteristics of surgical patients who were admitted to the ICU lately and to find predictors of the need for intensive care.

Short-term ventilation of critically ill patients in recovery.

There is often a shortfall of critical care facilities which can result in a number of patients who need management in intensive care units (ICUs) being treated in a recovery unit prior to being found an ICU bed. This article describes a study which examined this situation. The patients’ origins, durations of stay in recovery, outcomes and final destinations are discussed. The authors conclude that recovery provides a hidden resource to supplement the lack of intensive care beds and suggest ways that the problem might be addressed.

Vascular surgical society of great britain and ireland: review of out-of-hours vascular procedures in a tertiary vascular unit

BACKGROUND: The aim of this study was to review out-of-hours vascular procedures in a tertiary vascular unit. METHODS: The vascular emergencies that presented outside normal working hours (17. 00 to 08.00 hours) in a vascular unit between January and June 1998 were reviewed. Only cases considered to be life or limb threatening and requiring urgent surgical or radiological intervention were assessed. RESULTS: The Table shows that a significant number of vascular emergencies was performed out of hours in one unit. This was, in part, due to an increase in the number of tertiary referrals, which represented 57 per cent of all emergency procedures. Reasons for the tertiary referrals were: no consultant vascular surgeon on call (33 per cent), no consultant interventional radiologist on call (26 per cent), lack of intensive care beds (30 per cent) and complex procedure (11 per cent). The overall mortality rate of patients referred in this period was 15 per cent. The unit has three consultant vascular surgeons, two consultant interventional radio- logists and one vascular specialist registrar. CONCLUSION: The significant increase in out-of-hours vascular emergencies, both surgical and radiological, has placed an enormous demand on senior members of the team. In addition, it has had a significant impact on the unit's elective admissions and waiting lists, in particular those for routine general surgery. To support the growth in complex emergency referrals, senior vascular fellows in both vascular surgery and radiology have been appointed and proposals are underway to restructure local vascular services.

Shortage of organs for transplantation

Of all the problems foreseen in the pioneering days of organ transplantation, a shortage of donor organs was not even remotely considered as a barrier to progress. Such has been the success of transplantation over the past two decades that organ shortage is now considered the major limitation. This week sees the publication of an extensive study by the British Transplantation Society's working party on organ donation.1 Chaired by Professor John Fabre, the working party examined a variety of issues influencing rates of organ donation in Britain. Clearly, the fact that fewer young people now die because of road traffic accidents or intracranial haemorrhage is a cause of donor loss that must be welcomed. However, the report highlights the fact that many medical and financial practices still mitigate against the efficient identification and recruitment of organ donors. In particular, the lack of intensive care beds means that many potential donors are not being ventilated, with the decision depending on locally devised prognostic criteria. As a result, waiting lists for renal transplantation continue to rise, putting increasing pressure on dialysis budgets. While it would be inappropriate …