Number Of Hospital Bed Days Research Articles

Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease.

The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life. Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case-managed group. In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case-managed patients had a significant improvement in their quality-of-life scores. In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.

Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease

Objectives: The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life.Methodology: Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case‐managed group.Results: In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case‐managed patients had a significant improvement in their quality‐of‐life scores.Conclusions: In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.

Mobile community treatment in inner city and suburban Sydney.

Intensive and assertive community based treatment was provided to 27 inner city and 45 suburban severely and chronically mentally ill patients in Sydney. The teams use assertive outreach methods to address the needs of these most difficult to treat patients who have only sporadically complied with outpatient treatment and who frequently required hospitalisation. The staff-patient ratio at 1:10 on both teams is much higher than in the conventional mental health centres. Preliminary outcomes indicate that the number of hospital bed days of the suburban patients dropped by 67%, that stability in accommodation for inner city patients increased, and that functioning improved significantly for patients treated by both teams.

Epidemiologic and public health aspects of insulin-treated diabetes in Denmark.

The epidemiology, mortality, and use of hospital services of insulin-treated diabetes mellitus have been studied in Fyn County, Denmark (450,000 inhabitants). The overall prevalence rate was 3.6 and 3.3 per 1000 for men and women, respectively, and overall annual incidence rates have been estimated to be 15 and 11 per 100,000, respectively. Based on a mortality analysis, it is estimated that the overall mortality rate in this patient population is 4-5% per year. During follow-up, hospital admission rates were estimated to be 0.47 and 0.53 per patient person-yr for men and women, respectively; corresponding values for estimated number of hospital bed days used by the patients were 7.2 and 9.6 per person-yr. Only 26% of the patients (74% in the age class 0-9 yr) attended a diabetes outpatient clinic at the prevalence date (1 July 1973); the remaining patients were supervised by their general practitioner. Based on these figures, an epidemiologic model for insulin-treated diabetes has been formulated, and it is concluded that this disease represents a major public health problem.

Factors affecting mortality and morbidity after surgery for obstructive jaundice.

<h3>Background</h3> A current concern is the number of people dying in hospital who have no medical need, or wish, to be there (Marie Curie Cancer Care, 2012). 72% of people would prefer to die at home (ComRes, 2014), yet just 25% do so, with 50% dying in hospital (Gomes, Calanzani, Higginson, 2011). Instinctively, hospice-led initiatives play an important role in minimising inappropriate hospital usage at the end of life, but there is a lack of robust data. <h3>Aim</h3> To establish the impact of different hospice led innovations on a) reducing the number of hospital bed days during the last 90 days of life, b) place of death and other secondary outcome measures: the number of emergency and inpatient admissions and discharges to a hospice in the last 90 days of life. <h3>Method</h3> Mixed methods study with a quantitative quasi-experimental longitudinal design employing a ‘difference of difference’ analysis of HES data to assess the impact on hospital utilisation in the last 90 days of life. Any encountered differences are compared to control cohorts. Stakeholders were qualitatively interviewed through open-ended, semi-structured and structured interviews followed by narrative, framework and content analysis respectively. <h3>Results</h3> Quantitative: ongoing, however, we anticipate data showing a reduction in the number of hospital beds days, in the last 90 days of life, within the locality of the intervention hospice. Qualitative: interviewed 188 people, including 24 patients and carers, across 27 interventions at 25 sites providing 31 recurrent topics of which the five most relatively frequent were the process of development, collaboration, the intervention group, staff roles and professional culture. <h3>Conclusions</h3> Qualitative evaluation of these innovations shows benefit to the patient experience and factors critical to success and replicability. Quantitative data will show the impact on NHS resources, and together the findings will enable better evidence-based commissioning, supporting service redesign at a local level. Final report due Sept. 2018.