Reduction Of Beds Research Articles

Age has an independent association with total cost of care in adults admitted to pediatric hospitals.

Previous studies in adults admitted to pediatric hospitals primarily investigated associations between complex chronic condition characteristics and patient outcomes. Our study explored the association of age with length of stay (LOS) and total cost in these adults, accounting for other patient factors. Using the Pediatric Health Information System, we included 1,215,736 patient encounters from 2021 to 2022. Unadjusted and adjusted analyses were performed using bivariable and multivariable log-linear regression. There was a significant positive association between age and total cost, with adults 18-20 years having 13% higher total cost (95% confidence interval [CI]: 12%-15%), 21-25 years with 25% higher total cost (95% CI: 22%-29%), and 25-99 years having 72% higher total cost (95% CI: 66%-79%) than 1-17 years. Our findings suggest expanding upon the existing status quo to identify the most appropriate environment to care for this unique and growing population, especially given the anticipated reduction in pediatric beds and subspecialty expertise.

Hip Fracture Incidence Over Twenty Years in Poland: The HiPoL Study

Introduction: In the previous report, we noted a significant increase in hip fracture incidence in the local study area. The aim of the study was the continuous observation of hip fracture incidence in the local community over the last 20 years and to estimate their projection for the next 30 years.Methods: Medical records of the patients aged 50 years and older in the period 2002 – 2021 (local data – area of the district Tarnowskie Góry and the city of Piekary Śląskie) with diagnosis ICD-10: S72.0; S72.1; and S72.2 (only the fragility fractures) were taken into analysis.Results: 2,723 fragility hip fractures in the local area were registered (72 % in women). The increase in the rate was constantly observed, even during the COVID – 19 pandemic. The incidence rate ratio for the local population increased to 1.41. The incidence rate in 2021 was for the total population 230.2 (men 151.3; women 294.2). For comparison in 2002, it was 129.0 (men 48.8; women 192.4). In 2050 the number of fractures according to our new estimation will increase.Conclusions: The number of fragility hip fractures in Polish men and women aged over 50 years in the local population increased. The epidemiological situation is still worsening. Therefore, especially due to the reduction of orthopedic beds and the aging population phenomenon the situation will be tragic to our patients.

Why Patient-Centered Built Environment Standards Matter More Than Numbers of Beds in Inpatient Psychiatry.

This article canvasses extant literature about values, evidence, and standards for inpatient psychiatry units' design. It then analyzes apparent trade-offs between quality of care and access to care using empirical and ethical lenses. From this analysis, the authors conclude that standards for the built environment of inpatient psychiatric care should align with patient-centeredness, even if a downstream consequence of implementing new patient-centered designs is a reduction in beds, although this secondary outcome is unlikely.

Resource Provision of the Obstetric Service of St. Petersburg with Beds and Medical Personnel

Introduction. In the context of a declining birth rate, maintaining and improving the level of women's reproductive health is the main task in the activities of the obstetric service, the normal functioning of which is impossible without satisfactory resource provision.
 Purpose. To conduct a comparative assessment of the resource provision of the obstetric service of St. Petersburg with obstetric beds and medical personnel with indicators in the Russian Federation and the Northwestern Federal District in dynamics for 2017–2021.
 Material and methods. Using the information obtained from statistical collections Federal State Budgetary Institution «Central Research Institute for the Organization and Informatization of Healthcare» of the Ministry of Health of Russia, a comparative assessment of the indicators of the provision of the obstetric service of the metropolis with obstetric beds and medical personnel in dynamics over five years was carried out. Statistical analysis of the obtained data was carried out using StatSoft STATISTICA 10.0.
 Results. In 2017–2021 the obstetric service of the metropolis had a lower, compared with Russia and the Northwestern Federal District, availability of obstetric beds, more than half of which were beds for pregnant women and women in childbirth. In the dynamics of the provision of St. Petersburg with obstetric beds in general, beds for pregnant women and women in childbirth, and beds for the pathology of pregnancy, a trend of annual reduction in beds, common with the Russian Federation and the federal district, was observed. However, the rates for all obstetric beds have declined less significantly than the national and county averages. Provision of women of childbearing age in St. Petersburg with obstetrician-gynecologists exceeded the average figures for Russia and the Northwestern Federal District. With the annual negative dynamics of the decrease in the provision of the obstetric service in the Russian Federation and the federal district with medical personnel, in the metropolis the increase in obstetrician-gynecologists for five years was 1.6 %, and the provision with midwives decreased less significantly. The contribution of the metropolis to the obstetric bed fund and medical personnel of the obstetric service of the federal district was more than a third and increased almost every year.

Surgical treatment of respiratory tuberculosis patients in the Siberian and Far Eastern Federal Districts during the initial period of the COVID-19 pandemic

The objective: to analyze the quality of phthisiosurgical care in the Siberian and Far Eastern Federal Districts monitored by Novosibirsk Tuberculosis Research Institute (NTRI).Subjects and Methods. Statistical reports for 2019 from phthisiosurgical departments of 17 Russian regions within the Siberian and Far Eastern Federal Districts were analyzed. The reports refl ected the initial period of the pandemic.Results. The analysis of the quality of phthisiosurgical care in the Siberian and Far Eastern Federal Districts covered the areas monitored by Novosibirsk Tuberculosis Research Institute, the Russian Ministry of Health. The main performance rates of phthisiosurgical departments of 17 Russian regions are presented for 2019, they demonstrate a positive trend, and their facilities and resources have signifi cantly improved. The trend towards reduction of phthisiosurgical beds is observed in the regions, which may be due to the service centralization and improved access to surgical and high-tech care in federal institutions. Surgical departments possesses substantial reserves for increasing the number of surgeries, one of which is the revision of cohorts.

The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion.

The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.

Influencia de la pandemia por Covid 19 en el trasplante de órganos

On 31 December 2019 COVID-19 Viral infection was diagnoses. On june 2020 only in 188 countries 33 millons of infected people were detected. Unfortunately in Spain the results of the treatment has been worse than in Germany, Italy, Corea, Taiwan., Grece, Portugal, France, Japan, and others. 778 transplanted patients were infected. 249 of them in Madrid area. Organ donation was reduced. National Organization of Organ Trasplantation diminished donation, and transplantation of kidney, liver, heart, lung close to 90% (in april, 0%) from march to july 2020. Living rolated or split, and cluster trasplantation was not permited. In Madrid area, on 2020 were done 37 transplantation less than in 2019 the causes of that were the reduction of UCI beds, time in the OR, reduction of doctors and nurses. 861.112 infected people, 32.992 died and from the total number of patients, 36.000 were included as, doctors, nurses and other related with health care areas new protocols, hospitals, intensive care areas, etc were established along 2020 going back to the previous results obtained during 2018-2019.

The fiftieth anniversary of the article that shook up psychiatry.

In January 2023, the fiftieth anniversary passes of David Rosenhan's article On being sane in insane places appearing in the prestigious journal "Science". This publication has become one of the most influential psychiatric papers of the second half of the 20th century, achieving 1,276 citations up to mid-2022. In the article, eight healthy persons are described, who came to psychiatric hospitals in the USA, reporting auditory hallucinations. They were all admitted, mainly with suspected schizophrenia, and ordered pharmacological treatment. Their stay ranged from 7-52 (mean 19) days, even though after the admission they did not confirm the symptoms. The article spotlighted an unjustified diagnosis of mental illness, resulting in psychiatric hospitalization in unfavorable conditions. Its consequences were manifold. It augmented the process of psychiatric deinstitutionalization and provided food for anti-psychiatric movements and humanistic psychiatry. However, it did accelerate the inception of an objective system of psychiatric diagnosis in the form of the 3rd edition of the Diagnostic and Statistical Manual (DSM-III), released in 1980. Susannah Cahalan's book The great pretender, published in 2019, undermines the reliability of the article. Based on many interviews and Rosenhan's notes, she pointed out many faults of the experiment. She was not able to retrospectively confirm the identities of the majority of participants, nor to receive the essential information from "Science". On the fiftieth anniversary of the article, its cognitive value for an objective diagnosis of mental illness and the role of psychiatric hospitalization as well as the negative consequences in the form of a drastic reduction of psychiatric beds in the USA are emphasized.

Australian older persons mental health inpatient and ambulatory services in 2015-2020 - A descriptive analysis and commentary.

To provide a commentary on Australian state/territory older persons mental health service (OPMHS) expenditure, inpatient and outpatient services and key performance indicators (KPIs). Descriptive analysis of data from the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics and the World Health Organisation. Between 2015-16 and 2019-20, annual expenditure on OPMHS in Australia increased by an average of only 2.3%, compared to 2.9% for all population groups, despite an increase in the number of over 65 year olds. Per capita recurrent expenditure on OPMHS decreased by an average of 1% annually. Australia's total mental health beds increased, whereas OPMHS beds decreased, mainly due to a reduction in non-acute beds. Outcomes for OPMHS admissions were similar to other age groups, except for a longer length of stay and reduced readmission rate. Older Australians accessed ambulatory mental health care at a lower rate and had a lower rate of improvement after a completed episode. OPMHS expenditure has not increased at commensurate levels compared to other populations. The mental health of people aged over 65 appears to be a neglected policy priority in Australia. The Royal Commission into Aged Care Quality and Safety may herald service and expenditure changes.

133 A CO-ORDINATED EFFORT: THE ADDITION OF A REHABILITATION COORDINATOR TO GERIATRICIAN LED OLDER PERSONS REHABILITATION SERVICES

Abstract Background It is well recognised that acute illness and hospitalisation can be associated with significant deterioration in mobility and function in older people. Flow to appropriate rehabilitation services has impacts not only on individual recovery but also in efficient utilisation of healthcare resources. This study describes the impact of a therapy trained Rehabilitation Coordinator (RC) on access to off-site inpatient and day hospital specialist rehabilitation services. Methods Over 6 months the rehabilitation coordinator collaborated with acute and community services to triage, assess and effectively utilise off-site specialist rehabilitation services with specific reference to role development, feasibility and safety. Key performance indicators measured included assessments completed, time from referral to assessment, time from accepted to transferred, number of admissions and length of stay. This data was compared against a 6-month control. Results The rehabilitation coordinator was involved in over 445 assessments (n=258 patients) in the 6 months of the study. Trusted assessment by the RC was assessed as equivalent to assessments completed by Consultant Geriatricians. COVID restrictions resulted in a reduction in available rehabilitation beds between the control and pilot periods. There was a 22% increase in rehabilitation admissions and a 63% reduction in mean length of stay during the pilot period. There was also a reduction in average time from referral to assessment (1.5 working days versus 5.6 workings days); and time to transfer to rehabilitation (2.1 days versus 6.7 days). New pathways of care developed included rapid access to day hospital care from acute inpatient care. Additional benefits were seen in RC-led education, quality improvement and research projects. Conclusion The addition of a rehabilitation coordinator enhanced patient access to and progress through inpatient and outpatient older person’s rehabilitation services. The RC provided both oversight and continuity of care throughout the patient journey between hospital and home.

Surgical Care under COVID-19 Pandemic Conditions (Literature Review)

Since March 2020, when COVID-19 pandemic was declared by WHO, the new coronavirus infection has spread widely around the world, claiming many lives and destroying the economies, social structures, and various aspects of people’s lives. The pandemic has had a major impact on health facilities, including the surgical service. The healthcare system had to completely reorganize its methods of work. The need to deploy a significant number of infectious disease beds necessitated the convertion of many medical organizations into Covid hospitals, with a reduction in surgical units and beds. The scheduled surgical operations were therefore cancelled and postponed. Emergency surgical care was provided as needed, albeit in a reduced scope. The number of patients seeking emergency surgical care decreased mainly due to the fear of contracting COVID-19. The data show that there is a significant increase in the number of perioperative complications and mortality, especially in patients with acute surgical pathology and co-occurring COVID-19. The paper presents the data from professional literature on the peculiarities of surgical care in the context of the coronavirus pandemic, changes in a number of obligatory indicators of the quality of surgical care for patients.

The health cost of reducing hospital bed capacity

In the past two decades, most high-income countries have reduced their hospital bed capacity. This could be a sign of increased efficiency but could also reflect a degradation in quality of care. In this paper, we use repeated cross-sections on mortality and staffed hospital beds per capita in all 21 Swedish regions to estimate the potential death toll from reduced bed capacity. Between 2001 and 2019, mortality and beds decreased across all regions, but regions making smaller bed reductions experienced on average greater decreases in mortality, equivalent to one less death per three beds retained. This estimate is stable to a wide range of specifications and to adjustment for potential confounders, which supports a causal interpretation. Our results imply that by providing one more bed, Swedish health care could produce about three quality-adjusted life years (QALYs) at a cost of SEK 400,000 (∼US$40,000) per QALY. These findings could be informative about the marginal productivity of health care and support the credibility of empirical work attempting to estimate the opportunity cost of funding new healthcare interventions subject to a constrained budget.

Capillary rarefaction during bed rest is proportionally less than fibre atrophy and loss of oxidative capacity.

Muscle disuse from bed rest or spaceflight results in losses in muscle mass, strength and oxidative capacity. Capillary rarefaction may contribute to muscle atrophy and the reduction in oxidative capacity during bed rest. Artificial gravity may attenuate the negative effects of long-term space missions or bed rest. The aim of the present study was to assess (1) the effects of bed rest on muscle fibre size, fibre type composition, capillarization and oxidative capacity in the vastus lateralis and soleus muscles after 6 and 55days of bed rest and (2) the effectiveness of artificial gravity in mitigating bed-rest-induced detriments to these parameters. Nineteen participants were assigned to a control group (control, n=6) or an intervention group undergoing 30min of centrifugation (n=13). All underwent 55days of head-down tilt bed rest. Vastus lateralis and soleus biopsies were taken at baseline and after 6 and 55days of bed rest. Fibre type composition, fibre cross-sectional area, capillarization indices and oxidative capacity were determined. After just 6days of bed rest, fibre atrophy (-23.2±12.4%, P<0.001) and reductions in capillary-to-fibre ratio (C:F; 1.97±0.57 vs. 1.56±0.41, P<0.001) were proportional in both muscles as reflected by a maintained capillary density. Fibre atrophy proceeded at a much slower rate between 6 and 55days of bed rest (-11.6±12.1% of 6days, P=0.032) and was accompanied by a 19.1% reduction in succinate dehydrogenase stain optical density (P<0.001), without any further significant decrements in C:F (1.56±0.41 vs. 1.49±0.37, P=0.459). Consequently, after 55days of bed rest, the capillary supply-oxidative capacity ratio of a fibre had increased by 41.9% (P<0.001), indicating a capillarization in relative excess of oxidative capacity. Even though the heterogeneity of capillary spacing (LogR SD) was increased after 55days by 12.7% (P=0.004), tissue oxygenation at maximal oxygen consumption of the fibres was improved after 55days bed rest. Daily centrifugation failed to blunt the bed-rest-induced reductions in fibre size and oxidative capacity and capillary rarefaction. The relationship between fibre size and oxidative capacity with the capillary supply of a fibre is uncoupled during prolonged bed rest as reflected by a rapid loss of muscle mass and capillaries, followed at later stages by a more than proportional loss of mitochondria without further capillary loss. The resulting excessive capillary supply of the muscle after prolonged bed rest is advantageous for the delivery of substrates needed for subsequent muscle recovery.

COVID-19: retrospective analysis of cardiac surgery capacity in German heart centers

HintergrundUm Veränderungen in der herzchirurgischen Patientenversorgung während der COVID-19-Pandemie in Deutschland zu objektivieren, hat die Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) eine strukturierte Umfrage durchgeführt.MethodeAn dieser Umfrage unter 79 herzchirurgischen Fachabteilungen im Juni 2021 beteiligten sich 53 Fachabteilungen. Folgende Zeitpunkte wurden der Umfrage zugrunde gelegt: 01.01.2020 als Zeitpunkt vor Beginn der COVID-19-Pandemie und der 30.04.1921 als Stichtag für die Datenerhebung. Zu diesem Zeitpunkt war die „dritte Welle“ der Pandemie in Deutschland bereits abgeflaut, und eine Rückkehr zum Routinebetrieb erschien absehbar.ErgebnisAm 01.01.2020 standen den 53 teilnehmenden herzchirurgischen Fachabteilungen dauerhaft insgesamt 800 Intensivtherapiebetten zur Verfügung. Mit Stand zum 30.04.2021 hatte sich diese Intensivbettenkapazität um 25,6 % auf 595 reduziert. Auch die Anzahl der OP für herzchirurgische Eingriffe hatte sich während der beiden ersten „Lockdowns“ in Deutschland von 207 vor der Pandemie auf 152 reduziert (−26,6 %). Während der COVID-19-Pandemie wurden stationäre Bereiche umgewidmet, sodass 50,9 % der Teilnehmer angaben, dass ärztliches Personal und in 75,5 % der teilnehmenden Fachabteilungen auch pflegerisches Personal in spezielle COVID-19-Bereiche delegiert wurde.SchlussfolgerungSeit Beginn der Coronapandemie im Januar 2020 und dem Auslauf der „dritten Welle“ im Mai 2021 hat sich die herzchirurgische Versorgung in Deutschland erheblich verändert: Dies führte durch Schließung von Intensivbetten und OP in herzchirurgischen Fachabteilungen zu erheblichen Implikationen der Patientenversorgung.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00398-022-00527-5) enthalten.

Examining the Ratio of Obstetric Beds to Births, 2000-2019.

The number of U.S. births has been declining. There is also concern about rural obstetric units closing. To better understand the relationship between births and obstetric beds during 2000-2019, we examined changes over time in births, birth hospital distributions (i.e., hospital birth volume, ownership, and urban-rural designation), and the ratio of births to obstetric beds. We analyzed American Hospital Association Annual Survey data from 2000 to 2019. We included U.S. hospitals with at least 25 reported births during the year and at least 1 reported obstetric bed. We categorized birth volume to identify and describe hospitals with maternity services using seven categories. We calculated ratios of number of births to number of obstetric beds overall, by annual birth volume category, by three categories of hospital ownership, and by six urban-rural categories. The ratio of births to obstetric beds, which may represent need for maternity services, has stayed relatively consistent at 65 over the past two decades, despite the decline in births and changes in birth hospital distributions. The ratios were smallest in hospitals with < 250 annual births and largest in hospitals with ≥ 7000 annual births. The largest ratios of births to obstetric beds were in large metro areas and the smallest ratios were in noncore areas. At a societal level, the reduction in obstetric beds corresponds with the drop in the U.S. birth rate. However, consistency in the overall ratio can mask important differences that we could not discern, such as the impact of closures on distances to closest maternity care.

Does local community effort relate to neighbors' homelessness?

Interjurisdictional spillovers can compromise the effectiveness of homeless assistance policy and service provision, as individuals that become homeless in service deserts are forced to move to nearby communities that provide services they require. The resulting migration causes difficulties in accurately measuring the effectiveness of homeless assistance policies and hinders the establishment of measures aimed at ending homelessness at a regional level. The present investigation addresses these challenges by exploring how local community effort aided by government and nonprofit organizations relates to interjurisdictional outcomes. Our findings indicate that an increase in homeless services offered by nonprofit organizations in a community relates with fewer services (i.e., reduction in total beds per homeless person) and more homelessness in neighboring communities. Further, simultaneously increasing the number of both government and nonprofit organizations mitigates some of the negative spillovers. These findings augment the results yielded by previous research in this field, as they indicate that cross-sector collaboration can benefit the broader community and is more effective in reaching vulnerable populations and reducing homelessness than investing in government and nonprofit-led efforts executed independently.

Understanding the Effect of Economic Recession on Healthcare Services: A Systematic Review.

Background:We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.Methods:We developed a systematic review of scientific literature for the period 2008–2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles’ reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.Results:Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.Conclusion:Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.

On the issue of Moscow health care reforms: a review of publications

The article presents review of scientific publications from databases of CyberLeninka and RSCI related to Moscow health care reforms within the framework of the Moscow State program "The Development of Moscow health care (Metropolitan health care) for 2012-2020". The analysis established that during reforms positive shifts in Moscow health care system occurred, expressed by significant improvement in material and technical base of institutions, implementation of new diagnostic and treatment technologies, increasing of salary of medical workers, implementation of information technologies. However, the Moscow health care system continues to encounter challenges from problems related to staffing (especially the district service), high workload of medical personnel, insufficient level of motivation and low level of qualifications of medical workers. The implemented system of general medical practice did not contribute into strengthening the role of district physician as coordinator of patient flows. The fragmentation and lack of continuity in functioning of health care institutions remains too. The hospital-replacing technologies, designed to compensate reduction in beds, have not received development in primary health care. because of lacking of economic incentives for institutions and low tariffs. The serious problems associated with shortcomings in organization of functioning of medical institutions are established that requires further improvement of methods of analyzing functioning of medical institutions and organizational activities at all levels, considering effectiveness of activities implemented.

Community-Based Mental Health Services in Mexico.

This article describes the general characteristics of community-based mental healthcare in Mexico. Data from national surveys, special studies and statistics from the national information system during the period 2001-2017 are used. Available information on health systems, new regulations and the innovations implemented are reviewed, as well as research on psychosocial interventions conducted within the country. Data show a fragmented health system with services for workers and those without social security or private care. This is a treatment system essentially based on tertiary healthcare and not integrated into the general health system, with a significant treatment gap and delay in relation to the first treatment. At the same time, a slow but steady increase in the level of care provided at primary healthcare level and in specialized community services has been observed. This trend has been accompanied by an increase in the number of medical doctors, psychologists and, to a lesser extent, psychiatrists, incorporated into the primary healthcare services. At the same time, no new psychiatric hospitals have been built; there has been a proportional reduction in psychiatric beds but no increase in mental health services or beds allocated to first contact hospitals. Research initiatives have analysed the barriers to reform, and efficient interventions have been developed and tested for the community and for primary healthcare; special interventions are available for the most vulnerable but no formal efforts have been to facilitate their implementation. Evidence is available regarding the implementation of the transition from reliance on tertiary healthcare to reinforced primary care. At the same time, parity, financial protection, quality and continuity of care remain major challenges.

Access to care in the psychiatric sector: model success, funding failure

Access to care has always been at the heart of the concerns of the actors of psychiatry. History reminds us of this, from the alienist Philippe Pinel and his moral treatment to the creation of the Sector in 1960. The principle of sectorisation is the very organisational intelligence of French psychiatry. By proposing a continuity of care, in and out of hospital, by the same team, and a major focus on the prevention of disorders, the Sector guarantees access to care for all. This success is now being undermined. The reduction ofbeds accompanied by a financial loss, budget cuts or the demographic decline of practitioners arethe main ills of psychiatry, which must face the explosion of needs and demands for care.