Reduction Of Hospital Beds Research Articles

Human resource management in healthcare organizations

The article deals with changes in the human resources potential in the Russian health care system, which are the result of the reform of the medical sphere carried out in recent years. The COVID-19 pandemic, which began in early 2020, exposed significant shortcomings of the Russian healthcare reform, showing serious problems in the shortage of specialists, hospital beds, protective equipment, ventilators, tests, and medicines. The reduction of hospital beds and the number of infectious diseases doctors in order to increase the average salary in healthcare has led to the inability of the Russian healthcare system to cope with the spread of coronavirus infection without involving residents, professors, teachers and students of medical organizations. At the present stage of development, the issues of combating the spread of coronavirus infection, mobilization and professional training of medical workers are of particular relevance. Nevertheless, despite the results of the health care reform, which led to a massive reduction of medical organizations in our country, the number of doctors per 10,000 people in 2018 was 47.9 employees, over the past 20 years, has not changed much in the direction of reduction. In our view, we should not talk about a global reduction in human resources in healthcare. The existing personnel problems in healthcare are the low qualification of medical personnel and the General shortage of specialists in the labor market.

A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency: Pearls, Pitfalls, and Perspectives.

Objective:To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy.Summary of Background Data:COVID-19 emergency shocked national health systems, subtracting resources from treatment of other diseases. Its impact on surgical oncology is still to elucidate.Methods:A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in Italy.Results:In total, 54 surgical Units in 36 Hospitals completed the survey (95%). After COVID-19 emergency, 70% of Units had reduction of hospital beds (median −50%) and 76% of surgical activity (median −50%). The number of surgical procedures decreased: 3.8 (interquartile range 2.7–5.4) per week before the emergency versus 2.6 (22–4.4) after (P = 0.036). In Lombardy, the most involved district, the number decreased from 3.9 to 2 procedures per week. The time interval between multidisciplinary discussion and surgery more than doubled: 7 (6–10) versus 3 (3–4) weeks (P < 0.001). Two-third (n = 34) of departments had repeated multidisciplinary discussion of patients. The commonest criteria to prioritize surgery were tumor biology (80%), time interval from neoadjuvant therapy (61%), risk of becoming unresectable (57%), and tumor-related symptoms (52%). Oncological hub-and-spoke program was planned in 29 departments, but was active only in 10 (19%).Conclusions:This survey showed how surgical oncology suffered remarkable reduction of the activity resulting in doubled waiting-list. The oncological hub-and-spoke program did not work adequately. The reassessment of healthcare systems to better protect the oncological path seems a priority.

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease.

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality, and treatments require a multidisciplinary approach to address patient needs. This review considers different models of care across the continuum of exacerbations (1) chronic care and self-management interventions with the action plan, (2) domiciliary care for severe exacerbation and the impact on readmission prevention and (3) the discharge care bundle for management beyond the acute exacerbation episode. Self-management strategies include written action plans and coaching with patient and family support. Self-management interventions facilitate the delivery of good care, can reduce exacerbations associated with admission, be cost-effective and improve quality of life. Hospitalization as a complication of exacerbation is not always unavoidable. Domiciliary care has been proposed as a solution to replace part, and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital bed days, readmission rates and costs; low-risk patients can be identified using risk stratification tools. A COPD discharge bundle is another potentially important approach that can be considered to improve the management of COPD exacerbations complicated by hospital admission; it comprised treatments that have demonstrated efficacy, such as smoking cessation, personalized pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD bundles may also improve the transition of care from the hospital to the community following exacerbation and may reduce readmission rates. Future models of care should be personalized – providing patient education aiming at behaviour changes, identifying and treating co-morbidities, and including outcomes that measure quality of care rather than focusing only on readmission quantity within 30 days.

Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation

BackgroundPrevious models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients...

Study investigates use of children’s community nursing teams and the associated costs

Children’s community nursing teams (CCNT) provide acute, long-term, and end of life care at home rather than in hospital. Among many benefits for children and families, CCNTs may also reduce hospital bed use.

Details emerge of plans to cut NHS services in England.

Details have emerged of plans to cut NHS services as part of a major reorganisation of care across England. Proposals to close hospital wards, shut or downgrade emergency departments, and reduce hospital bed numbers were included in draft “sustainability and transformation plans” (STPs) drawn up by leaders in the NHS, local government, and other local healthcare services. The details of the plans, which are subject to consultation and sign off from NHS England, were disclosed by the campaign group 38 Degrees,1 which commissioned the healthcare consultancy firm Incisive Health to collate and analyse the proposals.2 The draft plans were drawn up after NHS England, in December 2015, instructed local leaders to work together to establish 44 STP “footprints” covering the whole of England. These footprints must meet the triple aims of improving health outcomes, improving …

Systematic Review and Meta-analysis of Geriatric Specialist Health Care Team Implementations to Reduce Hospital Bed Days for Older Adult Inpatients with Dementia and Cognitive Disorders

Systematic Review and Meta-analysis of Geriatric Specialist Health Care Team Implementations to Reduce Hospital Bed Days for Older Adult Inpatients with Dementia and Cognitive Disorders

Editorial

Readmissions to hospital have been a hot political issue for several years. Most of us working in acute medicine will have managed patients who – with hindsight – should have stayed in hospital a bit longer. Pressures to shorten length of stay, as a result of rising admissions combined with reduced hospital bed numbers over the past two decades have inevitably contributed to this. The rhetoric of blame implied by the terminology of ‘failed discharge’ is unhelpful, but emphasises the need for vigilance in discharge planning. Financial penalties levied on hospitals for exceeding negotiated levels of readmission, combined with their use as quality indicators for acute medical units keeps this high up in the priority list for physicians and managers. However there is another side to this. For many patients, readmission is a consequence of their disease process, rather than a failure of clinical care. The timing of discharge for patients with frailty, chronic or terminal disease requires a complex balance to be struck – readmission may sometimes be avoidable by keeping a patient in hospital for longer, but this is not always what the patient wants. The article in this edition by Tim Cooksley and colleagues highlights this issue in a specific group of patients with cancer. Their conclusion is that, in this patient group, readmission to hospital is not a useful quality indicator. Although the study was conducted in a tertiary cancer care unit, the key messages are of relevance to those working in general acute medical units, where patients with cancer often represent a significant proportion of admissions. Furthermore the article mentions some interesting innovations, such as a telephone ‘hotline’, which may be of benefit to other groups of patients managed in the acute medicine setting. This edition features a number of articles relating to the roles of junior doctors on the acute medical unit. The Acute Medicine trainee survey demonstrates that ‘variety’ is still one of the main attractions of the speciality, with over 75% of respondents indicating that this is one of the aspects that they most enjoyed about their training. However there is clearly much more work to be done to encourage more trainees to choose acute medicine as their career. One way to increase recruitment may be to improve the experience for foundation and core medical trainees on the AMU – the article by Eirini Kafsiki suggests that administrative tasks may be impacting on training time for this key group of junior doctors. The authors identify some solutions which have been applied locally, while Nicola Cooper’s viewpoint article explains how we might change perceptions of what constitutes ‘training’ on the AMU. Finally I am delighted that we have been able to publish the abstracts of the excellent oral presentations at the recent Society for Acute Medicine meeting in Bristol. Those who attended will be aware that this conference was also my final meeting as part of the SAM council, as my tenure has now come to an end. I would like to wish the conference committee well in their planning for the autumn meeting in Manchester on 10th-11th September, which is shaping up to be another great event. Hope to see you all there!

A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use

Background: Studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK.Aims: To observe the long-term effect of ACT on bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design.Methods: Bed use was compared for equal periods of time either side of starting support from an ACT team.Results: Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018).Conclusions: The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.

Reducing hospital bed use by frail older people: results from a systematic review of the literature

Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. WE SYSTEMATICALLY SEARCHED THE FOLLOWING DATABASES: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people.

Mental healthcare in the community

During the last decade or so, there has been a growing international recognition of the high burden of disease associated with mental health problems, with local research that supports this view. The most comprehensive study of common mental disorders in South Africa, the South African Stress and Health Study, carried out in 1999, showed a lifetime prevalence for these disorders of 30.3%. Of those who had had a mental disorder in the past year, only 25.2% sought treatment and a tiny number, 5.7%, used any formal mental health service. In the years since that study, the HIV/AIDS and substance abuse epidemics have contributed further to this burden, while at the same time mental health services have seen a reduction in hospital beds with de-institutionalisation, yet little growth in community-based services.

Dal team accoglienza al bed management ospedaliero

Reduction on number of hospital beds i.e. on patients' admission among hospitals in Lazio has lead to a reformulation of health service framework within Lazio indentifying hospital as the only place to go to treat acute and urgent diseases. San Camillo-Forlanini, the largest hospital in Rome, according to the regional health plan, the recovery plan and the redevelopment of network hospital has had a significant reduction of hospital beds leading, as consequence, to the need of an internal reorganization. In order to correctly address this issue, the management of the Hospital started in February 2008 a project, setting up a group made up by nursing coordinators which had as a main aim to manage the number of hospital beds needed for emergencies. This group has been called "Admission Team" and nurses within the group are familiar with hospital policies and organization. The team collaborates daily with physicians and nurses in emergency room, in order to decide the most appropriate health care protocol for each patient. The project follows a specific methodology i.e. Systemic Analysis. Over the years this project has contributed to the improvement to a number of indicators and more generally to the health care within the hospital together with the enhancement of education of new managerial roles among health professional. In 2009, the Regional Council of Lazio has recognized this project as strategic within private and public hospitals.

Gynaecological robotic surgery in an Irish setting—cost analysis

Robotic surgery is associated with reduced hospital stay compared with open surgery. While the initial outlay is expensive, the increased number of patients amenable to this minimal access approach compared with conventional ‘keyhole surgery’ has the potential for financial savings. Our aim was to show the cost per surgery and the potential for savings with increased caseload and reduced hospital bed stay. A cost analysis was performed incorporating an audit of robotic surgery over the initial 3 years. This was performed using prospectively acquired data completed after each robotically assisted case. Depreciation and maintenance on the robot accounted for an outlay of €260,000/annum. Due to the learning curves and hospital constraints, in year 1, an average of 1.5 cases were performed per week at a cost of €5,980/case, this cost reduced to €4,250 over the next 2 years with an increase to 2.4 cases/week. We projected that if maximum usage of nine cases/week was achieved the cost would reduce to €2,523/case. In 2010, 36 % of all hysterectomies were performed robotically. The average length of stay for robot-assisted cases was two nights compared to six to eight nights for open hysterectomy. The robotic approach is associated with savings of approximately €201,933/year compared with a similar tertiary referral hospital in Ireland with no robot. Purchasing a robot is costly but associated with greater cost savings when reduced length of stay is accounted for. Furthermore, maximisation of robotic use further decreases the cost per case.

PleurX Peritoneal Catheter Drainage System for Vacuum-Assisted Drainage of Treatment-Resistant, Recurrent Malignant Ascites

The PleurX peritoneal drainage catheter for drainage of malignant ascites in a community setting has been evaluated by the NICE Medical Technologies Evaluation Programme. This article outlines the evidence included in the Sponsor's submission, the independent critique by the External Assessment Centre (EAC) and the recommendations made by the Medical Technologies Advisory Committee (MTAC). In accordance with the scope issued by NICE, the intervention technology was the indwelling PleurX peritoneal catheter drainage system, the comparator was large-volume paracentesis (LVP; inpatient or outpatient) and the population was patients with treatment-resistant, recurrent malignant ascites. Nine studies (ten papers) were identified with a total of 180 PleurX-treated patients; six were case series with more than four patients that, despite being low in the hierarchy of evidence, provided useful safety information. Technical success of the initial PleurX placement procedure was 100% across five studies which reported this outcome. One study reported equal complication rates between patients treated with indwelling PleurX catheters (40 patients and 40 catheters) and those receiving repeated LVPs (67 patients and 392 procedures), 7.5% (3/40; 95% CI 1.6, 20) and 7.5% (5/67; 95% CI 2.2, 15), respectively. All remaining studies were single-arm and reported complication rates of between 0% and 59%; this wide range was largely due to variation in the definition of complications and adverse events. Using validated tools, one case series reported improvements in several ascites-related symptoms after placement of the PleurX catheter; however, an overall quality-of-life improvement at 12 weeks was not demonstrated. Positive patient opinions relating to improved symptom control and convenience were reported in a qualitative study. Cost analysis demonstrated that PleurX offered savings to the NHS when compared with repeated LVPs performed in an inpatient setting. This saving of £679 per patient was driven primarily by reducing hospital bed days (year 2009-2010 values), but would require 23.5 additional community nurse visits. Advice from clinical experts was that additional home visits were overestimated as many patients would receive such visits regardless of whether a PleurX drain had been fitted. The model demonstrated that PleurX would be more expensive than LVP procedures performed in a setting where one or less hospital bed days were used (e.g. day case or outpatient). There was uncertainty surrounding the number of patients for whom insertion of a PleurX drain would be appropriate as well as the point in the care pathway at which such treatment should be administered. MTAC supported the case for adoption and considered that the available evidence showed PleurX was clinically effective, has low complication rates, can improve quality of life and is less costly than inpatient LVP. In Medical Technology Guidance 9 (MTG9), NICE recommended that PleurX peritoneal catheter drainage system be considered for use in patients with treatment-resistant, recurrent malignant ascites.

The Impact of a Temporary Medical Ward Closure on Emergency Department and Hospital Service Delivery Outcomes

To describe the effect of a 3-week closure of a 28-bed medical ward on Emergency Department (ED) and hospital outcomes. This was a prospective comparative observational study of all ED attendances (visits; n = 11 383) made to a regional teaching hospital in Queensland, Australia, during a 9-week period (November 24, 2008-January 4, 2009). A 3-week period of ward closure was compared with equal time periods before and after. Hospital health information systems data were linked manually to describe and compare outcomes: median ED length of stay, access block, hospital length of stay, and in-hospital mortality. Ward closure reduced hospital bed capacity by 5.9%. During ward closure there was a higher proportion of access block (38% vs 33% in both pre- and posttimes), longer wait time to see a doctor, and longer overall ED length of stay, compared with pre-ward closure time period. Temporarily closing a medical ward had a negative effect on some ED and hospital outcomes. When major refurbishments are required, alternative capacity measures need to be considered to minimize the impact on health service delivery and patient outcomes. Reducing elective surgery and opening replacement beds elsewhere in the hospital are possible solutions.

Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision

The cost-effectiveness of Fracture Liaison Services (FLSs) for prevention of secondary fracture in osteoporosis patients in the United Kingdom (UK), and the cost associated with their widespread adoption, were evaluated. An estimated 18 fractures were prevented and £21,000 saved per 1,000 patients. Setup across the UK would cost an estimated £9.7 million. Only 11% to 28% of patients with a fragility fracture receive osteoporosis treatment in the UK. FLSs provide an efficient means to identify patients and are endorsed by the Department of Health but have not been widely adopted. The objective of this study was to evaluate the cost-effectiveness of FLSs in the UK and the cost associated with their widespread adoption. A cost-effectiveness and budget-impact model was developed, utilising detailed audit data collected by the West Glasgow FLS. For a hypothetical cohort of 1,000 fragility-fracture patients (740 requiring treatment), 686 received treatment in the FLS compared with 193 in usual care. Assessments and osteoporosis treatments cost an additional £83,598 and £206,544, respectively, in the FLS; 18 fractures (including 11 hip fractures) were prevented, giving an overall saving of £21,000. Setup costs for widespread adoption of FLSs across the UK were estimated at £9.7 million. FLSs are cost-effective for the prevention of further fractures in fragility-fracture patients. The cost of widespread adoption of FLS across the UK is small in comparison with other service provision and would be expected to result in important benefits in fractures avoided and reduced hospital bed occupancy.

Nidotherapy in the treatment of substance misuse, psychosis and personality disorder: secondary analysis of a controlled trial

Aims and methodTo examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.ResultsPatients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P= 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P= 0.03). The mean cost savings for each patient allocated to nidotherapy was £14705 per year, mainly as a consequence of reduced psychiatric bed use.Clinical implicationsNidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.

Primary care in an era of hospital bed reduction: what can we infer from QOF and PBC?

The Quality and Outcomes Framework (QOF) has been efficiently and effectively incorporated into practice routines. One possible negative effect of this has been a move towards a more biomedical form of practice.There has been patchy but real engagement with practice-based commissioning (PBC), with significant moves in some areas towards GPs acting collectively to improve services across the health economy, including engaging in performance management of each others' practice.Together, responses to QOF and PBC suggest that GPs may be willing and able to act both individually and collectively to try to mitigate the negative impacts of future spending reductions. General practice will be under a great deal of pressure in the next few years. Understanding the impact of past policy changes is essential if we are to ensure that the core values of general practice are maintained.

Anticipating the New Health Act: Messages from the Innovation Forum

Nine councils in the Innovation Forum for high‐performing local authorities voluntarily set a target of reducing hospital bed days for people aged 75+ by 20% over the three years to 2006/07. This kind of objective was new for the NHS, as much as for local government. It was motivated by a concern among the councils that hospital admission exposed residents to risks to their independence and well‐being which should be avoided wherever possible. They wished to demonstrate the value of the local authority community leadership or, as it has since become known, ‘place making’ role. Their success in meeting this target supports the new NHS White Paper's proposed transfer of functions and responsibilities from PCTs to councils. It suggests that councils can successfully adopt, in appropriate circumstances, the lead responsibility for ensuring strategic co‐ordination of place‐based commissioning in health and well‐being.

Diffusion of innovations in health care: Does the structural context determine its direction?

The aim of this study was to present and illustrate an instrument to measure the level of innovation at country level. The data used are the Organisation for Economic Co-operation and Development (OECD) health data 2009, in particular the information on use of medical technology. Two composite scales expressing a relative level of adoption of innovations in health care are regressed, using multilevel regression analysis, on country characteristics. The country characteristics are selected as proxies on availability or scarcity of resources in a country. We expect that scarcity will promote adoption of innovations that enhance efficiency, and that availability of resources will promote advanced, expensive innovations. Two scales were constructed. One scale indicates the use of efficiency-enhancing innovations (day case treatment), and the other scale indicates availability of advanced technical innovations. The application of day case treatment is significantly associated with education level (+), the ratio of people aged 15-64 versus younger and older people (+) and the number of hospital beds (-). Availability of advanced medical devices are associated with the expenditure on health (+), demographic dependency (-), number of hospital beds (+), and the annual reduction of hospital beds (-). Diffusion of innovations is influenced by characteristics of the country and of the healthcare system; fewer resources encourage diffusion of innovations that enhance efficiency and more resources encourage diffusion of complex, expensive devices. This indicates that decisions by healthcare professionals on which innovation to adopt is embedded in a context that is influenced and shaped by the availability of resources on macro level.