Short-stay Hospitals Research Articles

Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN

Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level. Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director.

Considerações da comissão de saúde suplementar do CBO sobre o tratamento com antiangiogenicos

Considerações da comissão de saúde suplementar do CBO sobre o tratamento com antiangiogenicos

Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery.

We hypothesized that improved acute postoperative pain relief will be achieved using general anaesthesia (GA) either in combination with continuous thoracic paravertebral block (GA-cPVB) or single shot (GA-sPVB) as compared to GA supplemented by local wound infiltration (GA-LWI) after unilateral major breast cancer surgery.A randomised controlled trial was conducted in 46 adult women in a day-care or short-stay hospital setting after major breast cancer surgery. Pain-intensity was measured using an 11-point visual analogue scale (VAS) until postoperative day 2. GA-sPVB was stopped due to slow inclusion.No significant difference in VAS score was noted between GA-LWI (VAS median 0.5 (interquartile range 0.18–2.00)) and GA-cPVB, (VAS 0.3 (0.00–1.55, p = 0.195)) 24 hours after surgery or at any point postoperatively until postoperative day 2.We conclude that both GA-LWI and GA-cPVB anaesthetic techniques are equally effective in treatment of acute postoperative pain after major oncological breast surgery. As GA-LWI is easily to perform with fewer complications and it is more cost-effective it should be preferred over GA-cPVB.

Perceived Hopelessness and Family Support among Elders in Long-Term Care Hospitals

Purpose: This study was conducted to examine the perceived hopelessness and family support among elders in long-term care hospitals. Methods: Participants were 226 elderly patients who were 65 years of age or over residing in two long-term care hospitals located in G city and J area. A structured questionnaire was used for measurement of levels of hopelessness and family support. Data were collected from February 1 to March 31, 2013. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation, and stepwise multiple regression analysis with the IBM SPSS Statistics 21.0 version program. Results: The mean score for hopelessness was 3.41, and the score for family support was 3.04. Family support, economic status, and period of hospitalization accounted for 24% of the variance in hopelessness. Conclusion: The findings indicate that family support and short-stay hospitalization are needed to decrease hopelessness in elderly people requiring long-term care. Individual intervention programs towards improvement in family support and shorter periods of hospitalization should be considered to decrease hopelessness.

Informatics: International Classification of Diseases-10: Implications for Nursing

One of the biggest events to hit healthcare data in decades is the conversion of coded clinical data to the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision, commonly referred to as ICD-10. The last change of this nature was in 1983 when Medicare implemented ICD-9 as part of the Inpatient Prospective Payment System (IPPS). Since that time, healthcare has advanced significantly and ICD-9 codes no longer represent the advances and complexities in care provided to patients; thus healthcare in the United States is expected to transition to ICD-10 on October 1, 2015.ICD-10 is intended to support the systematic recording, analysis, interpretation, and comparison of morbidity and mortality data from around the world (World Health Organization, 2011). There are two parts to ICD-10: ICD-10Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS). Compared to ICD-9-CM with 14,000 codes, ICD-10-CM has 69,000 available codes to be used for diagnosis codes on all inpatient and outpatient accounts. In ICD-9-PCS there are approximately 3,000 codes; this will change with ICD-10-PCS to 72,000 available codes to be used only for inpatient procedural coding.ICD-10 will touch everything from registration and scheduling, to revenue cycle and payer contracts, information systems, and ultimately will be used to improve patient care and outcomes. The important and widespread uses of ICD-10 data make it critical to understand these new documentation requirements. As healthcare prepares for ICD-10 and the coding of data using an electronic platform, it is important to ask, What are the implications for nursing? Although the answer to this question is not easily found, this informatics column will shed light on the issue by providing a sample case and highlighting the role of nurse informaticists in this historical change in healthcare data. We will conclude that nursing's role in data collection and entry is important in the building of the ICD-10 database, and that the benefits to be achieved from this monumental effort are dependent on accurate documentation and coding.Sample Case: Pressure UlcerPressure ulcer was chosen as a sample case to examine in this column due to the costs incurred in treating pressure ulcers. It was also chosen based on the historical precedent whereby staging of pressure ulcers has been coded in ICD-9-CM from nursing charting/documentation (.Cfin.ters..fQr-MlfidLcare-&jyiadicai,d..S.er.v:ic.es.l[CMS3-& .N,ati.Q.n.aL.Cen.ter for Health ..Statistics LN.CHS.].,. 2.Q.Q.S).MethodThe following steps were used to identify nursing documentation needs for pressure ulcers related to ICD-10.1. Define pressure ulcers.2. Download the ICD-10-CM codes and identify all diagnoses related to pressure ulcers.3. Identify the data elements, i.e., the words used, in the pressure ulcer diagnoses in ICD-10-CM codes.4. Identify related data elements in the current electronic health record (EHR) nursing documentation on pressure ulcers.5. Perform a gap analysis between current EHR documentation by nurses on pressure ulcers and what is needed for nursing documentation in ICD-10-CM.6. Reconcile findings with other databases using nursing documentation on pressure ulcers in short-stay hospitals.7. Collaborate with health information management (HIM) to validate findings.8. Present findings to Chief Nursing Officers, as well as wound care nurses and physical therapists.9. Work with information technology EHR builders to build the data base related to ICD-10-CM that is needed for nurses to document in the EHR.10. Prepare educational materials for staff nurses regarding the changes in pressure ulcer documentation for ICD-10-CM.11. Pilot education materials among staff nurses, making adjustments as needed.12. Disseminate educational materials/offerings regarding nursing documentation of pressure ulcers related to ICD-10-CM. …

Length of hospitalisation for people with severe mental illness.

In high-income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically although considerable variation remains. In lower-income countries this variation may be greater. Some argue that reduction in hospital stay leads to 'revolving door admissions' and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care. To evaluate the effect of short stay/brief admission hospital care with long stay/standard in-patient care in people with serious mental illness. We searched the Cochrane Schizophrenia Group's register of trials, July 2007 and updated this search in May 2012. We included all randomised controlled trials comparing planned short/brief with long/standard hospital stays for people with serious mental illnesses. We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based using a fixed-effect model. For continuous data, had we identified such data, we planned to calculate fixed-effect mean differences (MD). We assessed risk of bias for included studies and rated quality of evidence using GRADE. We included six relevant trials undertaken between 1969 and 1980. We found no significant difference in death (n = 175, 1 RCT, RR in the longer term 0.42, CI 0.10 to 1.83, very low quality evidence). In the long term, there was no difference in improvement of mental state (n = 61, 1 RCT, RR 3.39, CI 0.76 to 15.02, very low quality evidence). There was no difference in readmission to hospital (n = 651, 4 RCTs, RR by the long term 1.26, CI 1.00 to 1.57, low quality evidence). Data for leaving the study prematurely by the longer term showed no difference (n = 229, 2 RCTs, (RR 0.77, CI 0.34 to 1.77, low quality evidence). There was a significant difference favouring short stay (P = 0.01) in numbers of participants with delayed discharge from hospital exceeding the time planned in study (n = 404, 3 RCTs, RR in the longer term 0.54, CI 0.33 to 0.88, low quality evidence). There was no difference in numbers of participants lost to follow-up (n = 404, 3 RCTs, RR by the longer term 1.07, CI 0.70 to 1.62, low quality evidence). Finally, there was a significant difference favouring short-stay hospitalisation for social functioning, including unemployment, unable to housekeep, or unknown employment status (n = 330, 2 RCTs, RR by longer term 0.61, CI 0.50 to 0.76, very low quality evidence). The effects of hospital care and the length of stay is important for mental health policy. We found limited low and very low quality data which were all over 30 years old. Outcomes from these studies do suggest that a planned short-stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified especially where a short-stay policy is not routine care.

Ambulatory management of gastrointestinal emergencies: What are the current literature data?

Ambulatory management is a modality of care defined in France by a hospitalization of less than 12h without an overnight stay. Currently, few data are available on its role in the management of gastrointestinal emergencies, such as appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis or emergency proctologic surgery. The aim of this systematic review was to study the published data regarding the feasibility of ambulatory management of emergency visceral surgery and to enquire about the possibilities of further development of this form of management. A literature search was conducted from the PubMed(®) databank taking into account all published data up to July 2013. For acute appendicitis, the success rate of short-stay hospitalization was 72% with unplanned read-mission rates ranging from 0 to 53%, a rate of unscheduled consultations ranging from 0 to 11%, and unplanned inpatient hospitalization rates ranging from 0% to 5%. For acute cholecystitis and proctology, there are few published data. Ambulatory management has been sparingly studied in the setting of gastrointestinal surgical emergencies. However, there is probably a place for development of this form of management.

Trends in short-stay hospitalizations for older adults from 1990 to 2010: implications for geriatric emergency care

IntroductionGeriatric patients are more likely than younger patients to be admitted to the hospital when they present to the emergency department (ED). Identifying trends in geriatric short-stay admission may inform the development of interventions designed to improve acute care for the elderly. ObjectiveTo evaluate trends in US geriatric short-stay hospitalizations from 1990 to 2010. MethodsRetrospective study using the National Hospital Discharge Survey (NHDS). Trends in short-stay hospitalizations were analyzed from 1990 to 2010 for age groups 22 to 64, 65 to 74, 75 to 84, and at least 85 years using linear regression. ResultsA total of 4.5 million survey visits representing 580 million adult hospitalizations were available for analysis; 250 million (43%) were among patients 65 years or older. Of these, 12%, 25%, and 40% were ≤1, ≤2 and ≤3 days' short-stay admissions, respectively. Between 1990 and 2010, short-stay admissions increased as a percentage of total hospitalizations for each geriatric age group but remained relatively constant for younger adults. Admissions from NHDS were similar to admissions from the ED for years where ED-specific data were available. The older a patient was (age >65 years), the more likely their admission was to have started in the ED. DiscussionFor all elderly patients, short-stay admissions represented a growing proportion of total admissions, regardless of the definition of short stay. These trends were identified despite the NHDS exclusion of observation status hospitalizations. The increase in short-stay admissions was the most pronounced in the extreme elderly (age ≥85 years). Future research is needed to optimize treatment for geriatric patients presenting to the ED, some of whom, with brief observation and appropriate follow-up, may be better cared for without hospitalization.

Pulmonary Embolectomy in Elderly Patients

ObjectiveThe relation of age to case fatality rate in patients undergoing pulmonary embolectomy has not been reported. In view of the importance of age in the selection of patients who may be candidates for pulmonary embolectomy, we explored the database of the Nationwide Inpatient Sample to determine the impact of age on the case fatality rate. MethodsPatients with pulmonary embolism who underwent pulmonary embolectomy in short-stay hospitals throughout the United States, 1999-2008, were identified from the Nationwide Inpatient Sample. In-hospital all-cause case fatality rate was assessed according to age. ResultsThe proportion of patients who underwent pulmonary embolectomy decreased with age among both stable and unstable patients. Case fatality rate with pulmonary embolectomy in stable patients increased with age beginning at age 51 to 60 years. Among patients aged 51 to 60 years, the case fatality rate was 100 of 575 (17.4%). This rate increased to 60 of 130 (46.2%) among patients aged more than 80 years (P < .0001). The case fatality rate did not correlate with age in unstable patients. ConclusionsThe case fatality rate with pulmonary embolectomy in stable patients increases with age greater than 51 to 60 years and is high among the elderly. The case fatality rate with pulmonary embolectomy in unstable patients does not seem to be related to age.

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics. This was a retrospective, cross-sectional analysis of ED psychiatric visits for children<18years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors. From 2001 to 2010, an average of 28.3 million pediatric visits to EDs occurred annually. Among those, an approximately 560,000 (2% of ED visits) were psychiatric visits each year. Pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010 (p=0.01). Teenagers (adjusted odds ratio [AOR]= 3.92, 95% confidence interval [CI]=3.37 to 4.57) and publicly insured patient visits (AOR= 1.47, 95% CI=1.25 to 1.74) had increased odds of psychiatric ED visits. Pediatric ED psychiatric visits are increasing. Teenagers and children with public insurance appear to be at increased risk. Further investigation is needed to determine what the causative factors are.

Case Fatality Rate with Vena Cava Filters in Hospitalized Stable Patients with Cancer and Pulmonary Embolism

BackgroundIn view of the high risk of pulmonary embolism in patients with cancer, we tested the hypothesis that stable patients with pulmonary embolism who have cancer might be a subset of patients who would show a lower case fatality rate with vena cava filters than without filters. MethodsStable patients with pulmonary embolism and cancer at discharge from short-stay hospitals throughout the US from 1998-2009 were identified from the Nationwide Inpatient Sample. Patients with pulmonary embolism who had a diagnostic code for shock, ventilatory support, thrombolytic therapy, or pulmonary embolectomy were excluded because such patients have been shown to have lower case fatality rate with filters. ResultsIn-hospital all-cause case fatality rate was lower with vena cava filters in stable patients with pulmonary embolism and solid malignant tumors providing they were aged >30 years, but there was variability according to type of tumor and age of patient. On average, case fatality rate among those >30 years with filters was 7070 of 69,350 (10.2%) (95% confidence interval, 10.0-10.4) versus 36,875 of 247,125 (14.9%) (95% confidence interval, 14.8-15.1) without filters (P <.0001) (relative risk 0.68). Among stable patients with hematological malignancies, case fatality rate, except in the elderly, was higher among those with vena cava filters than those without filters. ConclusionStable patients with pulmonary embolism and solid malignant tumors who are older than age 30 years appear to be a subset of patients with pulmonary embolism who would benefit from vena cava filters, but this needs to be tested prospectively.

A short-stay unit for thyroidectomy patients increases discharge efficiency

BackgroundPatients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. MethodsA retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. ResultsA total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). ConclusionsA designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow.

Abstract 6: What Proportion of High-Cost Patients’ Inpatient Spending is Preventable?

Objective: A small proportion of patients accounts for a substantial proportion of healthcare spending in the U.S., and the majority of costs in this group are due to inpatient hospitalizations. Many interventions targeting high-cost patients have aimed to prevent hospitalizations for common medical conditions. However, there is surprisingly little data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable. We sought to determine the proportion and dollar value of preventable hospitalizations among the high-cost Medicare population, and if these patterns differ for non-high-cost beneficiaries. Methods: We assigned standardized costs to each inpatient and outpatient service contained in standard 5% Medicare files from 2009. Patients under the age of 65, those with any Medicare Advantage enrollment, and those who died during in 2009 were excluded. Costs were summed across the year and across settings for each patient in our sample. We defined those in the top decile of cost as “high-cost” patients. We then used the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) to identify potentially preventable hospitalizations. These include conditions such as heart failure, diabetes, hypertension, and asthma, for which good outpatient care can potentially prevent the need for hospitalization. We calculated the proportion of short-stay acute-care hospital costs that were accounted for by these preventable hospitalizations for the high-cost and non-high-cost patient groups. All costs are projected to the total Medicare sample. Results: There were 1,710,989 patients in our sample. High-cost patients were older (median age 75 versus 73), more often male (43.2% versus 39.3%), and more often black (12% versus 9%) than non-high-cost patients, and had a higher burden of comorbid illnesses. Inpatient spending, projected to the total Medicare population, was $90.3 billion. The 10% of Medicare patients that made up the “high-cost” cohort accounted for 72% ($65 billion) of all inpatient spending. However, within the high-cost group, only 9.7% of the spending ($6.3 billion) was due to preventable hospitalizations, while the remaining 90.3% ($58.9 billion) was spent on other causes of hospitalization. Within the non-high-cost group, though their overall spending was lower, a slightly higher proportion of hospitalizations were potentially preventable (14.7%, or $3.7 billion). Conclusions: Though high-cost patients account for the majority of inpatient spending, fewer than one in ten of their hospitalizations are potentially preventable through better outpatient care. Thus, focusing on outpatient interventions such as case management may not be optimally targeted. We also need strategies that make hospital care more efficient so that each episode of inpatient care is less expensive regardless of its cause.

COPD Surveillance—United States, 1999-2011

This report updates surveillance results for COPD in the United States. For 1999 to 2011, data from national data systems for adults aged ≥ 25 years were analyzed. In 2011, 6.5% of adults (approximately 13.7 million) reported having been diagnosed with COPD. From 1999 to 2011, the overall age-adjusted prevalence of having been diagnosed with COPD declined (P = .019). In 2010, there were 10.3 million (494.8 per 10,000) physician office visits, 1.5 million (72.0 per 10,000) ED visits, and 699,000 (32.2 per 10,000) hospital discharges for COPD. From 1999 to 2010, no significant overall trends were noted for physician office visits and ED visits; however, the age-adjusted hospital discharge rate for COPD declined significantly (P = .001). In 2010 there were 312,654 (11.2 per 1,000) Medicare hospital discharge claims submitted for COPD. Medicare claims (1999-2010) declined overall (P = .045), among men (P = .022) and among enrollees aged 65 to 74 years (P = .033). There were 133,575 deaths (63.1 per 100,000) from COPD in 2010. The overall age-adjusted death rate for COPD did not change during 1999 to 2010 (P = .163). Death rates (1999-2010) increased among adults aged 45 to 54 years (P < .001) and among American Indian/Alaska Natives (P = .008) but declined among those aged 55 to 64 years (P = .002) and 65 to 74 years (P < .001), Hispanics (P = .038), Asian/Pacific Islanders (P < .001), and men (P = .001). Geographic clustering of prevalence, Medicare hospitalizations, and deaths were observed. Declines in the age-adjusted prevalence, death rate in men, and hospitalizations for COPD since 1999 suggest progress in the prevention of COPD in the United States.

Accreditation of hospitals in Lebanon: is it a worthy investment?

This study explores the views of Lebanese hospitals on the worthiness of accreditation vis-à-vis its associated expenses in addition to examining the type and source of financial investments incurred during the accreditation process. Observational cross-sectional design. All private short-stay hospitals registered with the Syndicate of Private Hospitals in Lebanon (110 hospitals). Hospital's views on the worthiness of accreditation in lieu of its associated expenses. Other measures explored included areas of expenditure increase and sources of expenses coverage for accreditation. Three-fifths of responding hospitals (63% response rate) considered accreditation as a worthy investment. Favorable views on accreditation were mostly related to its effect on enhanced quality and safety culture. Unfavorable views regarding the worthiness of accreditation investment were justified by absence of link with enhanced tariffs from payers (25.7%). All hospitals incurred increased expenses due to accreditation. Areas of highest increase included training of staff (95.7%), consultants' costs (80.0%) and infrastructure maintenance (77.1%). Most of the hospitals covered expenses through internal absorption (52%) or bank loans (45.7%). The financial burden of accreditation on hospitals has to be factored in the decision of its adoption at a national level, especially in developing countries.

Reducing short-stay hospital admissions by ruling out non-ST elevation myocardial infarction and estimating coronary artery disease likelihood on an emergency department observation ward.

Chest pain is an important presentation in adult patients attending emergency departments (ED). The process of ruling out an acute coronary syndrome (ACS) conventionally requires a short in-patient stay. This places a significant burden on healthcare systems. Recent developments have encouraged us to explore the role of an ED observation ward in the management of these patients.We designed and implemented two proformas (‘flowformas’). The first provides integrated guidance and documentation for the management of chest pain in the ED. In patients determined to be at low risk of short-term adverse outcomes the ACS rule-out process is now completed on the ED observation ward rather than on the cardio-respiratory admission ward. The second proforma is used before discharge to determine the likelihood of underlying coronary artery disease (CAD), thereby allowing risk-based follow-up arrangements to be made. We collected data on all patients admitted to EDU on the NSTEMI rule-out pathway over a 12-month period.Between Feb 2012 and Feb 2013, 816 patients fulfilling the criteria were admitted on the pathway. 67 patients (8%) required admission due to ACS. 15 patients were admitted on two, and one on three occasions.In conclusion, it is possible to deliver ACS rule-out on an emergency observation ward. This reduces healthcare costs and shortens hospital stay.

Economic crisis: cost and effectiveness of short stay hospital units

Length of stay is the main determinant of the cost of hospitalization, which is why strategies must be implemented to reduce conventional hospital stays while maintaining quality levels. Short Stay Units (SSU) were created with the aim of reducing hospital stays in a certain group of patients and pathologies. The aim of this paper is to evaluate the literature on the evidence of decreased length of stay, efficiency, readmissions in the emergency department, cost-effectiveness, and mortality of these units. We made a systematic review of the literature, using the MeSH terms "Observation Unit", "Short-Stay Ward", "Monday to Friday Clinic" , "Monday to Friday Surgery Ward", "Short Stay Hospitalization", "Alternative to Conventional Hospitalization", "Alternative Admissions" in the MEDLINE database, Web of Knowledge and the Cochrane Library from January 1 1960 to January 1 2012. The studies reviewed were selected according to the U.S. Preventive Services Task Force Protocol. The SSU made it possible in certain groups of patients to reduce the period of stay and maintain efficiency, showing no increases in emergency readmissions or mortality. The SSU can be an instrument to reduce the cost of the health process in a certain group of pathologies.

En plena crisis económica: coste y efectividad de las unidades de estancia corta hospitalarias

Background and objectives: the length of stay is the main determinant of the cost of hospitalization, must implemented strategies to reduce conventional hospital stay keeping quality levels. Stay Units (UEC) are born with the aim of reducing hospital stay a group of patients and pathologies. The aim of this is paper is to evaluate the literature on the evidence of decreased length of stay, efficiency, readmisions the emergency department, cost-effectiveness, and mortality of these units. Methods: We performed a systematic review of the literature, using the MeSH terms Observation Unit, Short-Stay Ward, Monday to Friday Clinic Monaday to Friday Surgery Ward, Short Stay hospitalization , Alternative to Conventional hospitalization , Alternative Admissions in MEDLINE database and Cochrane Library from January 1, 1960 to November 30, 2011. The studies reviewed were selected according to the U.S. Preventive Services Task Force Protocol. Results: The UEC allowed certain group of patients, reduce the period of stay, maintain efficiency, showing no increases emergency readmissions or mortality. Conclusions: The UEC can be an instrument to reduce the cost of health process a certain group of pathologies.

De opkomst van geboortecentra en hun rol in de zorg

Are birth centres the right answer to the current problems in maternity care? Birth centres are a relatively new development in the Netherlands. Home birth is still very common but an increasing number of women prefer the ‘safety’ of a more clinical environment, especially since the publication of and all the media attention about the Euro-Peristat data on perinatal deaths. The Steering Group ‘Pregnancy and Childbirth’ recommended in 2009 more integration in the maternity care in the Netherlands, including the introduction of birth centres with close links to a hospital. Currently about 30 birth centres are operational, of various sizes and philosophies, located inside, alongside or detached from a hospital, with salaried personnel (midwives, maternity care assistants) or independent practitioners, with or without access to medical technology and methods of pain relief, and with various ways of funding. What is lacking is a general view on what a birth centre should be, how it should operate, and which population it should serve. What is also needed is insight into the effects of birth centre care on maternity care outcome variables, insight into cliënts’ and care providers’ experiences with birth centre care and insight into the costs of birth centre care compared to home birth or short-stay hospital birth. Therefore, in a unique cooperation between research institutes, medical facilities, professional organisations and care providers a research program has been developed to evaluate birth centres on aspects as integration of care, quality of care, experiences of cliënts and care providers, economic outcomes and implications for further implementation of birth centres in the Netherlands.

Understanding and Interpreting the National Hospital Ambulatory Medical Care Survey: Key Questions and Answers

SEE EDITORIAL, P. 722. Editor’s Note: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is widely used for medical research. Nearly 500 articles have been published based on this database, including 28 in Annals of Emergency Medicine. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments in nonfederal, general, and short-stay hospitals, conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics (http://www.cdc.gov/nchs/ahcd.htm). Strengths of the NHAMCS survey are its rigorous methodology, nationally representative nature, large size, wide array of variables, and capacity to examine long-term trends. Investigators can freely download the database and test locally developed hypotheses. Challenges with NHAMCS are that, given its logistic and statistical complexity, resulting research can be difficult for readers to interpret and for editors and reviewers to critique. There are important limitations and caveats to this survey that, if overlooked, could lead to misleading or inaccurate conclusions. In this article, we have a posed a series of questions to 2 NHAMCS statisticians, and we believe that their answers will be invaluable to both NHAMCS investigators and readers of its research.