Total Bed Days Research Articles

Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements

The incidence of health care-acquired infection (HAI) and the consequence for patients with HAI tend to vary from study to study. By including all patients, all medical specialties, and performing a follow-up analysis, this study contributes to previous findings in this research field. Data from the Swedish National Point Prevalence Surveys of HAI 2010-2012 was merged with cost per patient data from the county Health Care Register (N = 6,823). Extended length of stay (LOS) and costs related to an HAI were adjusted for sex, age, intensive care unit use, and surgery. Patients with HAI (n = 732) had a larger proportion of readmissions compared with patients with no HAI (29.0% vs 16.5%). Of the total bed days, 9.3% was considered to be excess days attributed to the group of patients with an HAI. The excess LOS comprised 11.4% of the total costs (95% CI, 10.2-12.7). The 1-year overall mortality rate for patients with HAI in comparison to all other patients was 1.75 (95% CI, 1.45-2.11), all 5 of these differences were statistically significant (P < .001). Even if not all outcomes for patients with an HAI can be explained by the HAI itself, the increase in inpatient days, readmissions, associated costs, and higher mortality rates are quite notable.

Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort

ObjectiveTo quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort.DesignA prospective population-based study of men and women.SettingNorfolk, UK.Participants11...

Use of somatostatin analogues in the pancreonecrosis therapy (kliniko-experimental research)

Experimentalmodel of acute destructive pancreatitis onrats of Wistar line with weight of 300±30 gwas reproduced.There were 5 animal groups (one control group and four experimental groups). Experimental animals received oktreotidin different doses. In 2 days there were estimated the blood biochemistryand histopathologic features of liver and pancreas of operated animals. In clinical part there were formed two groups of patients out of selected case histories by a principle of similarity of complex therapy differing in oktreotid doses, namely: 1) pancreatonecrosis patients estimated of 3 to 8 points by Ranson scale in whose treatment regimen oktreotid 300 mkg/day (n=70) dose was included; 2) pancreatonecrosispatients estimated of 3 to 8 points by Ransonin whose treatment regimenoktreoid1200 mkg/day (n=38) was included. There were compared indices of lethal outcomes, average bed-days, and dynamics of laboratory findings, number and volume of surgical procedures. Dose-related effect of a synthetic analogue of somatostatin, acetateoktreotid, was proved. Introduction in complex therapy of pancreatonecrosisthe highest possible authorized doses of oktreotid (1200 mkg/day) is conducive to more favorable course of illness, dynamic reduction of amilazemia, decrease of lethal outcomes and total bed-day, and also, reduction of initial and repeated operative procedures.

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England

Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006-2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. Results The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. Conclusions There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical complications, associated anomalies). These data will enable us to give more detailed information to families following prenatal or postnatal diagnosis. They also allow more detailed planning of resource allocation for neonatal admissions.

Hospitalisations, admission costs and re‐fracture risk related to osteoporosis in Western Australia are substantial: a 10‐year review

Objective:To quantify hospitalisation costs to Western Australia (WA) for osteoporosis‐related fractures and estimate risk of readmission after incident fracture. Methods:All hospitalisation records for WA residents aged ≥50 years admitted to a WA hospital between 2002 and 2011 due to osteoporotic fractures were extracted from the WA Hospital Morbidity Data System. Data linkage enabled identification of the first (index) fracture admission, determination of subsequent osteoporotic fracture‐related readmissions, and quantification of total admission costs and bed days. Cox proportional hazard models assessed factors influencing first readmission. Results:A total of 5,326 patients were admitted to WA hospitals for an index fracture. Of the 2,037 (38.2%) patients who sustained a re‐fracture requiring readmission, 1,223 (23.0%) had one re‐fracture episode, 453 (8.5%) has two, and 361 (6.8%) has three or more re‐fracture episodes requiring readmission. Cost of index admissions was $57,007,262 while $48,948,623 was associated with readmissions (CPI‐adjusted to 2011/12). Cumulative probability of readmission within six months of the index admission was 20% (males) and 17% (females). Conclusions:Osteoporotic fracture‐related hospitalisations impose a substantial financial impact on WA, exceeding $100 million in a decade. Implications:Considering the large system costs, policy and programs to improve identification of index fractures and initiation of osteoporosis treatments and primary prevention initiatives are justified.

HCP-09BENEFITS OF A NEURO-ONCOLOGY NURSE PROGRAM

BACKGROUND: The position of a neuro-oncology support coordinator within brain tumour units is becoming more widespread. There is no standard model of care for this position. Although it is clear that these positions are beneficial, there is little hard data to demonstrate this benefit to hospital administrations, who ultimately decide on funding for this role. METHODS: A Neuro-Oncology Nurse role was established at Monash Medical Centre in 1997, with a Palliative Care nurse taking that position. In many ways palliative care for these patients begins at diagnosis, and the palliative care background has been of great benefit with the changing needs of our patients towards the later stages of their illness. This model was reproduced at Cabrini Hospital, an acute private hospital in Melbourne, in early 2012. The Cabrini health service includes a palliative care hospital and a rehabilitation hospital, which has helped us coordinate services for our patients. RESULTS: We have compared the admission profile of patients in the 2 years before and the 2 years after the establishment of the Neuro-Oncology Nurse position at Cabrini. Although there were a similar number of patients treated in the 2 study periods, there was a 24% reduction in the total bed days in the acute private hospital (393 less bed days over 2 years), more admissions to palliative care and rehabilitation, increased outpatient rehabilitation visits and increased palliative care home visits. There was a 46% reduction of the average length of stay and a 17% reduction in the 30-day readmission rate in the acute hospital. CONCLUSIONS: This data demonstrates the benefits of the Neuro-Oncology Nurse position to the health service. It also indicates some of the benefits to our patients, with a reduction in time spent in the acute hospital setting and improved access to continuing care services.

Outpatient parenteral antimicrobial therapy with ceftriaxone for acute tonsillopharyngitis: efficacy, patient satisfaction, cost effectiveness, and safety.

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is the administration of intravenous antimicrobial therapy to patients in an outpatient setting. It may be used for patients who have infections that require parenteral treatment but who are otherwise stable enough to not require admission as inpatients.ObjectiveWe aimed to review the treatment of patients with acute tonsillopharyngitis at the OPAT health care clinic in the Bahrain Defense Force Royal Medical Services (BDF-RMS), with regard to efficacy, patient satisfaction, cost effectiveness, and safety.MethodsA retrospective case notes review was conducted for all patients admitted to the OPAT clinic in the BDF-RMS with acute tonsillopharyngitis treated with ceftriaxone, between March 2012 and March 2014.ResultsIn the period between March 2012 and March 2014, 97 patients with acute tonsillopharyngitis were treated with ceftriaxone for a minimum of 3 days at the OPAT clinic. In total, 94.8% of patients completed the prescribed course of ceftriaxone. Total cure was achieved in 89.7% of patients. Usage of the OPAT clinic led to cost savings of 10,693 BD, while total bed days saved were 301 over the 2-year period examined by this study. Participants in the program expressed high satisfaction rates, and the average (± standard deviation) score on a patient satisfaction survey was 4.41 (± 0.31) out of a total of 5. This study highlights the efficacy, patient satisfaction, cost effectiveness, and safety of the OPAT clinic service for the treatment of acute tonsillopharyngitis with ceftriaxone. We found a 45.5% drop in admission rate for acute tonsillopharyngitis after starting the OPAT service clinic and that 301 bed days were saved through this treatment.ConclusionThis study showed that the management of acute tonsillopharyngitis with ceftriaxone in the OPAT clinic is safe, clinically effective, and cost effective, with low rates of complications/readmissions and high levels of patient satisfaction.

Variation in Use of Pediatric Cardiology Subspecialty Care: A Total Population Study in California, 1983 to 2011

BackgroundAmerican Academy of Pediatrics guidelines emphasize regionalized systems of care for pediatric chronic illness. There remains a paucity of information on the status of regionalized systems of care for pediatric congenital heart disease (CHD). ObjectivesThis study evaluated variations in use of pediatric cardiology specialty care centers (PCSCC) for pediatric patients with CHD in California between 1983 and 2011. MethodsWe performed a retrospective, total population analysis of pediatric CHD patients using the California Office of Statewide Health Planning and Development unmasked database. PCSCCs were identified by California's Title V program. ResultsThere were 164,310 discharges meeting inclusion criterion. Discharges from PCSCCs grew from 58% to 88% between 1983 and 2011. Regionalized care was highest for surgical (96%) versus nonsurgical (71%) admissions. Admissions with a public payer increased from 42% (1983) to 61% (2011). Total bed days nearly doubled, and median length of stay increased from 2 to 3 days (nonspecialty care) and from 4 to 5 days (specialty care). There was a decrease in the pediatric CHD in-hospital death rate from 5.1 to 2.3 per 100,000 between 1983 and 2011, and a shift toward a larger percent of deaths occurring in the newborn period. ConclusionsCalifornia’s inpatient regionalized specialty care of pediatric CHD has increased substantially since 1983, especially for surgical CHD discharges. The death rate has decreased, the number of bed days has increased, and a large proportion of these discharges now have public payers. Health care reform efforts must consider these shifts while protecting advances in regionalization of pediatric CHD care.

Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis.

BackgroundSerious mental illness (SMI), which encompasses a set of chronic conditions such as schizophrenia, bipolar disorder and other psychoses, accounts for 3.4 m (7 %) total bed days in the English NHS. The introduction of prospective payment to reimburse hospitals makes an understanding of the key drivers of length of stay (LOS) imperative. Existing evidence, based on mainly small scale and cross-sectional studies, is mixed. Our study is the first to use large-scale national routine data to track English hospitals’ LOS for patients with a main diagnosis of SMI over time to examine the patient and local area factors influencing LOS and quantify the provider level effects to draw out the implications for payment systems.MethodsWe analysed variation in LOS for all SMI admissions to English hospitals from 2006 to 2010 using Hospital Episodes Statistics (HES). We considered patients with a LOS of up to 180 days and estimated Poisson regression models with hospital fixed effects, separately for admissions with one of three main diagnoses: schizophrenia; psychotic and schizoaffective disorder; and bipolar affective disorder. We analysed the independent contribution of potential determinants of LOS including clinical and socioeconomic characteristics of the patient, access to and quality of primary care, and local area characteristics. We examined the degree of unexplained variation in provider LOS.ResultsMost risk factors did not have a differential effect on LOS for different diagnostic sub-groups, however we did find some heterogeneity in the effects. Shorter LOS in the pooled model was associated with co-morbid substance or alcohol misuse (4 days), and personality disorder (8 days). Longer LOS was associated with older age (up to 19 days), black ethnicity (4 days), and formal detention (16 days). Gender was not a significant predictor. Patients who self-discharged had shorter LOS (20 days). No association was found between higher primary care quality and LOS. We found large differences between providers in unexplained variation in LOS.ConclusionsBy identifying key determinants of LOS our results contribute to a better understanding of the implications of case-mix to ensure prospective payment systems reflect accurately the resource use within sub-groups of patients with SMI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1107-6) contains supplementary material, which is available to authorized users.

Acute hospital care: how much activity is attributable to caring for patients with dementia?

People with dementia are among the most frequent service users in the acute hospital. Despite this, the acute hospital is not organized in a manner that best addresses their needs. We examined acute dementia care over a 3-year period from 2010 to 2012 in a 600-bed university hospital, to clarify the service activity and costs attributable to acute dementia care. Nine hundred and twenty-nine patients with dementia were admitted during the study period, accounting for 1433/69 718 (2%) of all inpatient episodes, comprising 44 449/454 169 (10%) of total bed days. The average length of stay was 31.0 days in the dementia group and 14.1 days in those >65 years without dementia. The average hospital care cost was almost three times more (€13 832) per patient with dementia, compared with (€5404) non-dementia patients, accounting for 5% (almost €20 000 000) of the total hospital casemix budget for the period. Service activity attributable to dementia care in the acute hospital is considerable. Moreover, given the fact that a significant minority of cognitive impairment goes unrecognized after acute admissions, it is likely that this is under-representative of the full impact of dementia in acute care. Although the money currently being spent on acute dementia care is considerable, it is being used to provide a service that does not meet its user needs adequately. It is clear that acute hospitals need to provide a more 'dementia friendly' service for acutely unwell older persons.

Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.

BackgroundTo evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years.MethodsThe MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups.ResultsOver the 4 year period, program participation resulted in significant reductions in hospital admissions (−11.4%, P < 0.0001), readmissions (−36.7%, P < 0.0001), and bed days (−17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia’s risk equalization system for private insurers.ConclusionsResults confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

Significant reduction in alcohol-related admissions to an intensive care unit in Dublin.

In 2008, we conducted an audit in our general intensive care unit (ICU) which demonstrated a high workload from alcohol-related admissions which represented 12 % of total admissions and 16.8 % of total available bed days at that time. To repeat the audit 5 years later in 2013 to assess the current workload from alcohol-related admissions and whether this had increased or decreased in the intervening time period. We retrospectively collected data from every admission to our 17-bed general ICU for the 6-month period from June 1 2013 to November 30 2013. We identified all admissions that were related to alcohol misuse. Their admission diagnosis, age, gender, ICU length of stay, APACHE 2 score (Acute Physiology and Chronic Health Evaluation 2) and 30-day mortality were recorded. The results of the 2013 audit were then compared with data from the 2008 study. There were 30 % less alcohol-related admissions to our ICU in 2013 compared to the same period in 2008. The study group had a longer length of stay on average but a lower mortality than the control group. There has been a significant reduction in the ICU workload from alcohol-related admissions in our general ICU in the past 5 years.

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

ObjectivesWe evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation.DesignInterrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1) other NHS trusts in London and (2) all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011.SettingNine NHS acute trusts in the London, England.ParticipantsPatients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012.Main Outcome MeasuresAnnual trend readmission rates (and in total bed days) within 7, 28 and 90 days, before and after implementation.ResultsIn hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa) pre and -5.32% pa post (p for difference in trends = 0.012)). Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44). Comparisons with a national control group were similar.ConclusionsThe COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

Abstract T P271: Establishment of Stroke Ward Results in Immediate Reduction of Major Complications

Background and Purpose: Randomized controlled trials have consistently shown that stroke units decrease both mortality and morbidity compared with conventional care in general medical wards. There are however limited data on the specific types of in-hospital medical complications and their effect on outcomes. The objective of this study was to determine whether establishing a specialized geographically defined Stroke Ward results in reducing the major complications in patients suffering from acute stroke within the same hospital system. Methods: This is a prospective study from January 2014 till July 2014. Data was collected from a web-based stroke registry in two phases. In phase 1 (from January 1, 2014 till March 08, 2014), we collected data of stroke patients admitted at in the medical wards. In phase 2, a protocol-based multidisciplinary care Stroke Ward became operational where most of the patients were admitted. Outcomes measures were number and type of complications, mortality, discharge disposition, and length of stay, and were adjusted for age, sex, and medical co-morbidities. Results: There were 130 admissions in phase 1 and 345 in phase 2. Commonest complications included, aspiration pneumonia 29% vs 12% (p&lt;0.001) and pressure ulcers in 35% vs 11% (p&lt;0.001). Average length of stay decreased from 12 days to 4 days (p&lt;0.001). In phase 1, 70 % of patients were discharged home, while 23% were transferred to rehabilitation while in phase 2, 75% of patients were discharged home, while 18% patients were sent to rehabilitation. Ninety percent of complications happened in medical wards, mainly in patients who over stayed in emergency department (more than 8 hours) waiting for bed in Stroke Ward or medical floor. Conclusion: A protocol based multidisciplinary care Stroke Ward care significantly reduces common early complications of acute stroke. It also helps in significantly reducing the length of stay, saving total bed days at a tertiary care hospital, hence improving the overall care of these patients.

Abstract W MP27: Treatment with Intravenous Thrombolysis in Acute Ischemic Stroke is Associated with Reduced Bed Day Use: A Nationwide Propensity Score Matched Follow-Up Study

Introduction: Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need for hospital admissions during follow-up. Methods: We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). IV-tPA-treated patients were propensity-score matched with IV-tPA eligible but non-treated ischemic stroke patients from stroke centers not offering tPA. The adjusted Hazard ratio (HR) for first readmission was estimated by multivariable Cox regression among patients who survived the initial stroke admission. Total all-cause bed day use in the first year after stroke admission was determined for patients with a potential follow-up time of at least one year and was compared between groups by a paired t-test after logarithmic transformation. Results: We identified 1896 IV-tPA-treated and 1896 corresponding propensity-score matched non-treated patients surviving the initial stroke admission. A total of 43.2% of the patients were readmitted to hospital during a median of 0.8 years. The adjusted HR for first readmission was 0.93 (95% CI: 0.79-1.09) when comparing IV-tPA-treated with non-treated patients. In 1462 matched pairs followed the first year after stroke the median all-cause bed day use was 10 (IQR: 4-37) in the group of tPA-treated and 16 (IQR: 6-43) in the group of non-treated patients. The relative bed day use was 0.81 (95% CI: 0.74-0.88) when comparing IV-tPA-treated with non-treated patients. Conclusion: Use of IV-tPA in ischemic stroke patients was associated with lower long-term all-cause hospital bed day use.

Development and implementation of an obesity management service in the ACT: A preliminary report

Referral and attendance records were examined, in addition to indicators measured in the initial assessment. A summary of data collected at baseline will be presented including the following parameters: demographic breakdown (gender, age), anthropometry (mean Body Mass Index and mean waist circumference), and emotional well-being (PHQ-2 Depression Screening Tool and Dartmouth COOP Chart). Records relating to referral source, comorbid physical and mental health conditions, bariatric surgery status and attendance rates will also be presented, in addition tomeasures assessed in group education and physical activity programs. A summary of initial treatment planning in the OMS will also be presented, including total case manager assignment, referral to internal and external providers, and occasions of service in the 30 days following initial assessment. An overview of health service use records in the 12 months preceding assessment in the OMS assessing occasions of service for emergency presentations, number of admissions and total bed days, outpatient appointments, total medical and allied health specialists will also be provided. Assessment of the first 50 patients accessing the ACT Health Obesity Management Service provides a detailed summary of patient characteristics to date. Additional case series should be examined over time to continue to understand this population and optimise assessment, treatment and evaluation methods.

Evidence of sustained benefit: Use of teleconsultation to support people living in residential care settings

Introduction: An increasing proportion of the population require long term supported care in nursing or residential care home settings. As high users of healthcare services, interventions that can be delivered in their place of residence offer substantial benefit to the patient, their carers and to the wider health system. Teleconsultation using 2 way video links has been used to deliver such interventions and its use appeared in early results to reduce the need for hospital admission and Emergency Department (ED) attendance. Aims: To evaluate, using 2nd year activity and outcome data, whether the impact a dedicated 24/7 teleconsultation service (the Hub) has on admissions, ED attendance and total hospital bed days used by the residents of a cohort of local nursing and residential care homes is sustained beyond the initial “honeymoon” period following introduction of a novel service. Results: From a population comprising the residents of the nursing and residential care homes in the locality served by a single acute hospital, hospital admissions, ED attendances and total bed days used were measured using routinely collected hospital statistics. Hub activity statistics were initially collected using manual audit. Data were recorded for the year before and the year after each care home began using teleconsultation. Initial findings, from 17 care homes supporting a population of just over 1000 people, showed that there appeared to be a 45% reduction in admissions and a 60% reduction in total bed days used by residents from these locations in the 12 months following introduction of the service. As the numbers of locations supported has risen and data collection methods have been automated, these figures have settled at a reduction in acute admissions of 35% (n=654 to 437), a reduction in ED attendance of 53% (n=798 to 379) and of total bed days used by 59% (n=8247 to 3435). These reductions equate to a fall in the number of hospital beds required to service this level of in-patient activity from 22.6 to 9.4 (-59%). Service user satisfaction remains high at >9/10 across a range of measures using a questionnaire-based International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116540– http://www.ijic.org/ approach. The service continues to grow, with 100 care homes now receiving support across a wide geographical area. Conclusions: Use of teleconsultation, delivered on a 24/7 basis, appears to be supporting sustained reductions in the need for in-patient and ED hospital services and service user satisfaction with the approach remains very high. These reductions equate to substantial falls in the number of hospital beds required by this frail and difficult to move population. At scale deployment of this approach could offer real benefit to patients and both commissioning and provider organisations.

A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis.

Background:We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.Aim:To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.Methods:In this prospective study conducted over 5 years, we assessed patients’ eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.Results:A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.Conclusion:Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres.

Centralization of complex healthcare services into specialist high-volume centres is believed to improve outcomes. For injured patients, few studies have evaluated the centralization of major trauma services. The aim of this study was to evaluate how a regional trauma network affected trends in admissions, case mix, and outcomes of injured patients. A retrospective before-after study was undertaken of severely injured patients attending four hospitals that became major trauma centres (MTCs) in March 2012. Consecutive patients with major trauma were identified from a national registry and divided into two groups according to injury before or after the launch of a new trauma network. The two cohorts were compared for differences in case mix, demand on hospital resources, and outcomes. Patient volume increased from 442 to 1326 (200 per cent), operations from 349 to 1231 (253 per cent), critical care bed-days from 1100 to 3704 (237 per cent), and total hospital bed-days from 7910 to 22,772 (188 per cent). Patient age increased on MTC designation from 45.0 years before March 2012 to 48.2 years afterwards (P = 0.021), as did the proportion of penetrating injuries (1.8 versus 4.1 per cent; P = 0.025). Injury severity fell as measured by median Injury Severity Score (16 versus 14) and Revised Trauma Score (4.1 versus 7.8). Fewer patients required secondary transfer to a MTC from peripheral hospitals (19.9 versus 16.1 per cent; P = 0.100). There were no significant differences in total duration of hospital stay, critical care requirements or mortality. However, there was a significant increase, from 55.5 to 62.3 per cent (P < 0.001), in the proportion of patients coded as having a 'good recovery' at discharge after institution of the trauma network. MTC designation leads to an increased case volume with considerable implications for operating theatre capacity and bed occupancy. Although no mortality benefit was demonstrated within 6 months of establishing this trauma network, early detectable advantages included improved functional outcome at discharge.

PTH-144 Nationwide Study Of Emergency Admissions To Acute Hospitals In England For Anorexia Nervosa: Implications For Marsipan

IntroductionPatients with anorexia nervosa (AN) develop significant physical complications leading to emergency admission (EmAd) to acute hospitals. There are few data on national burden, institutional case volume, frequency, nature or...