Total Hospital Bed Research Articles

Factors influencing the COVID-19 daily deaths' peak across European countries

ObjectivesThe purpose of this study was to determine predictors of the height of coronavirus disease 2019 (COVID-19) daily deaths' peak and time to the peak, to explain their variability across European countries. Study designFor 34 European countries, publicly available data were collected on daily numbers of COVID-19 deaths, population size, healthcare capacity, government restrictions and their timing, tourism and change in mobility during the pandemic. MethodsUnivariate and multivariate generalised linear models using different selection algorithms (forward, backward, stepwise and genetic algorithm) were analysed with height of COVID-19 daily deaths' peak and time to the peak as dependent variables. ResultsThe proportion of the population living in urban areas, mobility at the day of first reported death and number of infections when borders were closed were assessed as significant predictors of the height of COVID-19 daily deaths' peak. Testing the model with a variety of selection algorithms provided consistent results. Total hospital bed capacity, population size, the number of foreign travellers and the day of border closure were found to be significant predictors of time to COVID-19 daily deaths' peak. ConclusionsOur analysis demonstrated that countries with higher proportions of the population living in urban areas, countries with lower reduction in mobility at the beginning of the pandemic and countries having more infected people when closing borders experienced a higher peak of COVID-19 deaths. Greater bed capacity, bigger population size and later border closure could result in delaying time to reach the deaths' peak, whereas a high number of foreign travellers could accelerate it.

Association between Medicare\u2019s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share

BackgroundMedicare’s Hospital Readmissions Reduction Program (HRRP), implemented beginning in 2013, seeks to incentivize Inpatient Prospective Payment System (IPPS) hospitals to reduce 30-day readmissions for selected inpatient cohorts including acute myocardial infarction, heart failure, and pneumonia. Performance-based penalties, which take the form of a percentage reduction in Medicare reimbursement for all inpatient care services, have a risk of unintended financial burden on hospitals that care for a larger proportion of Medicare patients. To examine the role of this unintended risk on 30-day readmissions, we estimated the association between the extent of their Medicare share of total hospital bed days and changes in 30-day readmissions.MethodsWe used publicly available nationwide hospital level data for 2009–2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. Using a quasi-experimental difference-in-differences approach, we compared pre- vs. post-HRRP changes in 30-day readmission rate in hospitals with high and moderate Medicare share of total hospital bed days (“Medicare bed share”) vs. low Medicare bed share hospitals.ResultsWe grouped the 1904 study hospitals into tertiles (low, moderate and high) by Medicare bed share; the average bed share in the three tertile groups was 31.2, 47.8 and 59.9%, respectively. Compared to low Medicare bed share hospitals, high bed share hospitals were more likely to be non-profit, have smaller bed size and less likely to be a teaching hospital. High bed share hospitals were more likely to be in rural and non-large-urban areas, have fewer lower income patients and have a less complex patient case-mix profile. At baseline, the average readmissions rate in the low Medicare bed share (control) hospitals was 20.0% (AMI), 24.7% (HF) and 18.4% (pneumonia). The observed pre- to post-program change in the control hospitals was − 1.35% (AMI), − 1.02% (HF) and − 0.35% (pneumonia). Difference in differences model estimates indicated no differential change in readmissions among moderate and high Medicare bed share hospitals.ConclusionsHRRP penalties were not associated with any change in readmissions rate. The CMS should consider alternative options – including working collaboratively with hospitals – to reduce readmissions.

Measuring the Response Performance of U.S. States against COVID-19 Using an Integrated DEA, CART, and Logistic Regression Approach.

Measuring the U.S.’s COVID-19 response performance is an extremely important challenge for health care policymakers. This study integrates Data Envelopment Analysis (DEA) with four different machine learning (ML) techniques to assess the efficiency and evaluate the U.S.’s COVID-19 response performance. First, DEA is applied to measure the efficiency of fifty U.S. states considering four inputs: number of tested, public funding, number of health care employees, number of hospital beds. Then, number of recovered from COVID-19 as a desirable output and number of confirmed COVID-19 cases as a undesirable output are considered. In the second stage, Classification and Regression Tree (CART), Boosted Tree (BT), Random Forest (RF), and Logistic Regression (LR) were applied to predict the COVID-19 response performance based on fifteen environmental factors, which were classified into social distancing, health policy, and socioeconomic measures. The results showed that 23 states were efficient with an average efficiency score of 0.97. Furthermore, BT and RF models produced the best prediction results and CART performed better than LR. Lastly, urban, physical inactivity, number of tested per population, population density, and total hospital beds per population were the most influential factors on efficiency.

Development and validation of a machine learning model predicting illness trajectory and hospital utilization of COVID-19 patients: A nationwide study.

ObjectiveThe spread of coronavirus disease 2019 (COVID-19) has led to severe strain on hospital capacity in many countries. We aim to develop a model helping planners assess expected COVID-19 hospital resource utilization based on individual patient characteristics.Materials and MethodsWe develop a model of patient clinical course based on an advanced multistate survival model. The model predicts the patient's disease course in terms of clinical states—critical, severe, or moderate. The model also predicts hospital utilization on the level of entire hospitals or healthcare systems. We cross-validated the model using a nationwide registry following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1 to May 2, 2020 (n = 2703).ResultsPer-day mean absolute errors for predicted total and critical care hospital bed utilization were 4.72 ± 1.07 and 1.68 ± 0.40, respectively, over cohorts of 330 hospitalized patients; areas under the curve for prediction of critical illness and in-hospital mortality were 0.88 ± 0.04 and 0.96 ± 0.04, respectively. We further present the impact of patient influx scenarios on day-by-day healthcare system utilization. We provide an accompanying R software package.DiscussionThe proposed model accurately predicts total and critical care hospital utilization. The model enables evaluating impacts of patient influx scenarios on utilization, accounting for the state of currently hospitalized patients and characteristics of incoming patients. We show that accurate hospital load predictions were possible using only a patient’s age, sex, and day-by-day clinical state (critical, severe, or moderate).ConclusionsThe multistate model we develop is a powerful tool for predicting individual-level patient outcomes and hospital-level utilization.

Extracorporeal Membrane Oxygenation and Continuous Kidney Replacement Therapy: Technology and Outcomes - A Narrative Review.

The number of patients using critical care is increasing as our populations live longer thanks to advances in medical therapies. This is reflected by an increase in both usage and number of critical care beds as compared with total hospital beds across the United States. As this aging population suffers more and more from multiorgan dysfunction, including but not limited to respiratory failure, cardiac failure, and acute kidney injury, technologies are used to facilitate recovery in those that would have assuredly passed away years ago. Some of these advancements include extracorporeal membrane oxygenation and continuous kidney replacement therapy. In this article, we review the literature regarding the history, technology, indications, and outcomes of synchronous extracorporeal membrane oxygenation and kidney replacement therapy.

Role of public-private partnerships to enhance the health care delivery system during the pandemic COVID-19

Development and economic growth are based on a healthy nation. A lot of attentions are needed to improve health conditions by providing necessary facilities through better infrastructure and medical professionals. Public health facilities continue to face staff shortage as over 85% specialist doctors, 75% doctors, 80% laboratory technicians, 53% nursing, and 52% ANM (auxiliary nurse midwife) short across states.At the same time when the prevalence of infectious diseases has increased worldwide over a period. Outbreaks have frequently been occurring, but every outbreak does not reach global pandemic level as the novel coronavirus (COVID-19) has. Although the number of COVID-19 cases are gradually increasing in India, experts have warned that this spread will lead to a rapid and massive increase in demand for health facilities. India's healthcare infrastructure is incapable of dealing with today’s crisis. In India, there is a significant shortage in the availability of beds in hospitals. It is only in recent years that India increased its bed capacity from 0.7 beds per thousand, in 2011, to 1.13 today. According to data from the National Health Profile-2019, we observed there are 7,13,986 total government hospital beds available in India; however, it is still insufficient to deal with this crisis. There are only 118 governments approved laboratories in India capable of performing COVID-19 tests so far.

Does Penrose's Law apply to Hungary? Data of an extended survey and reappraisal

Penrose described an observation in 1939, according to which an inverse relationship between the size of prison populations and the number of psychiatric beds existed. The purpose of this article was to investigate the validity of this statement for Hungary. The national data between 1989 and 2017 for 25 variables were extracted from the official reports of the Hungarian Central Statistical Office. The number of psychiatric beds decreased by 33%, while the number of prisoners increased by about 50%. At the same time, the number of mentally ill patients under compulsive treatment was low, but showed a slight, statistically significant increase. Variables measuring similar feature, for example, the psychiatric characteristics (alcoholics registered, suicide rate, number of hospital beds, welfare home inmates) are variables consistently moving in one direction or the other that may allow finding appropriate indicators of and explanations for the phenomena. An example is the number of psychiatric beds showing a parallel decrease to the numbers of total hospital beds, registered alcoholics, out-patient clinics for children, and suicide rate, and just the opposite direction with forensic settling, involuntary admissions, and welfare home inmates. Similarly, crimes, criminals, homicides, and prisoners can also be grouped. Correlation does not mean a cause and effect relationship, therefore, at the current state of knowledge the connection among variables is not clear in all the cases. To sum up, Hungarian statistical data for three decades support Penrose's original observation on psychiatric beds and prison population, while the Penrose's statement on the inverse relationship between the number of crimes and of psychiatric beds is not supported. However, until deeper relationships are explored, aggregation of variables into few factors seems impossible.

Organizational Factors Associated with Sepsis Bundle Compliance: A Nationwide Study

Sepsis is one of the leading causes of mortality in the United States (U.S.), accounting for over 220 000 deaths annually. To address the issue of mortality, the Centers for Medicare and Medicaid Services (CMS) launched a core measure with an associated clinical bundle. This measure requires completion of time‐sensitive bundled interventions (eg, fluid resuscitation, antibiotics). Completion of these interventions is known to improve the odds of survival. CMS reimbursement is not currently tied to a certain compliance level; however, it is under consideration. Hospitals’ compliance with the bundle is publicly reported as the SEP‐1 measure. The objective of this study was to examine which hospital organizational factors were associated with high and low compliance with the SEP‐1 measure.This study used a cross‐sectional design with 2017 hospital‐level data from the CMS Timely and Effective Care dataset, and the American Hospital Association (AHA)’s Annual Survey. A multivariate logistic regression with outcome variable of hospital compliance (high/low) with the SEP‐1 measure (0 = less than overall average on SEP‐1 score; 1 = greater than overall average) was performed. Control variables included: number of beds (<100, 100‐250, >250), teaching status (teaching, nonteaching), technology level (high, low), intensive care unit (ICU) beds (none, 1‐4, 5‐14, 15‐29, 30 or more), ownership (government, non‐for‐profit, for‐profit), sepsis case volume (0‐100, 101‐200, 201 or more), nurse hours per patient day, and Magnet certification status (yes/no).The study included 2429 acute care, nonspecialty adult U.S. hospitals. Hospitals were excluded if they did not complete the AHA survey.The overall average SEP1 score was 48.9% on a 0‐100 scale. Of 2429 hospitals, 49% were high compliance hospitals, and 51% were low compliance. Factors associated with increased odds of compliance included: for‐profit ownership (OR = 2.48; 95% CI = 1.78‐3.44; P < .01), higher sepsis case volume (OR 1.18, 95% CI 1.08‐1.28, P < .01), smaller numbers (5‐14) of ICU beds (OR 1.76, 95% CI 1.17‐2.63, P = .01), and more nursing hours (OR 1.01, 95% CI 1.00‐1.02, P < .01). Factors associated with decreased odds of compliance included: more than 250 hospital beds (OR 0.68, 95% CI 0.47‐0.99, P = .02), and teaching status (OR 0.58, 95% CI 0.41‐0.81, P < .01).For‐profit ownership, higher sepsis case volumes, a smaller number of ICU beds, and more nursing hours per patient day were positively associated with SEP‐1 bundle compliance. A higher number of total hospital beds (>250) and having a residency program (teaching hospital) were negatively associated with compliance.Sepsis is the most expensive condition treated in U.S. hospitals, and hospitals must consider how they can improve their outcomes. Two strategies hospitals could consider are restricting the size of their ICUs to allow for closer monitoring, and increasing their nurse staffing.Florida Nurses Foundation and Sigma Theta Tau International Theta Epsilon Chapter.

Folding a neuroscience center into streamlined COVID-19 response teams: Lessons in origami.

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.

Health systems efficiency in Eastern Mediterranean Region: a data envelopment analysis

BackgroundOne of the most important issues in public policy and welfare state is health care. Poor management leads to the waste of resources, including money, human resources, facilities, and equipment.AimsThis paper seeks to answer the question of which eastern Mediterranean countries are more effective in allocating their health resources, and does Iran, in relation to those countries, have an effective health system.MethodsThis study examined technical efficiency among eastern Mediterranean countries in 2018. Data were extracted from Global Health Observatory data World Health Organization. We applied input-oriented Data Envelopment Analysis (DEA) models to estimate efficiency scores. Inputs are Physicians density per 10,000 populations, Total hospital beds per 10,000 populations, Current expenditure on health, % of gross domestic product and outputs are infant survival rate and Life expectancy.ResultsThe most efficient health systems in the eastern Mediterranean were Bahrain, Egypt, Iran, Lebanon, Morocco, Oman, Pakistan, Qatar, Tunisia and the United Arab Emirates. The inefficient countries are Iraq, Jordan, Kuwait, Libya, Palestine and Saudi Arabia.ConclusionsAmong the efficient countries, one category of high-entry countries such as Bahrain and Qatar with high input especially in health expenditure had higher output. The second group of countries with lower inputs such as Iran and Morocco has been able to produce similar output with other countries. Also, inefficiency in countries such as Saudi Arabia can be attributed to this with higher input such as health expenditure has lower output such life expectancy and infant survival rate.

COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community.

COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community.

Geographic distribution and time trends of esophageal cancer in Brazil from 2005 to 2015.

The purpose of the present study was to investigate the geographical distribution and time trends of the incidence and lethality of esophageal cancer (EC) in Brazil. The present study conducted an ecological study of EC using records from January 2005 to December 2015 in the Health Informatics Department of the Brazilian Ministry of Health (DATASUS) registry. In addition to demographical data on the population, EC incidence and lethality rates were estimated from hospitalizations and in-hospital mortalities and were adjusted by total available hospital beds. The adjusted EC rates per 100,000 increased from 9.1 in 2005 to 12.1 in 2015. The prevalence among males increased from 69 to 78%, while the female rates remained stable over the same period. Although EC was the most common in South and Southeast Brazil, the rates increased proportionately more in the other regions of the country, especially among males. Geographical analysis revealed higher rates of EC in more urbanized areas, with a coast-to-inland gradient. While rates increased in people older than 50 years, they decreased among people below this age. However, the lethality rates remained stable and high during the study period, overlapping with hospital admission rates. The recent increasing trend in the EC incidence, with shifts from the south towards the north and from more urbanized towards rural areas, suggests that environmental factors are crucial in EC pathogenesis. The concentration of EC in South Brazil may reflect the presence of major environmental factors in association with a possible genetic predisposition. The unchanging high mortality associated with EC in the rapidly aging population suggests that EC will continue to impose a significant social and economic burden in the future.

An analysis of structure, organization and delivery of ICU care in Bangladesh

Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective.
 Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc.
 Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9).
 Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control committees. Basic life support training was required for doctors and nurses in 31.4 % and 27.5 % hospitals respectively. Small clinics/ hospitals (less than 50 bed capacity [n=18]) had significantly less government funding (p < 0.0001), were less attached to university hospital (p < 0.0001), had fewer referral centers (p < 0.001), had less total hospital beds (p < 0.004) and were less in case of ICU beds : hospital beds percentage (p < 0.003). 28 ICUs had no single room. Govt. hospitals/academic hospitals/Medical colleges had relatively more ICU beds .(12.33% - p < 0.004). 60.8% ICUs were operated as open units. Open units were more likely present in hospitals/clinics more than 50 beds. Multivariable analysis showed that the presence of 1:1 nursing staff was much lower in private hospitals. Funding sources and types of hospitals were independently associated with lower percentage of ICU beds (p < 0.002) and (p < 0.0001) respectfully. University affiliations was more likely associated with closed ICU (p < 0.002). Presence of MD CCM qualified intensivists are more in government funded hospitals (p < 0.003) than those of private hospitals
 Conclusions : Our study demonstrates considerable variation in the organization and staffing among Bangladeshi ICUs. Compared to 2007 study it shows increased trend in number of closed units( 39% vs 15%) and percentage of ICU beds relative to number of hospital beds (6.5% vs 4.8%) .
 Bangladesh Crit Care J March 2019; 7(1): 3-11

Avoidance of unnecessary hospital admissions through the implementation of a digital health programme

Introduction: 62% of hospital bed days are occupied by older adults 65 and older in the UK and it is estimated that there is a cost to the NHS of £820 million1. Elderly patients admitted to hospital have worse morbidity and mortality outcomes and often have a poorer experience2,3,. To reduce emergency admissions Tameside and Glossop Integrated Care NHS Foundation Trust developed a Digital Health Service, which supports frail people to stay within the community where their care can be managed, avoiding an Emergency room attendance and potential emergency admission. Practice change: To enhance the value of care provided to the local community a digital health service has been implemented in care homes. The service provides digital technology that enables care home staff to access a hospital specialist for advice and guidance on residents who have a deterioration in health before considering an Ambulance/ GP visit. Aim and theory of change: The aim is to use technology to enable care home staff to maintain older people with complex co-morbidities, within their home setting and avoiding unnecessary hospital admissions. Timeline: The programme was launched in March 2017 and will run for 3 years Highlights: In the period April and September 2017 94 Emergency and 258 GP attendances were avoided. Total hospital bed days saved 1268. Deflection rate of Emergency room attendance is currently 70% Comments on sustainability: The programme has now been expanded across the whole of the residential care home sector and will launched as a 24/7 service this year. Limitations: Awaiting more long term finding, ongoing evaluation is required to ensure that early results are sustainable overtime. Comments on transferability A joint End of Life bid is being developed. Conclusions: Elderly people suffer worsening health and poor experience when in hospital 3, 5. There is also a significant financial cost to systems treating frail elderly patients in hospitals 3. The Digital health programme enabled care staff to access acute hospital specialists for advice and guidance, which has led to a significant deflection in attendance. Discussions: The programme has proven successful at reducing admissions and in Emergency room attendance within the population group, data appears to show that the service has the potential to support people to remain within their place of residence rather than be treated in hospital. Lessons learned: General practitioners are key influencers within community setting and proved key to promoting and service

ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore

BackgroundTo test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital.MethodsThe ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months.ResultsVC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value < 0.001) of acute inpatient complications such as delirium, pneumonia, urinary tract infections, and pressure sores. VC program has shown significant reduction in median length of stay for acute hospital (13 to 9 days) as well as median combined length of stay for acute and sub-acute rehabilitation hospital (46 to 39 days), thus reducing the total duration of hospitalization and saving total hospital bed days. Operative and inpatient mortality, together with readmission rates, remained low and comparable to international Geriatric Fracture Centers (GFCs).ConclusionThe implementation of VC methodology has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

A National Frailty Education Programme

Rationale for Training: Population ageing is occurring rapidly and between 2015 and 2050, the number of people aged 60 years and older is expected to increase from 12% of the global population to 22% (WHO, 2012). In Ireland, currently 13% of the population is 65 years or older and this number is expected to double by 2040 (Central Statistics Office, 2008). As older people have different healthcare requirements, the Irish healthcare system needs to adapt to meet the demands associated with this demographic change. Healthcare spending in Ireland is expected to rise from 5.8 to 6.7% of GDP by 2035 (European Commission, 2009). Almost 22% of all hospital emergency department attendees are aged 65 and over and this age group account for 40% of all acute emergency medical admissions and 47.3% of total hospital bed days (HSE, ED Task Force Report, 2015, NCPOP, 2012). One of the greatest challenges posed by an ageing population is the ability of healthcare professionals to understand, recognise and manage frailty.Frailty: Frailty is theoretically defined as a clinically recognisable state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiologic systems (Qian-Li Xue, 2011). Frailty affects approximately 8-10% of people over the age of 65 and 25-50% of those aged 85 and over (Mytton et al., 2012; Collard et al., 2012; Savva et al., 2013). Although frailty is an increasingly common condition in older people, it is not an inevitable part of ageing and in some cases it can be treated or prevented depending on its underlying cause. A lack of consensus regarding the operational definition of frailty makes it difficult to identify and manage in clinical practice (Rodríguez-Mañas, et al., 2013). However, conceptualizing frailty as a continuum from not frail, to pre-frail, to frail is considered a valid way to identify subgroups of older adults at risk of adverse outcomes such as falls, worsening disability, prolonged hospitalization and death (Clegg &amp; Young, 2015). The potential for serious adverse outcomes is a central problem associated with frailty. For people with frailty even a relatively minor event such as an infection can result in a dramatic change in health state: from independent to dependent; mobile to immobile; postural stability to falling; lucid to delirious (Clegg, 2013).Further to this, frailty has been shown to be a strong and independent predictor of emergency department visits and hospitalizations (McNallan et al., 2013), hospital re- admissions (Pugh et al., 2014) and in-hospital mortality (Bagshaw et al., 2013). Unplanned admissions to hospital in an emergency situation can be both distressing and disruptive for frail older people, their families and carers. These admissions create rising demands on acute hospital beds and result in enormous costs to Ireland’s health service. Therefore, this topic has relevance for policy makers, clinicians and nursing staff who need to understand the risk factors for frailty to enable them to implement programmes for early detection, prevention and management. By increasing awareness and understanding of frailty, we can improve outcomes for these older adults and reduce demands on the health service.Methodology: It is proposed that the methodology applied to the implementation of the National Early Warning Score would be applied to the roll out of a frailty education programme. This includes:- Providing a training programme for a cohort of national trainers (N= to be agreed) who will:- Provide local education programmes- Maintain a database of locally trained staff- Lead local governance groupEstablishment of National Steering Group (incl. cohort of national trainers, and nominated stakeholders) to:- Develop an educational programme for delivery locally- Develop a framework for interdisciplinary education- Develop an e-learning programmeThe Longtitudinal Study on Aging (TILDA): Using cutting edge research and the unique resources at the TILDA Health Assessment Centre in Trinity College, TILDA will deliver a one-day training course to nurses interested in learning more about frailty. The course will incorporate key research findings from TILDA, provide an overview of the theoretical models underpinning frailty and include training in key frailty assessment tools. Nurses are an integral part of the collaborative approaches to services for patients with frailty. This training will encourage nurses to be proactive members in the early identification and assessment of frailty, ensuring effective management to improve outcomes for these vulnerable adults.

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy

ObjectivePerioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. MethodsThe billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. ResultsOur analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. ConclusionOur analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.

The Effectiveness of a Care Transitions and Rapid Response Nurse Intervention at Reducing Readmissions and Emergency Department Use for High Risk Patients

The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the postdischarge period. This article presents the results of a randomized control trial evaluating the effectiveness of an intervention involving a care transitions nurse and a rapid response nurse at lengthening the time to first readmission, emergency department use and total hospital bed days during the 30 days, 60 days and 90 days post-discharge periods for patients at high risk of readmission. The intervening impact of social isolation and patient frailty was also evaluated. No statistically significant differences were found between the intervention and control groups on the time to first readmission or in the post-discharge emergency department or inpatient bed use. Social isolation and frailty were not shown to significantly influence these outcomes.

Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use: A nationwide propensity score-matched follow-up study.

Background Thrombolysis with intravenous recombinant tissue-type plasminogen activator improves functional outcome in acute ischemic stroke. Few studies have investigated the effects of thrombolysis in a real-world setting. We evaluated the impact of thrombolysis on long-term hospital bed day use and the risk of readmission due to stroke-related complications. Methods We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). Thrombolysed patients were propensity-score matched with non-thrombolysed acute ischemic stroke patients admitted to stroke centers not yet offering thrombolysis in 2004-2006. The outcomes were length of the stroke admission, total all-cause hospital bed day use during the first year after the stroke, and the long-term risk of readmissions. Thrombolysed and non-thrombolysed patients were compared using multivariable log-linear regression and Cox regression. Results We identified 1095 thrombolysed and 1095 propensity score matched eligible but non-thrombolysed acute ischemic stroke patients. The median length of the stroke admission was 9 days in the thrombolysed group and 13 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.88; 95% CI: 0.78-1.00). The median all-cause hospital bed day use within the first year was 12 days in the thrombolysed group and 19 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.82; 95% CI: 0.73-0.92). There was no significant difference in the overall risk of readmission (adjusted hazard ratio, 0.91; 95% CI: 0.79-1.04); however, thrombolysis was associated with reduced risk of pneumonia (adjusted hazard ratio, 0.59; 95% CI: 0.35-0.97). Conclusions Thrombolysis in ischemic stroke was associated with lower long-term hospital bed day use and decreased risk of readmission due to pneumonia.

Integrated multidisciplinary community service for chronic obstructive pulmonary disease reduces hospitalisations.

Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbation affect patient outcomes and healthcare costs. The long-term impact of an integrated COPD disease-management approach on hospitalisation remains controversial. The aim of this study was to evaluate whether a multidisciplinary community service reduces respiratory hospitalisations for COPD patients. A total of 346 patients was followed for a mean duration of 27.3 months. The number of admissions, total bed days for respiratory (COPD exacerbation or pneumonia) or general medical causes and length of stay (LOS) per respiratory admission was compared before and after referral with the service. A secondary multivariate analysis examined which clinical parameters best predict benefit from such service. The total respiratory admission and hospital bed days after referral were reduced by 31% (288 vs 417, P < 0.001) and 40.4% (1637 vs 2746, P < 0.0001) respectively, compared with the equivalent duration prior. The average LOS for each respiratory admission was also significantly reduced after referral (6.61 vs 5.70, P = 0.02). Overall, 55% patients experienced a reduction in admission frequency and hospital days. The impact on admission frequency and hospital days was the greatest in those with an at least moderate disease (GOLD ≥2, odds ratio (OR): 3.2, 95% confidence interval (CI): 1.2, 8.9; P = 0.019) and those who completed pulmonary rehabilitation (PR) (OR: 1.7, 95% CI: 1.1, 2.8; P = 0.04). In contrast, general medical admissions increased, one-third attributable to a cardiovascular cause both before and after referral. The implementation of COPD multidisciplinary community service was associated with reduced respiratory hospitalisations in the long term. Patients with moderate or severe disease and who are able to complete PR are much more likely to benefit.