Total Number Of Beds Research Articles

A pilot survey on the outpatient chemotherapy unit of national university hospitals in Japan for early palliative care

Abstract Background Over the past decade, multiple randomized controlled trials have demonstrated that involvement of palliative care services concurrent with chemotherapy (Cx) can improve health outcomes including overall survival. It is widely accepted that not only inpatients, but also outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with Cx. However, it is not established how to integrate early palliative care into standard oncology care. Since 2002, Outpatient Chemotherapy Unit, which is the room for cancer outpatients to receive Cx, has been established in hospitals under National health insurance in Japan. Methods To build an early palliative care delivery system for outpatients with cancer, we conducted a pilot survey on the management status of the outpatient chemotherapy unit from 2007 to 2017. The data was extracted from the Database Center of National University Hospitals in Japan ( http://plaza.umin.ac.jp/dbcenter/index.html ). Results There were 42 outpatient chemotherapy units of national university hospitals in Japan (The median of beds in each unit was 21 (range: 8-65)). The number of outpatient Cx conducted in the units has been increasing continuously year by year since 2002, which has been 2.6 times in the last decades (the median: from 2400/yr in 2007 to 6200/yr in 2017). Focusing on the 18 small scale university hospitals as ours (the total number of beds in each hospital equals to around 600 beds), it has been tripled from 1600/yr in 2007 to 4800/yr in 2017. Conclusions This survey revealed that the rapid growing number of cancer patients have been receiving Cx in outpatient settings in the last decade in Japan. Because the routine work burden has also been increasing, proper staffing and human resource development are considered urgent issues. It is necessary to consider the new model to promote integration of oncology and early palliative care for outpatients in Japan.

The Accreditation of Human Resources and Physical Space of the Iranian Heart Centre: Comparison to the national and international standards

Objective: Standardization of hospital resources and physical space can be an important strategy to increase productivity and effectiveness of services. The study was conducted with the aim of comparative accreditation of human resources and physical space in Mazandaran heart centre compared with the standards.
 Method: This comparative descriptive study was carried out in Sari city (centre of Mazandaran province) during 2016-2017. The data collection tool consists of two checklists for investigating the physical space and human resources of the hospital. To evaluate the quality of the content, a checklist was distributed to 5 experts from Mazandaran University of Medical Sciences. After corrections the checklist was applied. Data were analyzed by SPSS software version 16 and descriptive statistics.
 Findings: The total number of nurses in this hospital was 288 and the total number of beds was 171. The human resources in the nursing, nutrition, operating room, anaesthesia departments were not standard. The ratio of total human resource to the number of beds was also estimated as 4.04. Results showed that the physical conditions in the hospital were moderately standard. The physical conditions of the hospital in most dimensions based on checklist, except the physical location of hospital and the features of its doors, were in accordance with the standard requirements.
 Conclusion: Considering the inappropriate distribution of human resource in the hospital and the non-standard design of physical space for providing services with better quality and increasing patients' satisfaction, it is recommended that experts control more carefully standard requirements.

Predictors of Death in Necrotizing Skin and Soft Tissue Infection.

Necrotizing skin and soft tissue infection (NSTI) is a surgical emergency that is associated with high morbidity and mortality. This study aims to identify predictors of in-hospital death following a NSTI. We queried the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for California between 2006 and 2011. We used conventional and advanced statistical methods to identify predictors of in-hospital mortality, which included: logistic regression, stepwise logistic regression, decision trees, and K-nearest neighbor (KNN) algorithms. A total of 10,158 patients had a NSTI. The full and stepwise logistic regression models had a ROC AUC in the validation dataset of 0.83 (95% CI [0.80, 0.86]) and 0.81 (95% CI [0.78, 0.83]), respectively. The KNN and decision tree model had a ROC AUC of 0.84 (95% CI [0.81, 0.85]) and 0.69 (95% CI [0.65, 0.72]), respectively. The top predictors of in-hospital mortality in the KNN and stepwise logistic model included: (1) the presence of in-hospital coagulopathy, (2) having an infectious or parasitic diagnoses, (3) electrolyte disturbances, (4) advanced age, and (5) the total number of beds in a hospital. Patients with a NSTI have high rates of in-hospital mortality. This study highlights the important factors in managing patients with a NSTI which include: correcting coagulopathy and electrolyte imbalances, treating underlying infectious processes, providing adequate resources to the elderly population, and managing patients in high-volume centers.

An international survey of maximum surgical blood ordering schedule creation and compliance

Background and ObjectivesMaximal surgical blood order schedules (MSBOS) are prepared to assist surgeons and anaesthesiologists with pretransfusion test orders. The literature on the prevalence and usefulness of MSBOS in international settings is lacking. We developed a survey to understand the prevalence of MSBOS in hospitals and to analyse compliance with MSBOS recommendations.Method and MaterialsA survey tool was developed by the Biomedical Excellence for Safer Transfusions (BEST) collaborative. The survey link was distributed to BEST members who were encouraged to forward the link to colleagues. Survey respondents were asked to contribute data regarding their hospital's MSBOS and MSBOS compliance.ResultsThere were 174 completed surveys. Greater than half of respondents did not have an MSBOS. The total number of beds was significantly different (P = 0·04) in hospitals with (N = 81) or without (N = 93) an MSBOS. Less than a quarter of respondents felt that their MSBOS was being followed despite widespread access to the MSBOS. Over 60% of type and screen orders were MSBOS compliant; however, just 42% of cross‐match orders were compliant. There was a significant difference between the number of red‐blood‐cell units returned to the blood bank when comparing MSBOS compliant and MSBOS non‐compliant cross‐match orders (227 versus 788 units, respectively, P = 0·0026).ConclusionsAn MSBOS could be a useful tool to help with pretransfusion test orders; however, the majority of respondents lacked a MSBOS. In hospitals with a MSBOS, it was reported to be under‐utilized, which might contribute to the low compliance rates seen for cross‐match orders.

A simulation study of bed allocation to reduce blocking probability in emergency departments: A case study in China

Improving the bed allocation policy can alleviate the blocking, a situation where admitted patients cannot be transferred from the Emergency Departments (the upstream) to inpatient departments (the downstream) due to unavailability of beds. We aim to find a bed allocation policy that reduces the blocking probability and improves bed utilisation considering the interaction between the neighboring departments, as well as the priorities of different departments. This concept and the proposed model are tested in a real-life case at a hospital in China. A two-stage bed allocation simulation model is developed to evaluate the effect of bed assignment on the blocking probability and bed utilisation. Results show that the blocking probabilities can be reduced by 1.32%–8.98% and 1.74%–4.16% under different priority assignment cases and total number of beds. Sensitivity analyses are performed to examine the effect of varying patient arrival rate on the performance of bed allocation policy.

2097. Do Catheter-Associated Bloodstream Infections Affect Patients’ Perception of Care?

BackgroundFew cross-sectional studies have reported an association between patient satisfaction, a metric for performance-based hospital reimbursement, and catheter-associated bloodstream infections (CLABSI), but the persistence of this relationship over time has not been examined. Therefore, our aim in this study was to examine this relationship over a 4-year period using data from almost all hospitals in the United States.MethodsWe used the publicly accessible Hospital Compare website to extract data on hospital characteristics, hospital-level CLABSI and patient satisfaction scores (Hospital Compare Consumer Assessment of Healthcare Providers and Systems survey data) from 2011 to 2014. Mixed linear regression models were used to examine the relationship between the four domains of satisfaction scores (included in models separately) and observed to expected CLABSI ratio without and with adjustment for hospital ownership, availability of emergency services, nurse to bed ratio, resident to bed ratio, total number of beds, total number of physicians, and urban vs. rural status.ResultsOf the 3,528 hospitals (12,396 observations) with patient satisfaction data, CLABSI data were available for 2,129 hospitals. The mean (SD) CLABSI ratio was 0.54 (0.56), patient satisfaction with physician and nurse communication were 80.2% (4.4%) and 77.3% (4.9%), respectively; 70% (9.1%) of patients recommended a hospital and 68.8% (8.0%) rated a hospital 9 or 10 (on a 1–10 scale). Over 4 years, CLABSI scores decreased each year (−0.02, 95% CI = −0.03 to −0.01) while satisfaction scores increased (physicians: 0.16, 95% CI = 0.12–0.19; nurses: 0.56, 95% CI = 0.52–0.60; hospital recommendation:0.18, 95% CI = 0.12–0.23; hospital rating: 0.56, 95% CI = 0.50–0.62). In adjusted models, higher CLABSI ratios were associated with lower satisfaction with physician (−0.09, 95% CI = −0.17 to −0.01) and nurse (−0.12, 95% CI = −0.21 to −0.02) communication. In contrast, CLABSI ratios were not associated with hospital recommendation (−0.09, 95% CI = −0.22 to 0.04) or rating (−0.07, 95% CI = −0.21 to 0.06).ConclusionIn this first longitudinal study of most hospitals in the United States, hospitals with higher CLABSI ratios had lower patient satisfaction with physician and nurse communication but not with hospital recommendation or rating.Disclosures All authors: No reported disclosures.

Procedure-Specific Volume and Nurse-to-Patient Ratio: Implications for Failure to Rescue Patients Following Liver Surgery.

The effect of various hospital characteristics on failure to rescue (FTR) after liver surgery has not been well examined. We sought to examine the relationship between hospital characteristics and FTR after liver surgery. The 2013-2015 Medicare-Provider Analysis and Review (MEDPAR) database was used to identify Medicare beneficiaries who underwent liver surgery. The effect of various hospital characteristics on FTR was compared among the highest mortality hospitals (HMH) and the lowest mortality hospitals (LMH). Among 4902 patients undergoing hepatectomy, patients treated at HMH had a higher risk of FTR (OR 3.08, 95% CI 2.03-4.66). Hospital factors such as total number of beds (OR 0.80, 95% 0.56-1.15), operating rooms (OR 0.81, 95% 0.57-1.14), and overall hospital surgical volume (OR 0.88, 95% 0.61-1.25) were not associated with FTR (all p > 0.05). In contrast, hospitals with a greater nurse-to-patient ratio had a markedly lower risk of FTR following a complication (OR 0.70, 95% CI 0.54-0.91; p = 0.007) (Table3). As volume of liver operations and nurse-to-patient ratio decreased the risk of FTR increased (p > 0.001). After risk-adjusting for patient characteristics, both the effect of surgical volume (adjusted OR 0.66, 95% CI 0.46-0.94; p = 0.022) and nurse-to-patient ratio (adjusted OR 0.68, 95% CI 0.51-0.90; p = 0.008) remained strongly associated with FTR. FTR rates varied considerably among hospital performing hepatectomy. Higher procedure-specific hepatectomy volume, as well as a higher nurse-to-patient ratio, accounted for a reduction in the FTR rates. These data highlight the importance of not only procedure volume, but also adequate nurse staffing in reducing FTR and improving mortality following complex procedures such as hepatectomy.

Geographical maldistribution of surgical resources in South Africa: A review of the number of hospitals, hospital beds and surgical beds.

The global burden of surgical disease has been studied to a limited extent. Despite the proven benefits of surgery, surgical services remain poorly resourced. Contributing to this global crisis is the critical lack of data regarding available resources. To analyse the distribution of some resources necessary for the provision of surgical care. The distribution and number of surgical resources (number of surgical beds) relative to the general resources (number of hospitals and total number of beds) in South Africa were analysed. All hospitals in the country, including those in the public and private sectors, were contacted, and the total number of hospitals, the level of care (district v. regional v. tertiary), the total number of hospital beds, and the number of surgical beds were determined. The data were analysed according to the provincial distribution and the public v. private sector distribution relative to the size of the population. A total of 544 hospitals were included in the study - 327 in the public sector and 217 in the private sector. The public sector hospitals included 257 district-, 49 regional- and 21 tertiary-level hospitals. Nationally, there were 1 hospital, 187 hospital beds and 42 surgical beds per 100 000 population. Gauteng Province (GP), the Eastern Cape, KwaZulu-Natal (KZN) and the Western Cape had the most hospitals and GP had the largest number of private hospitals. GP and KZN had the largest total number of beds (n=29 181 and n=22 889, respectively) and number of surgical beds (n=7 289 and n=4 651, respectively). GP had the largest number of private surgical beds (n=4 837). There was a marked variation in the number of hospitals, total number of beds, and number of surgical beds among provinces. This study provided an estimation of the number of hospitals, total number of beds, and number of surgical beds, and showed a marked variation among provinces and between the public and private sectors.

Patterns of Hospital Performance on the Hospital-Wide 30-Day Readmission Metric: Is the Playing Field Level?

Hospital performance on the 30-day hospital-wide readmission (HWR) metric as calculated by the Centers for Medicare and Medicaid Services (CMS) is currently reported as a quality measure. Focusing on patient-level factors may provide an incomplete picture of readmission risk at the hospital level to explain variations in hospital readmission rates. To evaluate and quantify hospital-level characteristics that track with hospital performance on the current HWR metric. Retrospective cohort study. A total of 4785 US hospitals. We linked publically available data on individual hospitals published by CMS on patient-level adjusted 30-day HWR rates from July 1, 2011, through June 30, 2014, to the 2014 American Hospital Association annual survey. Primary outcome was performance in the worst CMS-calculated HWR quartile. Primary hospital-level exposure variables were defined as: size (total number of beds), safety net status (top quartile of disproportionate share), academic status [member of the Association of American Medical Colleges (AAMC)], National Cancer Institute Comprehensive Cancer Center (NCI-CCC) status, and hospital services offered (e.g., transplant, hospice, emergency department). Multilevel regression was used to evaluate the association between 30-day HWR and the hospital-level factors. Hospital-level characteristics significantly associated with performing in the worst CMS-calculated HWR quartile included: safety net status [adjusted odds ratio (aOR) 1.99, 95% confidence interval (95% CI) 1.61-2.45, p<0.001], large size (> 400 beds, aOR 1.42, 95% CI 1.07-1.90, p=0.016), AAMC alone status (aOR 1.95, 95% CI 1.35-2.83, p<0.001), and AAMC plus NCI-CCC status (aOR 5.16, 95% CI 2.58-10.31, p<0.001). Hospitals with more critical care beds (aOR 1.26, 95% CI 1.02-1.56, p=0.033), those with transplant services (aOR 2.80, 95% CI 1.48-5.31,p=0.001), and those with emergency room services (aOR 3.37, 95% CI 1.12-10.15, p=0.031) demonstrated significantly worse HWR performance. Hospice service (aOR 0.64, 95% CI 0.50-0.82, p<0.001) and having a higher proportion of total discharges being surgical cases (aOR 0.62, 95% CI 0.50-0.76, p<0.001) were associated with better performance. The study approach was not intended to be an alternate readmission metric to compete with the existing CMS metric, which would require a re-examination of patient-level data combined with hospital-level data. A number of hospital-level characteristics (such as academic tertiary care center status) were significantly associated with worse performance on the CMS-calculated HWR metric, which may have important health policy implications. Until the reasons for readmission variability can be addressed, reporting the current HWR metric as an indicator of hospital quality should be reevaluated.

P332 The development of NCUs in China: A 2nd nationwide survey

Objectives This report presents results of the 2nd nationwide survey concerning neurocritical care units (NCUs) in China. Methods This is an observational cross-sectional survey and close-ended self-reported questions were used. The questionnaire was sent to 31 different provinces (autonomous regions and municipalities) across China from October 1st, 2015 to January 1st, 2016. Basic information, equipment and device information, and staffing and organization information were investigated. Results In total, 101 questionnaires from 101 NCUs at 92 hospitals in 28 regions were received. Most of the hospitals with NCUs were large-scale (average hospital beds: 2150), teaching (84.8%), and tertiary hospitals (97.8%). The average number of NCU beds was 14, occupying 11.2% of the total number of beds in their department. Most of the equipment and devices (37/50) were available in over 80% of the 101 NCUs. However, some devices were centralized by hospital and operated with assistance from other departments. A total of 1250 full-time doctors and 1978 full-time nurses were employed at the NCUs. A few of the NCUs achieved a doctor-to-bed ratio of 0.5:1 (40.6%) and a nurse-to-bed ratio of 1:1 (37.6%). And respiratory therapists, clinical dieticians, clinical pharmacists, and physiotherapists were present in 5.9%, 32.7%, 36.6% and 49.5% of the 101 NCUs. Discussion According to this survey, the number of Chinese NCUs rose 32.9%, to 101 in 2015 from 76 in 2010. Among the 101 NCUs included in this survey, most of the basic devices and specialized devices were sufficiently available. But few NCUs (50%) have their own specialized equipment. Compared with the year 2010, the number of neurocritical care doctors and nurses is significantly higher in 2015. The staffing data of the 101 NCUs still reflect a severe shortage of NCU doctors and nurses. Conclusion The number of NCUs increased, the availability of NCU equipment became more sufficient, and the staffing of NCUs improved. However, we should pay attention to the management of specialized NCU equipment, the shortage of NCU staff, and the need of NCU training. Significance The results of this survey could expose deficiencies in Chinese NCUs development so that they can be studied and the suggestions can be provided for a more sustainable development of NCUs.

Impact of Stroke Center Certification on Mortality After Ischemic Stroke: The Medicare Cohort From 2009 to 2013.

An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission (P<0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.

OP134 Predictors Of Public Health Outcomes: A Case Study From Turkey

INTRODUCTION:In Turkey, there is a scarcity of knowledge about the predictors of health outcomes at a national level, and it is well known that there is a gap between rural and urban parts of developing countries in terms of the level of health outcomes. This study aims to find out predictor factors of the public health outcomes at a province level in Turkey.METHODS:Life expectancy at birth and mortality are used as public health outcome indicators. Logistic regression and Random Forest classification generated by using 50, 100, and 150 trees were used to compare prediction performance of health outcomes. The results of different prediction methods were recorded changing the “k” parameter from 3 to 20 in k-fold cross validation. The Area Under the ROC Curve (AUC) was used as a measure of prediction accuracy. Prediction performance differences were tested using Kruskall-Wallis analysis and visualized on a heatmap. Finally, predictor variables of public health outcomes were shown on a decision tree.RESULTS:Study results revealed that Logistic regression outperformed Random Forest classification. The difference between all prediction methods to predict public health outcome indicators was statistically significant (p&lt;.000). The heatmap shows that AUC values to predict mortality have superior performance when compared with life expectancy at birth. Decision tree graphs present that the most important predictor variables were total number of beds for mortality and percentage of higher education graduates for life expectancy at birth.CONCLUSIONS:The results of this study represent a preliminary attempt to determine public health outcome indicators. It is hoped that the results of this study serve as a basis to understand the determinants of health care outcomes at province level with focus on a developing country. This study illustrates that there is a need to spend extra effort for future studies to analyze public health outcomes to improve social welfare functions in health systems.

A description of the utilization of long term care and elderly care facilities in Hungary

Introduction: Due to demographic changes (the growing rate of elderly population), high patient expectations, increasing care and support needs and growing pressure for accountability, it is necessary to revise the health care system of Hungary. These facts mean general challenges at European level, but up to this point the Hungarian health care system is not ready for handling these changes with adequate solutions. According to the Hungarian Central Statistical Office the proportion of the population over 65 years is 17.2%, but considering the forecast of demographic trends it will increase. In this study we would like to give an overview about Hungarian long-term and elderly care services.Methods: This analysis shows the utilization of National Health Insurance Fund financed chronic and nursery care capacities (except rehabilitation). There are 11 573 long-term care beds in Hungary, which serve the people with chronic conditions and nursing needs. We have compared the utilization and age composition of the acute (performance based financing) and long-term care (financing by per diem) services. Furthermore we have examined the main professional activities which have been provided to over 65 years old patients by hospitals.Results: This study presents that during ten years there has been a significant growth in the proportion of the total hospital days of the population over 65. This proportion was 38% in 2004 and now this is 49%. We found that the proportion of population over 65 is 80% in long-term care departments which are led by physicians, and this number is 89% in the nursing departments. Furthermore, this population occupies 69 % of the hospital days in the departments of general internal medicine (the total number of beds is 3964). The lead diagnoses are chronic kidney failure, congestive heart failure, anemia and noninsulin-dependent diabetes mellitus in the departments of general internal medicine.In Hungary there are merely 150 geriatric beds and the distribution of them from a geographical perspective is unequal. It is an interesting fact that only 89 % of elderly people were served by the geriatric care units, despite the fact that this care is specialized for elderly people and multi-morbid conditions.The utilization of social services is full, the waiting time to get into residential homes is very long. 82% of the elderly people require nursing in residential homes, but at present this is not solved, controlled and financed.Discussion: Based on our results we have found that long-term care types are not sharply separated. It is not clear, what is the difference between the task of internal medicine, geriatric care and long-term care in elderly care. The shortcoming of the health care system is that the legal regulations do not fix the concrete activities; therefore the chronic care capacities frequently serve social and nursing needs. In addition, the home care capacities are not sufficient and there is no connection between social and health care providers.Conclusions: It is worth considering examining where we can connect the two sectors’ services, how we can incite the communication and cooperation, because without task sharing and coordination this services will not be able to satisfy efficiently the needs of elderly population.We have to highlight the possibilities of integrated care at system level and to build a service model especially focusing the people with chronic conditions and long-term nursing needs.

Mental healthcare in South America with a focus on Brazil: past, present, and future.

South America and Brazil have undergone major reforms in their mental healthcare systems during the past few decades. The Caracas Declaration, formulated in Venezuela in 1990, states that mental healthcare should be directed toward community treatment rather than hospital-based models. We review how mental health services were previously organized and how they are currently provided to persons with mental illnesses. In many South American countries, the number of beds in psychiatric hospitals has been reduced (e.g., between 2001 and 2005, from 18.3 to 12.7 and from 38.7 to 25.6 per 100 000 persons in Chile and Brazil, respectively). Meanwhile, the number of psychiatric beds in general hospitals has increased slightly and more human resources are being devoted to mental health services. Nevertheless, the total number of beds is still insufficient and financing for mental health programs is far below the optimum. More than 20 years after the Caracas Declaration, much has been done but many changes are still required. Some reforms have already been proposed but not put into practice. Future efforts should include fighting against stigma and improving budgeting for mental healthcare, a lack of which might be interpreted as structural stigma.

Distribution of hospital beds in Tehran Province based on Gini coefficient and Lorenz curve from 2010 to 2012.

IntroductionFair distribution of hospital beds across various regions is a controversial subject. Resource allocation in health systems rarely has focused on those who need it most and, in addition, is often influenced by political interests. The study assesses the distribution of hospital beds in different regions in Tehran, Iran, during 2010–2012.MethodsThis cross-sectional study was conducted in all regions of Tehran (22 regions) during 2010 to 2012. All hospital beds in these regions are included in the study. Data regarding populations of each region were obtained from the Statistics Center of Iran. According to the data, the total number of beds (N.B) and population (P) in 2010 (N.B=19075, P= 7585000), 2011 (N.B=21632, P= 9860500), and 2012 (N.B=21808, P=12818650). The instrument was a form, including the name of the hospital, the district in which the hospital was located, the number of staffed beds, the name of each region, and its population. Data analysis was performed using DASP software version 2.3.ResultsThe results demonstrate that the Gini coefficient of distributed beds in 22 regions of Tehran was 0.46 in all three years and specifically calculated 0.4666 in 2010, 0.4658 in 2011 and 0.4652 in 2012. The Gini coefficient of beds in 22 regions of Tehran is not fair in comparison with the population of each region during the years 2010 to 2012.ConclusionThe results demonstrate that the distribution of beds in regions in Tehran is not fair in relation to the population of each region—and some regions had no hospitals. Therefore, it is essential for policymakers to frequently monitor this issue and investigate the fair distribution of hospital beds.

ABOUT THE NEED OF PATIENTS WITH MALIGNANT TUMORS IN HOSPITAL PALLIATIVE CARE DURING LAST YEAR OF LIFE

In 2012, the State program of development of health care in the Russian Federation included a program of palliative care (PC), the result of the implementation of which should be a creation of a full infrastructure in the regions to provide PC to patients requiring active symptomatic treatment and psychosocial support in the later stages of incurable progressive disease. The aim of this study was to investigate the volume and location of inpatient medical care to patients who died from malignant neoplasms during the last year of life to determine their needs in the PC on the actual use of health services. Patients who died from cancer at home, in the last year of life received inpatient care at different levels of the health system (69.5 admissions per 100 patients per year), mostly in the MO Ministry of Healthcare (79.77 of all hospitalizations (CI 78, 9% -80.6%)), and 20,23 ± 3,0% in the regional oncologic center. Two hundred and twenty beds, which are used today to provide medical care for cancer patients during the last year of life, can be regarded as the minimum volume requirements in the palliative care for cancer patients, including a specialized hospitals (33.54 beds) at the existing levels of morbidity and mortality from cancer in the region, as well as the functioning and effectiveness of the health care system, primarily of outpatient care. The number of beds used by cancer patients for palliative care during the last year of life, made up 80.12% of the total number of beds for palliative care, calculated according to the standard recommended by the State Program of Health of the Russian Federation until 2020. We must bear in mind that in accordance with the standard of palliative care 80% of the number deployed beds should be used for cancer patients, and only 20% - for patients with other nosological forms of diseases. This underscores the relevance of developing and using practical criteria for the selection of patients with chronic progressive disease, and non-cancer diseases to provide specialized palliative care.

Profiling Mental Health Services in Portugal: Seven Years After the Reform

1. Introduction Despite recent improvements in the Portuguese mental health services (MHS), the low priority given for a long time to mental health within the general context of the country's health services, illustrated by inadequacies in planning and funding models, led to a significant delay in the improvement of MHS, when compared to other European countries. 2. Objectives To compare the profile of MHS in Portugal 7 years after the launching of the National Mental Health Plan in the following dimensions: capacity (adults and child/adolescents), human resources and use of services (discharges, appointments, day hospital). 3. Methods A full evaluation was conducted by the National Mental Health Programme, under the auspices of the General Directorate of Health, by means of a cross-sectional evaluation of national data. 4. Results Comparing the situation between 2005 and 2012, the most significant aspect is the reduction of the total number of beds in public MHS, mainly due to the elimination of 40% of beds in the decommissioned psychiatric hospitals. Regarding human resources, there was decrease in the number of psychiatrists working in public MHS. There was a significant increase in the number of outpatient appointments, both in child psychiatry (+30%) and adult psychiatry (+22%). 5. Conclusion Tough the development of new MHS in general hospitals, some geographic areas are still not covered by these services, namely in the southern region of the country. There is also a significant scarcity of other professionals, which prevents the improvement of multidisciplinary and comprehensive work.

병원의 간호사이직률과 병원의 구조적 특성

본 연구는 병원에 근무하는 간호사의 이직률과 병원의 구조적 특성 간 관련성을 확인하기 위하여 시행하였다. 자료는 한국보건산업진흥원에서 매년 조사하는 병원경영분석자료를 이용하였으며, 2008년에 전국에서 자기기입식으로 입력한 병원은 247개였다. 2008년 우리나라 간호사의 평균 이직률은 32.0%(공공병원 15.5%; ...

Historical facts about the Special psychiatric hospital 'Gornja Toponica' Nis, Serbia

The sale and the purchase of a large estate in the area of the village of GornjaToponica near Nis, was officially closed on the 9th of September 1911, providing the area on which today's Psychiatric Hospital was built. The land on which the hospital was constructed is known according to historical records and it was known as the 'King Milan's Estate'. It was the property of his ex-wife Natalija, who was divorced and banished from Serbia, the same lady who donated her spacious estate in Serbia to the University of Belgrade. The hospital started working in 1927. On that day 160 patients were transported from the Hospital for Mental Diseases in Belgrade to the railway station near Toponica. According to available data, in 1929, 320 patients were hospitalised in the hospital whose total number of beds was 160. Four doctors and 40 workers looked after and provided treatment to these number of patients. The number of applications for treatment kept increasing, so that in 1935 there were 492 patients, and in 1940 as many as 604 patients. The state hospital continued working also during World War II under very difficult, demanding and highly risky conditions for the patients, and in particular for the staff and management. The number of patients was increasing after building new pavilons in 1960. In 1970 the number of hospitalised patients was between 1200-1500. The current capacity of the hospital is 800 beds, the hospital has recruited 48 doctors (18 neuropsyhiatrists, 22 psychiatrics), 155 nurses, 41 senior nurses, 5 social workers and 9 psychologists. It should be noticed that the hospital are now actively involved in the implementation deinstituionalization and reorganization of psychiatry. As the first institution in the region, it has started and successfully implemented a pilot project of establishing the first Center for Mental Health in the community. There has also been significant progress in reducing the number of hospitalized patients with the trend of shortening the length of hospitalization and directing special attention to out-hospital treatment. It is planned to follow up the de-institutionalization and de-stigmatization psychiatric patients. The new management of hospital is moving into the new millennium according to the tradition based as far back in 1927. As the Hippocrates said 'Recovery takes time, but the right conditions.'.

Development and implementation of a regional intensive care health service model

PurposeThe purpose of this paper is to present a case study of a healthcare service redesign. Before 1998, five community hospitals in Winnipeg each managed their intensive care units (ICUs) independently, providing virtually no access to patients in rural and remote regions of the province of Manitoba; and two tertiary university affiliated hospitals were left with insufficient intensive care beds to service the rest of the provincial population in addition to their tertiary service responsibilities. The authors resolved to create a city‐wide integrated critical care services model, in order to improve patient access, quality of care and cost effectiveness.Design/methodology/approachA population demand analysis was performed and service objectives were defined. A gap analysis became the basis of an integrated service model design and an implementation plan was formulated.FindingsBeds were redistributed among community hospital ICUs to match available nursing resources. A credentialing process was developed to establish medical competency for attending physicians. A central bed registry and a referral triage system were implemented, to ensure that any Manitoban requiring an ICU admission acquired an appropriate bed in a timely manner. A regional computerized critical care database was introduced to all ICUs. The total number of beds was reduced from 92 to 84 and total occupancy fell from 65 to 58. The new model was entirely funded from bed reductions.Originality/valueThis paper describes the integration of a group of hospital‐based ICUs into a regional service delivery model developed to meet the needs of a provincial population.