Use Of Acute Hospital Beds Research Articles

Delayed hospital discharges and the trolley crisis.

We audited use of acute hospital beds in Connolly Hospital over a 3-month period (January-March 2020) which coincided with increased provision of step-down (nursing home) beds. Our results show both ineffective and inefficient baseline uses of these acute beds. Increased step-down beds improve patient care by reducing the trolley count, shortening average length of stay and reducing waiting lists. These data confirm that more step-down beds are a high priority for our Health Service to improve the effectiveness and efficiency of our hospitals i.e. better care at less cost.

Measuring medically unjustified hospitalizations in Switzerland

BackgroundInappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics.MethodsThe necessity of a hospital admission was determined using explicit criteria related to the recorded diagnoses. Two indicators (i.e. “unjustified” and “sometimes justified” stays) were applied to more than 800,000 hospital stays and a random sample of 200 of them was analyzed by two clinicians, using routine data available in medical statistics. The validation of the indicators focused on their precision, validity and adjustment, as well as their usefulness (i.e. interest and risk of abuse).ResultsRates, adjusted for case mix (i.e. age of patient, admission planned or not), showed statistically significant differences among hospitals. Only 6.5% of false positives were observed for “unjustified stays” and 17% for “sometimes justified stays”. Respectively 7 and 12% of stays had an unknown status, due to a lack of sufficiently precise data. Considering true positives only, almost one third of medical and pediatric stays were classified as not strictly justified from a medical point of view in Switzerland. Among these stays, about one fifth could have probably been avoided without risk. To enable a larger ambulatory shift, recommendations were made to strengthen the ambulatory care, notably regarding post-emergency follow-up, cardiac and pulmonary functions’ monitoring, pain management, falls prevention, and specialized at-home services that should be offered.ConclusionWe recommend using “unjustified stays” and “sometimes justified stays” indicators to monitor inappropriate hospitalizations. The latter could help the planning of reinforced ambulatory care measures to pursue the ambulatory shift. Nonetheless, we clearly advise against the use of these two indicators for hospitals financing purposes.

Cases of bed blockage in Northern Spain during 2010–2014: Delayed discharge from acute hospitalization to long-term care

Background The term ‘bed blocking’ is used in a situation where “patients who no longer require acute care are occupying acute care beds while awaiting lower-level placement”. This term is related with delayed discharge and represent an inefficient use of acute hospital beds. Evidence about this topic describes characteristics associated with a higher likelihood of became a bed-blocking: older age, lack of functional ability, emergency case and hospital's weighting. Our aim is to determinate in our region, which characteristics may influence the problem and to quantify inadequate hospitalization's days. Methods A descriptive retrospective study of patients with delayed discharge from acute hospitalization to long-term care was conducted. This study involved three public hospitals from the region of northern of Spain (Cantabria), during 2010–2014. The variables collected includes: age, gender, planned or emergency admission, level of hospital, diagnosis-related group (DRG) and inadequate hospitalization's days. Mean and standard deviation were estimated to continuous variables. Proportions were estimated with confidence intervals at 95% (95% CI) to discrete variables. Means were compared with t de Student and Anova. Results In the period between 2010 to 2014, it is found 1415 bed-blocking's cases in hospitals from Cantabria, waiting to be admitted in a to long-term care. Spent a total of 19,183 inadequate hospitalization's days. Mean of delayed discharge: 13.56 days [SD 14.34], range 1 to 131; 66.7% are delayed less than two weeks; 53.1% male and 46.9% female. Gender were not found to be significantly associated with delayed discharges but women [mean age 80.70] are significantly older than men [mean age 75.99]. The mean age of our population was 78.49 years [SD 10.48], range 27 of 102; 74.6% are older than 75 years but younger inpatients had delayed significantly longer; 94.1% of cases were emergency patients. Diagnosis-related group (DRG) more frequents were hip fracture (8.0%), stroke (7.5%), other central nervous system's disorder (5.6%) and simple pneumonia (4.0%). Compared with local hospital, the university hospital had delayed significantly longer. Conclusion Inpatient's characteristics related with bed blocking risk: older than 75, emergency admission in a university hospital and diagnosis that suppose unexpected lack of functional ability. Relation between gender and age could be related with gender role of caregiver. These results may reflect that university hospitals treat the more complex patients. Known the inpatient's characteristics, an early detection since the emergency admission could solve the delayed and prevent this inefficient use of acute hospital beds.

The relationship between workload and length of stay in Singapore

Prior studies link higher workload with longer length of stay (LOS) in the US. Unlike U.S. hospitals, Singaporean hospitals, like other major hospitals in the Asia-Pacific, are partially occupied by patients with non-acute needs due to insufficient alternative facilities. We examined the association between workload and length of stay (LOS) and the impact of workload on 30-day re-hospitalization and inpatient mortality rates in retrospective cohort in this setting. We defined workload as the daily number of patients per physician team. 13,097 hospitalizations of 10,000 patients were included. We found that higher workload was associated with shorter LOS (coefficient, −0.044 [95%CI, −0.083, −0.01]), especially for patients with longer stays (hazard ratios, not significantly greater than 1 before Day 4, 1.04 [95%CI, 1.01, 1.07] at Day 4 and 1.16 [95%CI, 1.10, 1.24] at Day 10), without affecting inpatient mortality (odds ratio (OR), 1.03 [95%CI, 0.99, 1.05]) or 30-day re-hospitalization (OR, 1.01 [95%CI, 0.99, 1.04]). This result differs from studies in the US and may reflect regional differences in the use of acute hospital beds for non-acute needs.

The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs.

Delayed discharges represent an inefficient use of acute hospital beds. Social isolation and referral to a public-funded rehabilitation unit were significant predictors of delayed discharges while admission from an institution was a protective factor for older hip fracture patients. Preventing delays could save between 11.2 and 30.7% of total hospital costs for this patient group. Delayed discharges of older patients from acute care hospitals are a major challenge for administrative, humanitarian, and economic reasons. At the same time, older people are particularly vulnerable to social isolation which has a detrimental effect on their health and well-being with cost implications for health and social care services. The purpose of the present study was to determine the impact and costs of social isolation on delayed hospital discharge. A prospective study of 278 consecutive patients aged 75 or older with hip fracture admitted, as an emergency, to the Orthopaedics Department of Hospital Universitário de Santa Maria, Portugal, was conducted. A logistic regression model was used to examine the impact of relevant covariates on delayed discharges, and a negative binomial regression model was used to examine the main drivers of days of delayed discharges. Costs of delayed discharges were estimated using unit costs from national databases. Mean age at admission was 85.5years and mean length of stay was 13.1days per patient. Sixty-two (22.3%) patients had delayed discharges, resulting in 419 bed days lost (11.5% of the total length of stay). Being isolated or at a high risk of social isolation, measured with the Lubben social network scale, was significantly associated with delayed discharges (odds ratio (OR) 3.5) as was being referred to a public-funded rehabilitation unit (OR 7.6). These two variables also increased the number of days of delayed discharges (2.6 and 4.9 extra days, respectively, holding all else constant). Patients who were admitted from an institution were less likely to have delayed discharges (OR 0.2) with 5.5 fewer days of delay. Total costs of delayed discharges were between 11.2 and 30.7% of total costs (€2352 and €9317 per patient with delayed discharge) conditional on whether waiting costs for placement in public-funded rehabilitation unit were included. High risk of social isolation, social isolation and referral to public-funded rehabilitation units increase delays in patients' discharges from acute care hospitals.

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

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

Prevalence of psychiatric and physical morbidity in an urban geriatric population

Background:With a rapidly increasing population of older aged people, epidemiological data regarding the prevalence of mental and physical illnesses are urgently required for proper health planning. However, there is a scarcity of such data from India.Aims:To study the frequency and pattern of psychiatric morbidity present and the association of physical illness with psychiatric morbidity in an elderly urban population.Settings and Design:Cross-sectional, epidemiological study.Materials and Methods:All the consenting elderly persons in a municipal ward division (n=202) were enrolled after surveying a total adult population of 7239 people. A door to door survey was undertaken where the participants were interviewed and physically examined. General Health Questionnaire-12, Mini Mental State Examination, CAGE Questionnaire and Geriatric Depression Scale were used in the interview apart from consulting the available documents. Other family members were also interviewed to verify the information.Statistical Analysis:Chi-square test with Yates correction.Results:Psychiatric illnesses were detected in 26.7% while physical illnesses were present in 69.8% of the population surveyed. Predominant psychiatric diagnoses were depressive disorders, dementia, generalized anxiety disorder, alcohol dependence and bipolar disorder. The most common physical illness was visual impairment, followed by cardiovascular disease, rheumatic illnesses, pulmonary illnesses, hearing impairment, genitourinary diseases and neurological disorders. Presence of dementia was associated with increased age, single/widowed/separated status, nuclear family, economic dependence, low education, cardiovascular disorders, rheumatic disorders and neurological disorders. Depression was associated with female sex, single/widowed/separated status, staying in nuclear families, economic dependence on others and co-morbid physical illnesses, specifically cardiovascular disorders and visual impairment.Conclusions:This study presented a higher rate of dementia and old age depression. The interesting association with several sociodemographic factors as well as physical illnesses may have important implications for health planning.

The Costs and Savings of a Regional Public Palliative Care Program: The Catalan Experience at 18 Years

Conceived as a World Health Organization demonstration project for public health initiatives at the end of life, the palliative care program in Catalonia illustrates the impact that similar initiatives may have in terms of cost savings for a regional health system. In a publicly funded and freely accessible health system, decreasing the number of hospital admissions, shortening the lengths of hospital stay, diminishing the frequency of emergency room consultations, shifting the use of acute hospital beds to palliative care beds for treating advanced disease inpatients, and substantially improving the use of opioids in the community are major determinants of the palliative care program's success. These features add to the opportunity the discipline offers to improve the quality of health care at the end of life. In this article, the information gathered over an 18-year trajectory of the program is summarized. Key features of the existing financial models used while developing palliative care in Catalonia are described, and the mechanisms by which palliative care may have contributed to increase savings for the health care system in end-of-life care, from €3,000,000 in 1995 to €8,000,000 in 2005, are discussed.

Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy

The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings. The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed. From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005. The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings.

Bed usage in a Dublin teaching hospital: a prospective audit

We prospectively audited inpatient bed use in our hospital for the first three months of this year. While 70% (mean age 54 +/- 20.8 years) of our patients went home on the day they were medically discharged, 30% (mean age 70.3 +/- 18.3 years) remained in the hospital awaiting step-down facilities. The total of 486 bed days occupied by overstaying patients would if available, have allowed treatment of 54% more patients without any increase in the hospital complement of beds, preventing the cancellation of elective procedures and preventing patients remaining on trolleys overnight. These prospective data emphasise (1) a highly inefficient use of acute hospital beds; (2) the need for step-down facilities; (3) efficient use of existing hospital beds is the highest priority both for optimal patient care and optimal use of expensive hospital resources; (4) efficient use of existing facilities should be achieved before the construction of additional facilities.

Alternatives to acute hospital care

The National Bed Inquiry indicated that up to 20% of older people might be inappropriately occupying acute hospital beds and could be discharged if alternative services were available. The report proposed the concept of ‘Intermediate Care’ as a scenario that might contribute to resolving issues around the use of acute hospital beds. The Department of Health (DoH) Circular to Health Authorities and Local Councils with regard to Intermediate Care and the publication of the National Service Framework for Older People have brought intermediate care into mainstream health policy.

Nurses' knowledge and attitudes towards older patients admitted to acute orthopaedic wards

The trend of rising use of acute hospital beds by older people has important implications for orthopaedic nursing. The need for a ‘geriatrically-orientated' approach to the care of older orthopaedic patients is now advocated, particularly for patients with hip fracture. As part of a larger investigation of care of hip fracture patients in four Scottish hospitals, nurses' knowledge and attitudes towards older people were assessed. This paper reports the findings of that assessment. No significant differences in knowledge and attitude scores overall were found across the four centres. However, when compared with the other three centres, the knowledge score was significantly higher in the unit with the most developed system of orthogeriatric collaboration, possibly suggesting a positive impact on nurses of geriatrician involvement in the care of older orthopaedic patients. The scales which were used to assess the nurses' knowledge and attitudes (i.e. Palmore's Facts on Aging Quiz and Kogan's Old People Scale) are discussed, noting doubts which have been raised about their contemporary value and, indeed, their general approach. The need remains, however, for continuing study of nurses' attitudes towards older people as population ageing continues.