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Vittori A, Tritapepe L, Chiusolo F, Rossetti E, Cascella M, Petrucci E, Pedone R, Marinangeli F, Francia E, Mascilini I, Marchetti G, Picardo SG. Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study. Perioper Med (Lond) 2023; 12:53. [PMID: 37752610 PMCID: PMC10523757 DOI: 10.1186/s13741-023-00342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data. METHODS We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018. RESULTS We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication. CONCLUSIONS Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luigi Tritapepe
- Department of Anesthesiology, Critical Care, and Pain Medicine, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
- Unit of Anesthesia and Intensive Care, Sapienza University, Piazzale Aldro Moro 5 00185, Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuele Rossetti
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, 67100, Coppito, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, , L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, Coppito, AQ, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giuliano Marchetti
- Surgery Unit, Bios Medical Center, Via Domenico Chelini, 39, 00197, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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San Jose-Saras D, Vicente-Guijarro J, Sousa P, Moreno-Nunez P, Espejo-Mambié M, Aranaz-Andres JM. Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach. J Gen Intern Med 2023; 38:1655-1663. [PMID: 36717430 DOI: 10.1007/s11606-022-07998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. OBJECTIVES To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. DESIGN AND PARTICIPANTS This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients' intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. MAIN MEASURES AND KEY RESULTS A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). CONCLUSIONS The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact.
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Affiliation(s)
- D San Jose-Saras
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Biología de Sistemas, Alcalá de Henares, Spain.,Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain.
| | - P Sousa
- National School of Public Health, Public Health Research Center, Comprehensive Health ResearchCenter, CHRC, NOVA University Lisbon, Lisbon, Lisbon, Portugal
| | - P Moreno-Nunez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| | - M Espejo-Mambié
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J M Aranaz-Andres
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
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Leti Acciaro A, Ramponi L, Adani R. Outpatient paediatric hand surgery: strategy in healthcare implementation and cost-efficient manner. Musculoskelet Surg 2021; 106:449-455. [PMID: 34292504 DOI: 10.1007/s12306-021-00723-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
The increasingly cost of health care is a relevant problem as well as prolonged waiting time for admission also in emergencies. Effective cost containment measures and expenditure controls are needed to achieve and maintain clinical and organizational appropriateness. Outpatient management has proven to be the most useful method for lower-cost treatment in less severe pathologies, requiring surgery without hospitalization. The current study provided to evaluate how this model was successfully applied also to the paediatric population in hand surgery. Methods. A retrospective cohort study of 645 patients from 8 to 18 years (mean age 14.9) was performed in children treated in outpatient setting from 2015 to 2019. The direct costs were evaluated as well as the mean waiting time for surgery, comparing the data with the previous five-year period. The mean reduction in waiting time for children emergencies was 57% (from 72 to 31 h) due to the Outpatient setting into a dedicated Day-Surgery Service organizational model. The visual graphed data showed a general clear growing trend towards outpatient surgery in adults and children. The overall effect was a 29.2% of reduction in spending between expected and achieved costs, recovering resources toward the increasing technology and innovation expenditures. Outpatient paediatric hand surgery was an effective and attractive option which leaded to decreased individual and social costs, with increased clinical and organizational appropriateness. Thus, reduced delay in treatment and provided benefits for children and familiars.
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Affiliation(s)
- Andrea Leti Acciaro
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124, Modena, Italy.
| | - Laura Ramponi
- Research Hospital Rizzoli Orthopedic Institute: Clinic of Orthopedic and Traumatology 1, Bologna, Italy
| | - Roberto Adani
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124, Modena, Italy
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Panahpour Eslami N, Nguyen J, Navarro L, Douglas M, Bann M. Factors associated with low-acuity hospital admissions in a public safety-net setting: a cross-sectional study. BMC Health Serv Res 2020; 20:775. [PMID: 32838764 PMCID: PMC7446119 DOI: 10.1186/s12913-020-05456-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background Given system-level focus on avoidance of unnecessary hospitalizations, better understanding admission decision-making is of utility. Our study sought to identify factors associated with hospital admission versus discharge from the Emergency Department (ED) for a population of patients who were assessed as having low medical acuity at time of decision. Methods Using an institutional database, we identified ED admission requests received from March 1, 2018 to Feb 28, 2019 that were assessed by a physician at the time of request as potentially inappropriate based on lack of medical acuity. Focused chart review was performed to extract data related to patient demographics, socioeconomic information, measures of illness, and system-level factors such as previous healthcare utilization and day/time of presentation. A binary logistic regression model was constructed to correlate patient and system factors with disposition outcome of admission to the hospital versus discharge from the ED. Physician-reported contributors to admission decision-making and chief complaint/reason for admission were summarized. Results A total of 349 (77.2%) of 452 calls resulted in admission to the hospital and 103 (22.8%) resulted in discharge from the ED. Predictors of admission included age over 65 (OR 3.5 [95%CI 1.1–11.6], p = 0.039), homelessness (OR 3.3 [95% CI 1.7–6.4], p=0.001), and night/weekend presentation (OR 2.0 [95%CI 1.1–3.5], p = 0.020). The most common contributing factors to the decision to admit reported by the responding physician included: lack of outpatient social support (35.8% of admissions), homelessness (33.0% of admissions), and substance use disorder (23.5% of admissions). Conclusions Physician medical decision-making regarding the need for hospitalization incorporates consideration of individual patient characteristics, social setting, and system-level barriers. Interventions aimed at reducing unnecessary hospitalizations, especially those involving patients with low medical acuity, should focus on underlying unmet needs and involve a broad set of perspectives.
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Affiliation(s)
| | | | | | | | - Maralyssa Bann
- Division of GIM/Hospital Medicine, Harborview Medical Center, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
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Caredda E, Guolo S, Rinaldi S, Brusco C, Raponi M. Outpatient surgery is the solution at hand for reducing costs and hospital stays for pediatric surgery too: a hospital trial. Minerva Pediatr 2019; 72:101-108. [PMID: 31129951 DOI: 10.23736/s0026-4946.19.05426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outpatient management has proven to be the most useful method of treatment for various minimally complex surgical specialties compared to day-hospital management or ordinary inpatient processes, a fact confirmed by numerous technical documents and works in the literature. METHODS We analyzed 27,713 surgical interventions carried out in our hospital between 2005 and 2017. This analysis included all interventions for which the indication of the level of care has moved, over the years, to an outpatient setting. We evaluated the direct costs of these services, comparing them by year and by treatment setting. RESULTS From the analysis of costs in general, for the same number of services, a reduction of 56.6% can be seen in the comparison between 2005 and 2017. In addition, the analysis of the length of stay shows an average reduction in the number of days of hospitalization from 2.9 to 1.2 between 2005 and 2017. On the basis of a large quantity of data, our study confirms that outpatient surgery can have a significant impact in reducing costs and days of hospitalization, even in a pediatric setting, demonstrating that it is the best choice in terms of saving resources and, above all, clinical and organizational appropriateness. CONCLUSIONS Outpatient surgery is in fact a valuable solution that provides an advantage for both the patient and his/her family, especially in the pediatric field, for the hospital and more generally for the health system as a whole.
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Affiliation(s)
- Emanuele Caredda
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy -
| | - Stefano Guolo
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Silvia Rinaldi
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Carla Brusco
- Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Falavigna G, Costantino G, Furlan R, Quinn JV, Ungar A, Ippoliti R. Artificial neural networks and risk stratification in emergency departments. Intern Emerg Med 2019; 14:291-299. [PMID: 30353271 DOI: 10.1007/s11739-018-1971-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
Emergency departments are characterized by the need for quick diagnosis under pressure. To select the most appropriate treatment, a series of rules to support decision-making has been offered by scientific societies. The effectiveness of these rules affects the appropriateness of treatment and the hospitalization of patients. Analyzing a sample of 1844 patients and focusing on the decision to hospitalize a patient after a syncope event to prevent severe short-term outcomes, this work proposes a new algorithm based on neural networks. Artificial neural networks are a non-parametric technique with the well-known ability to generalize behaviors, and they can thus predict severe short-term outcomes with pre-selected levels of sensitivity and specificity. This innovative technique can outperform the traditional models, since it does not require a specific functional form, i.e., the data are not supposed to be distributed following a specific design. Based on our results, the innovative model can predict hospitalization with a sensitivity of 100% and a specificity of 79%, significantly increasing the appropriateness of medical treatment and, as a result, hospital efficiency. According to Garson's Indexes, the most significant variables are exertion, the absence of symptoms, and the patient's gender. On the contrary, cardio-vascular history, hypertension, and age have the lowest impact on the determination of the subject's health status. The main application of this new technology is the adoption of smart solutions (e.g., a mobile app) to customize the stratification of patients admitted to emergency departments (ED)s after a syncope event. Indeed, the adoption of these smart solutions gives the opportunity to customize risk stratification according to the specific clinical case (i.e., the patient's health status) and the physician's decision-making process (i.e., the desired levels of sensitivity and specificity). Moreover, a decision-making process based on these smart solutions might ensure a more effective use of available resources, improving the management of syncope patients and reducing the cost of inappropriate treatment and hospitalization.
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Affiliation(s)
- Greta Falavigna
- CNR-IRCrES, Research Institute on Sustainable Economic Growth, Moncalieri, Italy.
| | - Giorgio Costantino
- Clinical Medicine Department, Fondazione IRCCS, Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Humanitas Research Hospital, Rozzano, Italy
| | - James V Quinn
- Division of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Andrea Ungar
- Syncope Unit, Geriatric Medicine and Cardiology, Careggi University Hospital, Florence, Italy
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Rahimi H, Ostovar R, Vali L, Angha P. Investigating inappropriate admissions and hospitalizations in Yasuj educational hospitals based on appropriateness evaluation protocol (AEP): A case study in the internal and surgical wards. Int J Health Plann Manage 2019; 34:636-643. [PMID: 30609065 DOI: 10.1002/hpm.2723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Examining the conditions for hospital admission and its appropriateness, and continuous investigation of hospital services are important issues that can improve resource productivity, service quality, and hospital efficacy. So, the present study was conducted to determine the appropriateness of the services provided in Yasuj educational hospitals. METHODS This descriptive-analytical study was carried out on 204 hospitalized patients who were selected through multistage quota sampling in 2016. The appropriateness evaluation protocol (AEP) was used to collect the data. Analytical tests such as paired t-test, chi-square test, and Fisher's exact test were used to determine the relationship between appropriate and inappropriate admission and hospitalization and demographic characteristics. The data were analyzed using the SPSS18 statistical software. RESULTS A total of 980 days of stay were evaluated, and according to the AEP, 35 days of hospitalization were considered inappropriate (3.57%). The mean hospitalization duration was 6/16 ± 5/53 days. The results showed that inappropriate admission and hospitalization rates were respectively 0.6% and 13.8%. CONCLUSION Unnecessary admissions and hospitalizations can be considered as one of the challenges of the health system. Reducing unnecessary hospitalization will increase hospital productivity, reduce the waiting list and hospitalization costs, and also reduce the risk of exposure to hospital infections. In order to prevent inappropriate admissions and unnecessary hospitalizations, special measures can be taken, including the use of clinical guidelines, modification of the discharge process, and modification of the lower levels of the service providing system.
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Affiliation(s)
- Hamed Rahimi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Rahim Ostovar
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Leila Vali
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Angha
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Casagranda I, Costantino G, Falavigna G, Furlan R, Ippoliti R. Artificial Neural Networks and risk stratification models in Emergency Departments: The policy maker's perspective. Health Policy 2015; 120:111-9. [PMID: 26744086 DOI: 10.1016/j.healthpol.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 10/08/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
The primary goal of Emergency Department (ED) physicians is to discriminate between individuals at low risk, who can be safely discharged, and patients at high risk, who require prompt hospitalization. The problem of correctly classifying patients is an issue involving not only clinical but also managerial aspects, since reducing the rate of admission of patients to EDs could dramatically cut costs. Nevertheless, a trade-off might arise due to the need to find a balance between economic interests and the health conditions of patients. This work considers patients in EDs after a syncope event and presents a comparative analysis between two models: a multivariate logistic regression model, as proposed by the scientific community to stratify the expected risk of severe outcomes in the short and long run, and Artificial Neural Networks (ANNs), an innovative model. The analysis highlights differences in correct classification of severe outcomes at 10 days (98.30% vs. 94.07%) and 1 year (97.67% vs. 96.40%), pointing to the superiority of Neural Networks. According to the results, there is also a significant superiority of ANNs in terms of false negatives both at 10 days (3.70% vs. 5.93%) and at 1 year (2.33% vs. 10.07%). However, considering the false positives, the adoption of ANNs would cause an increase in hospital costs, highlighting the potential trade-off which policy makers might face.
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Affiliation(s)
- Ivo Casagranda
- Emergency Department, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Giorgio Costantino
- Internal Medicine Department, "Fondazione IRCCS Ca' Granda" Hospital, Milan, Italy
| | - Greta Falavigna
- CNR-IRCrES (National Research Council of Italy - Research Institute on Sustainable Economic Growth), Moncalieri (Turin), Italy
| | - Raffaello Furlan
- Division of Internal Medicine, Humanitas Research Hospital, Rozzano, Italy; Università degli Studi di Milano, Milan, Italy
| | - Roberto Ippoliti
- Scientific Promotion, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy; Department of Management, University of Torino, Italy.
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Specchia ML, Poscia A, Volpe M, Parente P, Capizzi S, Cambieri A, Damiani G, Ricciardi W, De Belvis AG. Does clinical governance influence the appropriateness of hospital stay? BMC Health Serv Res 2015; 15:142. [PMID: 25889675 PMCID: PMC4392497 DOI: 10.1186/s12913-015-0795-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay. Methods A cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV© (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit. Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels. Results 47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = −0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness. Conclusions This study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV© and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.
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Affiliation(s)
- Maria Lucia Specchia
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Andrea Poscia
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. .,Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Massimo Volpe
- Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Paolo Parente
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Silvio Capizzi
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Andrea Cambieri
- Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Gianfranco Damiani
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Walter Ricciardi
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | | | - Antonio Giulio De Belvis
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. .,Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
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Woodhams V, de Lusignan S, Mughal S, Head G, Debar S, Desombre T, Hilton S, Al Sharifi H. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network. BMC Health Serv Res 2012; 12:153. [PMID: 22682525 PMCID: PMC3476394 DOI: 10.1186/1472-6963-12-153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 05/24/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.
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Affiliation(s)
- Victoria Woodhams
- Department of Health Care Management and Policy, University of Surrey, GUILDFORD, GU2 7XH, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, GUILDFORD, GU2 7XH, UK
- Division of Population Health Sciences and Education, Hunter Wing, St. George’s – University of London, LONDON, SW17 0RE, UK
| | - Shakeel Mughal
- Central Wandsworth Community Ward, Southfield Group Practice, 492a Merton Road, London, SW18 5AE, UK
| | - Graham Head
- The Sollis Partnership Ltd 20 Hook Road, Epsom, Surrey, KT19 8TR, UK
| | - Safia Debar
- Portobello Clinic, 12 Raddington Road, LONDON, W10 5TG, UK
| | - Terry Desombre
- Department of Health Care Management and Policy, University of Surrey, GUILDFORD, GU2 7XH, UK
| | - Sean Hilton
- Division of Population Health Sciences and Education, Hunter Wing, St. George’s – University of London, LONDON, SW17 0RE, UK
| | - Houda Al Sharifi
- Room 147, 1st Floor, Wandsworth Town Hall, Wandsworth High Street, London, SW18 2PU, UK
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Gamper G, Wiedermann W, Barisonzo R, Stockner I, Wiedermann CJ. Inappropriate hospital admission: interaction between patient age and co-morbidity. Intern Emerg Med 2011; 6:361-7. [PMID: 21655929 DOI: 10.1007/s11739-011-0629-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
The aim of the study is to determine the prevalence of inappropriate admission, and to identify the factors that influence appropriateness of hospital admission. Data were prospectively collected from all 345 consecutive patients admitted during the period of 1 month for acute hospital care at a 110-bed division of internal medicine using socio-demographic and medical information. Statistical analyses included χ2 tests, t tests, and logistic regression analyses. According to the European version of the Appropriateness Evaluation Protocol of hospital admission, 28.1% of medical admissions for acute care in the Central Hospital of Bolzano, Italy, have been classified as inappropriate. Factors that reduced appropriateness included female gender, age and chronic illness that are significantly associated with appropriateness of medical admission, whereas time of day or day of week of the emergency department (ED) visit does not influence appropriateness. In multiple logistic regression analyses, age and co-morbidity are not independently related to appropriateness, however, when tested for interaction, inappropriateness is significantly more frequent at a young age in the absence of co-morbidities, and, numerically most relevant, in elderly patients presenting with co-morbidities. In this evaluation of a single centre North Italian hospital admission, co-morbidity turns out to be an important age-dependent determinant of appropriateness. Although in the young age group, co-morbidity increases the likelihood of being appropriately admitted, the presence of chronic illness in the elderly increases the risk of inappropriate hospital use.
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Affiliation(s)
- Gudrun Gamper
- Department of Internal Medicine, Central Hospital of Bolzano, Lorenz Böhler Street 5, 39100, Bolzano, BZ, Italy
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Davies SJ, Yates D, Wilson RJT. Dopexamine Has No Additional Benefit in High-Risk Patients Receiving Goal-Directed Fluid Therapy Undergoing Major Abdominal Surgery. Anesth Analg 2011; 112:130-8. [DOI: 10.1213/ane.0b013e3181fcea71] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wong ELY, Yam CHK, Chan FWK, Cheung AWL, Wong FYY, Griffiths S, Yeoh EK. Perspective from health professionals on delivery of sub-acute care in Hong Kong: a qualitative study in a health system. Health Policy 2010; 100:211-8. [PMID: 21109327 DOI: 10.1016/j.healthpol.2010.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/29/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The perception and understanding of health professionals of the role of sub-acute care in the health system will have an impact on the potential effectiveness in preventing unnecessary hospitalization. This study aims to explore the perceived role and quality of sub-acute care services in the context of Hong Kong from the perspective of health service providers and to identify barriers to effectiveness. METHODS Seven focus groups were conducted and the discussion was led by a guide covering three main areas: definition/component/role of sub-acute, difficulties in the sub-acute care services provision, and suggestion for further improvement in the provision of sub-acute care. RESULTS The participants highlighted the positive role of sub-acute to promote patient's health and quality of life so as to reduce unnecessary hospitalization. The potential barriers in the sub-acute care identified were interrelated and focused mainly on systemic issues including lack of service coordination, specialist input and resources. The participants also suggested a number of practical ways to improve the quality of sub-acute care services. CONCLUSIONS The findings showed a need for further improvement in the process of sub-acute care by developing operation guideline and re-evaluating the allocation of resources to support the sub-acute care provision.
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Affiliation(s)
- Eliza L Y Wong
- Division of Health Systems, Policy and Management, School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Mould-Quevedo JF, García-Peña C, Contreras-Hernández I, Juárez-Cedillo T, Espinel-Bermúdez C, Morales-Cisneros G, Sánchez-García S. Direct costs associated with the appropriateness of hospital stay in elderly population. BMC Health Serv Res 2009; 9:151. [PMID: 19698130 PMCID: PMC2744673 DOI: 10.1186/1472-6963-9-151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. METHODS Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. RESULTS The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9-5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6-2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2-US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7-US$6,198.3), (p < 0.001). CONCLUSION Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.
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Affiliation(s)
- Joaquín F Mould-Quevedo
- Departamento de Negocios Internacionales, Instituto Tecnológico y de Estudios Superiores de Monterrey, México, D.F., México.
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Hammond CL, Pinnington LL, Phillips MF. A qualitative examination of inappropriate hospital admissions and lengths of stay. BMC Health Serv Res 2009; 9:44. [PMID: 19265547 PMCID: PMC2655293 DOI: 10.1186/1472-6963-9-44] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 03/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. METHODS Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. RESULTS The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. CONCLUSION Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.
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Affiliation(s)
- Christina L Hammond
- Rehabilitation Research and Education Group, School of Community Health Sciences, University of Nottingham, Derby, UK
| | - Lorraine L Pinnington
- Rehabilitation Research and Education Group, School of Graduate Entry Medicine & Health, University of Nottingham, Derby, UK
| | - Margaret F Phillips
- Rehabilitation Research and Education Group, School of Graduate Entry Medicine & Health, University of Nottingham, Derby, UK
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Hammond CL, Phillips MF, Pinnington LL, Pearson BJ, Fakis A. Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions. BMC Health Serv Res 2009; 9:40. [PMID: 19250523 PMCID: PMC2653500 DOI: 10.1186/1472-6963-9-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 02/27/2009] [Indexed: 11/16/2022] Open
Abstract
Background To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives. Methods Adults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed. Results A total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives. Conclusion Patients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.
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Affiliation(s)
- Christina L Hammond
- Rehabilitation Research and Education Group, School of Community Health Sciences, University of Nottingham, UK.
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Louis D, Taroni F, Melotti R, Rabinowitz C, Vizioli M, Fiorini M, Gonnella J. Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy. J Health Serv Res Policy 2008; 13:202-8. [PMID: 18806177 DOI: 10.1258/jhsrp.2008.007157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
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Affiliation(s)
- Daniel Louis
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Francesco Taroni
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Department of Social Medicine, University of Bologna, Bologna, Italy
| | - Rita Melotti
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Department of Anaesthesiology, University of Bologna, Bologna, Italy
| | | | - Maria Vizioli
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Regione Emilia-Romagna, Bologna, Italy
| | - Monica Fiorini
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Agenzia Sanitaria Regionale Regione Emilia-Romagna, Bologna, Italy
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Grocott MPW, Browne JP, Van der Meulen J, Matejowsky C, Mutch M, Hamilton MA, Levett DZH, Emberton M, Haddad FS, Mythen MG. The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol 2007; 60:919-28. [PMID: 17689808 DOI: 10.1016/j.jclinepi.2006.12.003] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 12/06/2006] [Accepted: 12/14/2006] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe the reliability and validity of the Postoperative Morbidity Survey (POMS). To describe the level and pattern of short-term postoperative morbidity after major elective surgery using the POMS. STUDY DESIGN AND SETTING This was a prospective cohort study of 439 adults undergoing major elective surgery in a UK teaching hospital. The POMS, an 18-item survey that address nine domains of postoperative morbidity, was recorded on postoperative days 3, 5, 8, and 15. RESULTS Inter-rater reliability was perfect for 11/18 items (Kappa=1.0), with Kappa=0.94 for 6/18 items. A priori hypotheses that the POMS would discriminate between patients with known measures of morbidity risk, and predict length of stay were generally supported through observation of data trends, and there was statistically significant evidence of construct validity for all but the wound and neurological domains. POMS-defined morbidity was present in 325 of 433 patients (75.1%) remaining in hospital on postoperative day 3 after surgery, 231 of 407 patients (56.8%) on day 5, 138 of 299 patients (46.2%) on day 8, and 70 of 111 patients (63.1%) on day 15. Gastrointestinal (47.4%), infectious (46.5%), pain-related (40.3%), pulmonary (39.4%), and renal problems (33.3%) were the most common forms of morbidity. CONCLUSION The POMS is a reliable and valid survey of short-term postoperative morbidity in major elective surgery. Many patients remain in hospital without any morbidity as recorded by the POMS.
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Affiliation(s)
- M P W Grocott
- Surgical Outcome Research Centre, University College London Hospitals, London, W1T 3AA, UK.
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Beech R, Russell W, Little R, Sherlow-Jones S. An evaluation of a multidisciplinary team for intermediate care at home. Int J Integr Care 2004; 4:e02. [PMID: 16773151 PMCID: PMC1393274 DOI: 10.5334/ijic.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Revised: 06/11/2004] [Accepted: 09/06/2004] [Indexed: 11/29/2022] Open
Abstract
Background The implementation of the National Health Service Plan for the UK will see an expansion of services for intermediate care. Such services are usually targeted at older people and aim to: prevent ‘avoidable’ admissions to acute inpatient care; facilitate the timely discharge of patients from acute inpatient care; promote patient rehabilitation. A range of services might fall under the banner of intermediate care. They are usually delivered in patients' homes or in non-acute institutions. This paper describes an evaluation of a multidisciplinary Rapid Response Team (RRT). This service aimed to provide a home based alternative to care previously provided in an acute hospital bed which was acceptable to patients and carers and which maintained clinical care standards. The service was provided for the population of Hereford, a rural town in the middle of England. Methods A mixed-method descriptive design using quantitative and qualitative techniques was used to monitor: the characteristics of service users, the types and amounts of care received, any ‘adverse’ events arising from that care, and the acceptability of the service to patients and carers. A collaborative approach involving key stakeholders allowed appropriate data to be gathered from patient case notes, RRT staff, local health and social care providers, and patients and their carers. A suite of self-completed questionnaires was, therefore, designed to capture study data on patients and activities of care, and workshops and semi-structured interview schedules used to obtain feedback from users and stakeholders. Results Service users (231) were elderly (mean age 75.9), from three main diagnostic categories (respiratory conditions 19.0%, heart/stroke 16.2%, falls 13.4%), with the majority (57.0%) having both medical and social care needs. All patients received care at home (mean duration 5.6 days) with only 5.7% of patients having to be re-admitted to acute care. Overall, patients and carers had positive attitudes to the new service but some expressed concerns about their ability to influence the choice of care option (24.1% and 25.0% of patients and carers, respectively), whilst 22.7% of carers were concerned about the quality of information about care. Conclusions Both the nature of schemes for intermediate care, and the policy context in which they are introduced, mean that pragmatic methodologies are often required to evaluate their impacts. Unfortunately, this need for pragmatism can then mean that it is difficult to reach definitive conclusions about the merits of schemes. However, the findings of this evaluation suggest that the Rapid Response Team provided an ‘acceptable’ alternative to an extended period of care in an acute setting. Such schemes may have relevance beyond the NHS of the UK as a means of providing a more appropriate and cost efficient match between patients' needs for care, the types of care provided, and the place in which care is provided.
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Affiliation(s)
- Roger Beech
- Centre for Health Planning and Management, Keele University, UK.
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Panis LJGG, Verheggen FWSM, Pop P, Prins MH. Appropriate length of extended day care. Int J Health Care Qual Assur 2004; 17:81-6. [PMID: 15301264 DOI: 10.1108/09526860410526691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extended day care (EDC) is a one-day admission spending one night in hospital. Many EDC patients do not need hospital care over night, so probably they could be transferred to a day surgery setting, resulting in decreased costs and increased efficiency. The objectives of the study were to assess the appropriate length of extended day care (ALED) and a possible transfer to day surgery. ALED was defined as the time between the start of the surgical procedure and the final moment appropriate hospital care was provided. About 80 per cent of the patients could possibly have been treated in day surgery. The other patients could not be transferred, because of a prolonged ALED. With the implementation of new policies on admission to and discharge from the hospital and the use of altered types of operation room scheduling or patient logistics the transfer of most EDC patients to day surgery would be possible.
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Affiliation(s)
- Lambert J G G Panis
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands
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McMullan R, Silke B, Bennett K, Callachand S. Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission. Postgrad Med J 2004; 80:23-6. [PMID: 14760174 PMCID: PMC1757957 DOI: 10.1136/pmj.2003.007500] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. DESIGN Prospective observational study. SETTING General medicine department of a teaching hospital in Belfast, UK. PARTICIPANTS Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. OUTCOME MEASURES Non-laboratory investigations requested, LOS, and diagnosis on discharge. RESULTS Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p<0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p<0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. CONCLUSION A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.
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Affiliation(s)
- R McMullan
- Department of Infectious Disease, Royal Victoria Hospital, and General Internal Medicine, Belfast City Hospital, Belfast, UK
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Kinder A, Stephens S, Mortimer N, Sheldon P. Severe herpes zoster after infliximab infusion. Postgrad Med J 2004; 80:26. [PMID: 14760175 PMCID: PMC1757965 DOI: 10.1136/pmj.2003.014373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moya-Ruiz C, Peiró S, Meneu R. Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital. Int J Qual Health Care 2002; 14:305-12. [PMID: 12201189 DOI: 10.1093/intqhc/14.4.305] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies. DESIGN Quasi-experimental pre-test/post-test with non-equivalent control group. SETTING A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100,000. STUDY PARTICIPANTS Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department). INTERVENTION Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments. MAIN OUTCOME MEASURES Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention. RESULTS There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant. CONCLUSIONS Providing physicians with feedback about percentage of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.
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Kaya S, Eroğlu K, Vural G, Shwartz M, Restuccia JD. Factors affecting appropriateness of hospital utilization in two hospitals in Turkey. J Med Syst 2001; 25:373-83. [PMID: 11708397 DOI: 10.1023/a:1011923710733] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine the extent of inappropriate hospital use, to investigate factors related to variations in appropriateness, and to identify reasons for inappropriateness, the Appropriateness Evaluation Protocol (AEP) was applied to 2,067 patient days in two hospitals between March 1997 and 1998 in Ankara, Turkey. A substantial amount of inappropriate utilization was found in both hospitals (34.2%, 24.6%). Factors affecting the appropriateness of hospital utilization and reasons for inappropriateness were varied and presented by internal medicine, general surgery, and gynecology services. In general, results of the logistic regression analysis indicated that inappropriateness was significantly associated with admission number (first admission/readmission), admission route (emergent/non-emergent), and day of the week. The most common reason for inappropriateness was diagnostic procedures and/or treatments that could have been carried out on an ambulatory basis. This study demonstrates that the AEP can be used as a tool to improve the efficiency of the Turkish hospitals.
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Affiliation(s)
- S Kaya
- Takemi Program in International Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Pereira S, Oliveira e Silva A, Quintas M, Almeida J, Marujo C, Pizarro M, Angélico V, Fonseca L, Loureiro E, Barroso S, Machado A, Soares M, da Costa AB, de Freitas AF. Appropriateness of emergency department visits in a Portuguese university hospital. Ann Emerg Med 2001; 37:580-6. [PMID: 11385326 DOI: 10.1067/mem.2001.114306] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. METHODS A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. RESULTS The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier. According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. CONCLUSIONS In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.
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Affiliation(s)
- S Pereira
- Serviço de Medicina 2, Hospital de São João, Porto, Portugal
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Casanova Matutano C, Gascón Romero P, Calvo Rigual F, Tomás Vila M, Paricio Talayero JM, Blasco González L, Peiró S. [Inappropriate utilization of pediatric hospitalization. Validation of the pediatric appropriateness evaluation protocol Spanish version]. GACETA SANITARIA 1999; 13:303-11. [PMID: 10490669 DOI: 10.1016/s0213-9111(99)71372-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To validate the Spanish version of the Pediatric Appropriateness Evaluation Protocol (PAEP). METHODS The protocol was applied by two independent reviewers to a sample of 104 clinical records of pediatric patients (age 6 months to 14 years) admitted to a general hospital in the Valentian Community. Reliability was tested by comparing their results. Validity was tested by comparing the results of one reviewer with the judgment of three pediatricians. The following measures were calculated: overall agreement (IO), specific agreement (IE), Cohen's κ, inappropriate use ratio, and, to evaluate the predictive value, sensitivity, specificity and positive and negative predictive value. RESULTS Interobserver reliability was high: the IO for admissions was 94.2% and 96.2% for days of care. The IE was 66.7% and 75% respectively, and κ showed values of excellent agreement: 0.77 (95% CI 0.59-0.94) for admissions and 0.83 (95% CI 0.68-0.99) for days of care. Validity was moderate: the IO for admissions was 92.35, and 90.4% for days of care. The IE was 60% and 58.3% respectively, and κ showed values of good agreement: 0.70 (95% CI 0.51-0.90) for admissions and 0.68 (95% CI 0.50-0.86) for days of care. Inappropriate use ratio was 1.13 for admissions and 0.73 for days of care. The sensitivity and specificity were high for admissions (80% and 94% respectively), while sensitivity was lower for days of care (64% and 98%). Regarding the prevalence of inappropriate use of this study, the positive predictive value ranged between 71% and 88%, and the negative predictive value ranged between 97% and 91%. CONCLUSIONS PAEP has a high reliability, moderate validity and good predictive value face to clinical judgment, and it is a useful instrument for assessing the inappropriate utilization of pediatric hospitalization.
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Affiliation(s)
- C Casanova Matutano
- Servicio de Pediatría, Hospital de Sagunto, Puerto de Sagunto, Valencia, 46520, España
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