1
|
Candelli M, Lumare M, Riccioni ME, Mestice A, Ojetti V, Pignataro G, Merra G, Piccioni A, Gabrielli M, Gasbarrini A, Franceschi F. Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1021. [PMID: 37374225 DOI: 10.3390/medicina59061021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Introduction: Emergency Department (ED) overcrowding is a health, political, and economic problem of concern worldwide. The causes of overcrowding are an aging population, an increase in chronic diseases, a lack of access to primary care, and a lack of resources in communities. Overcrowding has been associated with an increased risk of mortality. The establishment of a Short Stay Unit (SSU) for conditions that cannot be treated at home but require treatment and hospitalization for up to 72 h may be a solution. SSU can significantly reduce hospital length of stay (LOS) for certain conditions but does not appear to be useful for other diseases. Currently, there are no studies addressing the efficacy of SSU in the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB). Our study aims to evaluate the efficacy of SSU in reducing the need for hospitalization, LOS, hospital readmission, and mortality in patients with NVUGIB compared with admission to the regular ward. Materials and Methods: This was a retrospective, single-center observational study. Medical records of patients presenting with NVUGIB to ED between 1 April 2021, and 30 September 2022, were analyzed. We included patients aged >18 years who presented to ED with acute upper gastrointestinal tract blood loss. The test population was divided into two groups: Patients admitted to a normal inpatient ward (control) and patients treated at SSU (intervention). Clinical and medical history data were collected for both groups. The hospital LOS was the primary outcome. Secondary outcomes were time to endoscopy, number of blood units transfused, readmission to the hospital at 30 days, and in-hospital mortality. Results: The analysis included 120 patients with a mean age of 70 years, 54% of whom were men. Sixty patients were admitted to SSU. Patients admitted to the medical ward had a higher mean age. The Glasgow-Blatchford score, used to assess bleeding risk, mortality, and hospital readmission were similar in the study groups. Multivariate analysis after adjustment for confounders found that the only factor independently associated with shorter LOS was admission to SSU (p < 0.0001). Admission to SSU was also independently and significantly associated with a shorter time to endoscopy (p < 0.001). The only other factor associated with a shorter time to EGDS was creatinine level (p = 0.05), while home treatment with PPI was associated with a longer time to endoscopy. LOS, time to endoscopy, number of patients requiring transfusion, and number of units of blood transfused were significantly lower in patients admitted to SSU than in the control group. Conclusions: The results of the study show that treatment of NVUGIB in SSU can significantly reduce the time required for endoscopy, the hospital LOS, and the number of transfused blood units without increasing mortality and hospital readmission. Treatment of NVUGIB at SSU may therefore help to reduce ED overcrowding but multicenter randomized controlled trials are needed to confirm these data.
Collapse
Affiliation(s)
- Marcello Candelli
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Maria Lumare
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Maria Elena Riccioni
- Medical and Abdominal Surgery and Endocrine-Metabolic Scienze, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Antonio Mestice
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Veronica Ojetti
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Giulia Pignataro
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Giuseppe Merra
- Biomedicine and Prevention Department, Section of Clinical Nutrition and Nutrigenomics, Facoltà di Medicina e Chirurgia, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy
| | - Andrea Piccioni
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Maurizio Gabrielli
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Medical and Abdominal Surgery and Endocrine-Metabolic Scienze, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| | - Francesco Franceschi
- Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy
| |
Collapse
|
2
|
Alternativas seguras en la insuficiencia cardíaca. Hora de modificar paradigmas. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
3
|
Amores-Arriaga B, Garcés-Horna V. Safe alternatives in heart failure. Time to change paradigms. Rev Clin Esp 2022; 222:500-501. [PMID: 36114146 DOI: 10.1016/j.rceng.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022]
Affiliation(s)
- B Amores-Arriaga
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - V Garcés-Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
4
|
Mitchell DA, Crawford N, Newham BJ, Newton JR. The efficacy, safety and acceptability of emergency embedded Psychiatry Assessment and Planning Units: An evaluation of Psychiatry Assessment and Planning Units in close proximity to their associated emergency departments. Aust N Z J Psychiatry 2020; 54:609-619. [PMID: 31973563 DOI: 10.1177/0004867419899717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the efficacy, safety and acceptability as well as the patient demographics of three newly developed emergency department-embedded Psychiatric Assessment and Planning Units located in Metropolitan Melbourne at Austin, Peninsula and Eastern Health Services. METHODS The evaluation reviewed a 12-month period of service activity from 1 September 2017 to 31 August 2018, when all three Psychiatric Assessment and Planning Units services were operational. A 12-month period from 1 September 2014 to 31 August 2015 was compared as the pre-Psychiatric Assessment and Planning Units period. Mixed qualitative and quantitative methods were used. This included semi-structured interviews of 30 Psychiatric Assessment and Planning Units patients and 30 emergency department staff (10 of each for all 3 sites), patient survey, statistical analysis of Client Management Interface data for the emergency department and related Psychiatric Assessment and Planning Units as well as audit of RISKMAN registers. RESULTS There were 365 Austin, 567 Eastern and 791 Peninsula Psychiatric Assessment and Planning Units admissions. Psychiatric Assessment and Planning Units were generally well accepted by patients and emergency department staff, relatively safe, operating within the Key Performance Indicators with mixed effect on emergency department flow. Austin emergency department processing times improved post-Psychiatric Assessment and Planning Units (4 hours 57 minutes to 4 hours 19 minutes; p < 0.001) while deteriorating at Eastern and Peninsula. Adjustment Disorder and Depression and Borderline Personality Disorder were the most common admission diagnoses. While the Psychiatric Assessment and Planning Units had mixed utility on emergency department processing times, they appear to serve a demographic not previously accommodated in traditional emergency department psychiatry models. CONCLUSION The emergency department-embedded Psychiatric Assessment and Planning Unit model of care appears effective on some measures, safe and acceptable to patients and staff. The Psychiatric Assessment and Planning Units seem to service a group not previously accommodated in traditional emergency psychiatry models.
Collapse
Affiliation(s)
- D A Mitchell
- North East Area Mental Health Service, Austin Health, Heidelberg, VIC, Australia
| | - N Crawford
- Austin Mental Health Service, Heidelberg, VIC, Australia
| | - B J Newham
- Austin Mental Health Service, Heidelberg, VIC, Australia
| | - J R Newton
- Peninsula Community Mental Health Service, Frankston, VIC, Australia
| |
Collapse
|
5
|
Considine J, Berry D, Newnham E, Jiang M, Fox K, Plunkett D, Mecner M, Darzins P, O’Reilly M. Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study. BMC Health Serv Res 2018; 18:713. [PMID: 30217155 PMCID: PMC6137861 DOI: 10.1186/s12913-018-3527-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable. METHODS A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015. RESULTS In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1-5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission. CONCLUSIONS Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.
Collapse
Affiliation(s)
- Julie Considine
- Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin University, Geelong, Australia
| | - Debra Berry
- Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin University, Geelong, Australia
| | | | | | | | | | | | - Peteris Darzins
- Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mary O’Reilly
- Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
6
|
Strøm C, Stefansson JS, Fabritius ML, Rasmussen LS, Schmidt TA, Jakobsen JC. Hospitalisation in short-stay units for adults with internal medicine diseases and conditions. Cochrane Database Syst Rev 2018; 8:CD012370. [PMID: 30102428 PMCID: PMC6513218 DOI: 10.1002/14651858.cd012370.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Short-stay units are hospital units that provide short-term care for selected patients. Studies have indicated that short-stay units might reduce admission rates, time of hospital stays, hospital readmissions and expenditure without compromising the quality of care. Short-stay units are often defined by a target patient category, a target function, and a target time frame. Hypothetically, short-stay units could be established as part of any department, but this review focuses on short-stay units that provide care for participants with internal medicine diseases and conditions. OBJECTIVES To assess beneficial and harmful effects of short-stay unit hospitalisation compared with usual care in people with internal medicine diseases and conditions. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to 13 December 2017 together with reference checking, citation searching and contact with study authors to identify additional studies. We also searched several grey literature sources and performed a forward citation search for included studies. SELECTION CRITERIA We included randomised trials and cluster-randomised trials, comparing hospitalisation in a short-stay unit with usual care (hospitalisation in a traditional hospital ward or other services). We defined a short-stay unit to be a hospital ward where the targeted length of stay in hospital for patients was five days or less. We included both multipurpose and specialised short-stay units. Participants were adults admitted to hospital with an internal medicine disease or condition. We excluded surgical, obstetric, psychiatric, gynaecological, and ambulatory participants. Trials were included irrespective of publication status, date, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias of each included trial. We measured intervention effect sizes by meta-analyses for two primary outcomes, mortality and serious adverse events, and one secondary outcome, hospital readmission. We narratively reported the following important outcomes: quality of life, activities of daily living, non-serious adverse events, and costs. We used risk ratio differences of 15% for mortality and of 20% for serious adverse events for minimal relevant clinical consideration. We rated the certainty of the evidence and the strength of recommendations of the outcomes using the GRADE approach. MAIN RESULTS We included 19 records reporting on 14 randomised trials with a total of 2872 participants. One trial was ongoing. Thirteen trials evaluated short-stay unit hospitalisation for six specific conditions (acute decompensated heart failure (one trial), asthma (one trial), atrial fibrillation (one trial), chest pain (seven trials), syncope (two trials), and transient ischaemic attack (one trial)) and one trial investigated participants presenting with miscellaneous internal medicine disease and conditions. The components of the intervention differed among the trials as dictated by the trial participants' condition. All included trials were at high risk of bias.The certainty of the evidence for all outcomes was very low. Consequently, it is uncertain whether hospitalisation in short-stay units compared with usual care reduces mortality (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.47 to 1.15) 5 trials (seven additional trials reporting on 1299 participants reported no deaths in either group)); serious adverse events (RR 0.95, 95% CI 0.59 to 1.54; 7 trials (one additional trial with 108 participants reported no serious adverse events in either group)), and hospital readmission (RR 0.80, 95% CI 0.54 to 1.19, 8 trials (one additional trial with 424 participants did not report results for participants)). There was not enough information to confirm or refute that short-stay unit hospitalisation had relevant effects on quality of life, activities of daily living, non-serious adverse events, and costs. AUTHORS' CONCLUSIONS Overall, the quantity and the certainty of the evidence was very low. Consequently, it is uncertain whether there are any beneficial or harmful effects of short-stay unit hospitalisation for adults with internal medicine diseases and conditions - more trials comparing the effects of short-stay units with usual care are needed. Such trials ought to be conducted with low risk of bias and low risks of random errors to improve the overall confidence in the evidence.
Collapse
Affiliation(s)
- Camilla Strøm
- Holbaek Hospital, University of CopenhagenDepartment of Emergency MedicineHolbaekDenmark4300
| | - Jakob S Stefansson
- Rigshospitalet, University of CopenhagenDepartment of Anaesthesia, Centre of Head and OrthopaedicsCopenhagenDenmark
| | - Maria Louise Fabritius
- Rigshospitalet, University of CopenhagenDepartment of Anaesthesia, Centre of Head and OrthopaedicsCopenhagenDenmark
| | - Lars S Rasmussen
- Rigshospitalet, University of CopenhagenDepartment of Anaesthesia, Centre of Head and OrthopaedicsCopenhagenDenmark
| | - Thomas A Schmidt
- Holbaek Hospital, University of CopenhagenDepartment of Emergency MedicineHolbaekDenmark4300
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | | |
Collapse
|
7
|
Hung KKC, Graham CA, Yim WT, Yam ESF, Cheung NK, Rainer TH. Management of Suspected Deep Venous Thrombosis in an Emergency Medicine Ward in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Clinical signs and symptoms can vary for patients with deep venous thrombosis (DVT). DVT is an important diagnosis to recognise as it can lead to proximal embolism into the pulmonary circulation resulting in sudden collapse and death. The objective of this study is to describe the management of patients with suspected DVT in the emergency medicine ward (EMW) setting in Hong Kong using a standardised clinical pathway. Methods A retrospective review was conducted for patients with suspected DVT admitted to the EMW from April to December 2008 using a standardised protocol. The use of a clinical prediction rule and diagnostic tests (including the modified Well's score, D-dimer and ultrasound examination) and outcomes (including the length of stay and secondary admission rate) were investigated. Results A total of 100 patients with suspected DVT were admitted to the EMW in the nine-month study period. DVT was confirmed in 30% using ultrasonography. Fifty-two percent of patients were in the high-risk category according to the modified Well's score. Seventy-six percent of patients had positive D-dimer results. Ten percent of patients were safely discharged without an ultrasound examination. Mean length of stay in the EMW was 1.99 days. Thirteen percent of patients required second admission to other specialties. Conclusions This study suggests that a standardised clinical pathway based in the EMW can be used for patients with suspected DVT to reduce hospital admission.
Collapse
|
8
|
Ferré C, Llopis F, Martín-Sánchez FJ, Sempere G, Llorens P, Navarro C, Martínez-Ortiz M, Juan A, Sanpedro F, Guardiola JM, Guzmán M, Alvarez A, Arranz M, Daza M, Cortés E, Pérez V, Rua MA, Serra P, Guerrero F, Núñez JC, llull JA, Almela A, Anduiza J, Martín A, Juarez R, Gil J, Ferreira A, Lapuerta L, Castro C, Porras A, Valentín PM. General Characteristics and Activity of Emergency Department Short-Stay Units in Spanish Hospitals. J Emerg Med 2017; 52:764-768. [DOI: 10.1016/j.jemermed.2017.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/10/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
|
9
|
Miró Ò, Carbajosa V, Peacock WF, Llorens P, Herrero P, Jacob J, Collins SP, Fernández C, Pastor AJ, Martín-Sánchez FJ. The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study. Eur J Intern Med 2017; 40:30-36. [PMID: 28126381 DOI: 10.1016/j.ejim.2017.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether the presence of a short-stay unit(SSU) in a hospital influences the percentage of admissions, length of hospital stay(LOS) and outcomes in emergency department(ED) patients with acute heart failure(AHF). METHOD Retrospective analysis of AHF patients presenting to one of 34 Spanish ED included in EAHFE registry. Baseline and ED data of patients were collected. Patients were classified into two groups in function of being attended at hospitals with or without a SSU. Main outcome variables were the percentage of admissions from ED, and LOS for admitted patients. Secondary variables were all-cause death and ED revisits for worsening heart failure within 30days following discharge. RESULTS Of 9078 patients presenting to the ED (SSU 5191; no SSU 3887), 6796 (74.8%) were admitted. Compared to hospitals without a SSU, the admission rate in hospitals with a SSU was 8.9% higher (95%CI 6.5%-11.4%), but 30-day ED revisit and mortality rates were lower among patients discharged directly from the ED (-10.3%, 95%CI -16,9% to -3.7%; and -10.0%, 95%CI -16.6 to -3.4%, respectively). For admitted patients, the overall LOS was 9.3±9.5days, being 2.2days shorter (95%CI -2.7 to -1.7) in hospitals with a SSU, with no significant differences in in-hospital, 30-day mortality or 30-day ED revisit rates. CONCLUSIONS The data suggest that SSU may improve the safety of emergency care of patients with AHF, but at the cost of a higher rate of hospital admissions, and it may also reduce the LOS for admitted patients without affecting post discharge safety.
Collapse
Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, Spain
| | - Virginia Carbajosa
- Servicio de Urgencias, Hospital Universitario Rio-Hortega, Valladolid, Spain
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Pere Llorens
- Servicio de Urgencias, CortaEstancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cristina Fernández
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Spain
| | - Antoni Juan Pastor
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Francisco Javier Martín-Sánchez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos de Madrid, Spain.
| |
Collapse
|
10
|
Strøm C, Fabritius ML, Rasmussen LS, Schmidt TA, Jakobsen JC. Hospitalisation in short-stay units for internal medicine diseases and conditions. Hippokratia 2016. [DOI: 10.1002/14651858.cd012370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Camilla Strøm
- Holbaek Hospital, University of Copenhagen; Department of Emergency Medicine; Holbaek Denmark 4300
| | - Maria Louise Fabritius
- Rigshospitalet, University of Copenhagen; Department of Anaesthesia, Centre of Head and Orthopaedics; Blegdamsvej 9 Copenhagen Copenhagen Denmark 2100
| | - Lars S Rasmussen
- Rigshospitalet, University of Copenhagen; Department of Anaesthesia, Centre of Head and Orthopaedics; Blegdamsvej 9 Copenhagen Copenhagen Denmark 2100
| | - Thomas A Schmidt
- Holbaek Hospital, University of Copenhagen; Department of Emergency Medicine; Holbaek Denmark 4300
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
| |
Collapse
|
11
|
Profiling wound management in the emergency department: A descriptive analysis. ACTA ACUST UNITED AC 2016; 19:166-71. [PMID: 27448461 DOI: 10.1016/j.aenj.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes. The aim of this study was to describe the discharge and referral status of adult patients presenting to one Australian emergency department with a wound, skin or ulcer condition. METHODS A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014. RESULTS A total of 4231 wound, skin and ulcer conditions were managed, accounting for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer. CONCLUSIONS Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.
Collapse
|
12
|
Durmaz D, Goksu E, Yildiz G, Unal A, Kartal M, Oskay A, Simsek Y. The Factors Influencing Relapse in Patients Presenting to the Emergency Department with COPD Exacerbation. Turk J Emerg Med 2016; 15:59-63. [PMID: 27336065 PMCID: PMC4910009 DOI: 10.5505/1304.7361.2014.37791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/13/2014] [Indexed: 11/17/2022] Open
Abstract
Objectives Chronic Obstructive Pulmonary Disease (COPD) is associated with high mortality and morbidity and is projected to be the third most common cause of death worldwide by 2020. For a variety of reasons, there is a drive to manage a greater number of individuals as outpatients. Preventing readmissions can reduce associated morbidity and subsequent healthcare costs. Methods The aim of the present study was to determine the factors affecting the relapse of COPD exacerbated patients in the emergency department (ED). This study combines data from two prospective cohort studies. Patients included in the study were above 18 years of age, had a previous diagnosis of COPD, and presented to the ED for the treatment of acute exacerbation. All the information relevant to the study was collected during the patient's visit to the ED. Relapse was defined as an unscheduled visit to an ED or primary physician within 2 weeks of initial ED visit for worsening COPD symptoms. Telephone follow-up was done on all patients at the end of 2 weeks. Results The cohort consists of 196 patients. Relapse rate in this study was 27%. Mean respiratory rate, exacerbations in previous year, home nebulizator therapy, home oxygen therapy, admission to intensive care or hospital ward due to COPD exacerbation, previous intubation and abnormal chest x-ray were associated with increased re-visit in univariate analysis. However, after multivariate analysis, exacerbations in previous year (OR: 1.08, 95%CI: 1.01–1.15) and abnormal chest X-ray (OR: 2.5, 95%CI: 1.10–6.11) were still significant. Conclusions In conclusion, the number of ED visits previous year and abnormal chest x-ray can predict the revisit of a COPD exacerbated patient within 14 days of an ED visit.
Collapse
Affiliation(s)
- Dilek Durmaz
- Department of Emergency Medicine, Akdeniz University, Antalya, Turkey
| | - Erkan Goksu
- Department of Emergency Medicine, Denizli State Hospital, Denizli, Turkey
| | - Gunay Yildiz
- Department of Emergency Medicine, Denizli State Hospital, Denizli, Turkey
| | - Aslihan Unal
- Department of Emergency Medicine, Denizli State Hospital, Denizli, Turkey
| | - Mutlu Kartal
- Department of Emergency Medicine, Denizli State Hospital, Denizli, Turkey
| | - Alten Oskay
- Department of Emergency Medicine, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Yeliz Simsek
- Department of Emergency Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
| |
Collapse
|
13
|
[Are short-stay units an appropriate resource for hospitalising elderly patients with infection?]. ACTA ACUST UNITED AC 2016; 31:322-328. [PMID: 27211492 DOI: 10.1016/j.cali.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/03/2016] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and outcomes of elderly patients (≥ 75 years) with suspected infection attending the emergency department (ED) and to compare patients admitted to a short-stay unit (SSU) with those admitted to a conventional hospital unit (CHU). MATERIAL AND METHODS Prospective cohort study including, using opportunity sampling, patients ≥75 years treated for infection in the ED of 3 Spanish university hospitals (2013). Demographic variables, comorbidity, baseline performance status, presence of sepsis, infection type, destination on discharge, and mortality at 30 days were collected. RESULTS During the study period, 330 patients ≥75 years (mean age 83.8±7.3) were evaluated for a suspected infection in the ED, and 306 (93%) were admitted to the hospital, 175 (53%) to the CHU and 87 (26%) to the SSU. Medical history included hypertension (74.5%), arrhythmia (30%), chronic obstructive pulmonary disease (28%), and diabetes mellitus (26%), and risk factors for multidrug resistance, such as antibiotic treatment in 3 months prior to admission (48%), and institutionalisation (26%). A classic sepsis syndrome was found to be the source of infection in 53%, and was respiratory in half of patients. When comparing patients admitted to SSU and CHU, statistically significant differences (p<.05) were found in the Charlson index (1.95 vs. 2.51), Glasgow coma scale (14.6 vs. 14.3), classic sepsis syndrome (67% vs. 53%), severe sepsis (2.3% vs. 18%), length of stay (4.2 vs. 10.4 days), and mortality within 30 days (3.4% vs. 18%), respectively. CONCLUSIONS SSU may be an adequate alternative to CHU for elderly patients requiring admission with suspected infection.
Collapse
|
14
|
Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study. Int Emerg Nurs 2015; 27:37-41. [PMID: 26654881 DOI: 10.1016/j.ienj.2015.11.001] [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: 05/26/2015] [Revised: 10/02/2015] [Accepted: 11/01/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. BACKGROUND Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. METHODS A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. RESULTS No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. CONCLUSION The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department.
Collapse
|
15
|
Basic D, Hartwell TJ. Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. Clin Interv Aging 2015; 10:1637-43. [PMID: 26508846 PMCID: PMC4610790 DOI: 10.2147/cia.s90296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. Materials and methods This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models. Results The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37–3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17–2.85) and those with injury (OR: 2.35, 95% CI: 1.15–4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; P<0.001). Conclusion This study of older people in acute care shows that falls in the hospital are significantly associated with new placement in a nursing home. Given the predominantly negative experiences and the financial costs associated with placement in a nursing home, fall prevention should be a high priority in older people hospitalized with acute illness.
Collapse
Affiliation(s)
- David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - Tabitha J Hartwell
- Department of Geriatric Medicine and Rehabilitation, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia
| |
Collapse
|
16
|
Slatyer S, Toye C, Popescu A, Young J, Matthews A, Hill A, Williamson DJ. Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals. J Clin Nurs 2013; 22:445-55. [PMID: 23301580 DOI: 10.1111/jocn.12029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the perceptions of older patients who re-presented to hospital within 28 days of discharge from an acute medical unit (AMU), their family caregivers and appropriately experienced health professionals. BACKGROUND Hospitals are increasingly using AMUs to provide rapid assessment and treatment for medical patients. Evidence of efficacy is building, however in-depth exploration of the experiences of older patients who re-present to hospital soon after discharge from an AMU, and those who care for them, appears to be lacking. DESIGN A qualitative, descriptive design was used. METHODS In 2007, our team purposively sampled older patients who re-presented to hospital within 28 days of discharge from an AMU (n = 12), family caregivers (n = 15), and health professionals (n = 35). Data were collected using semi-structured interviews and subjected to thematic content analysis. RESULTS Four themes emerged: the health trajectory, communication challenges, discharge readiness and the decision to return. Re-presentation to hospital was seen as part of a declining health trajectory. The AMU was viewed as treating acute illness well, however patients and family caregivers left hospital with limited understanding of underlying health problems and, therefore, ill-prepared for future health crises. CONCLUSION There are clear benefits for older patients from AMUs, which expedite treatment for acute health crises. However, AMU discharge planning needs to consider patients' overall health status and likely future needs to optimise outcomes. Such a requirement is problematic in the context of acute time pressures. RELEVANCE TO CLINICAL PRACTICE To ensure prompt and expert attention to key aspects of discharge planning for older people leaving AMUs, there is a role for in-depth clinical expertise in the care of older people facing deteriorating life-limiting conditions. Therefore, a leadership role for nurses with geriatric and palliative care expertise, alongside medical and allied health professionals, merits attention in this context.
Collapse
Affiliation(s)
- Susan Slatyer
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
| | | | | | | | | | | | | |
Collapse
|
17
|
Schultz H, Qvist N, Mogensen CB, Pedersen BD. Experiences of patients with acute abdominal pain in the ED or acute surgical ward – A qualitative comparative study. Int Emerg Nurs 2013; 21:228-35. [DOI: 10.1016/j.ienj.2013.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022]
|
18
|
[Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): study of associated factors]. Med Clin (Barc) 2013; 143:245-51. [PMID: 24054770 DOI: 10.1016/j.medcli.2013.06.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs). PATIENTS AND METHODS This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (>72h). A logistic regression model was used to control the effects of confounding factors. RESULTS Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P=.040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P=.002), basal oxygen saturation<90% on arrival to the Emergency Department (OR 2.21, 95% CI 1.51-3.23; P<.001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P=.028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P=.008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%). CONCLUSIONS Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization.
Collapse
|
19
|
Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments. Int Emerg Nurs 2013; 22:116-20. [PMID: 24080095 DOI: 10.1016/j.ienj.2013.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. METHODS This study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. RESULTS During the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27 days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13 days from the previous length of 5.16 days. CONCLUSIONS EMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.
Collapse
|
20
|
Marcos M, Hernández-García I, Ceballos-Alonso C, Martínez-Iglesias R, Mirón-Canelo JA, Laso FJ. [Impact of short-stay units on the quality of medical care in Spain]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2013; 28:199-206. [PMID: 23867614 DOI: 10.1016/j.cali.2013.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/25/2013] [Accepted: 04/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain. MATERIAL AND METHODS A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables. RESULTS Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units. CONCLUSIONS SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model.
Collapse
Affiliation(s)
- M Marcos
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | | | | | | | | | | |
Collapse
|
21
|
Juan Pastor A. Las unidades de corta estancia médicas. ACTA ACUST UNITED AC 2013; 28:197-8. [DOI: 10.1016/j.cali.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 05/07/2013] [Indexed: 11/24/2022]
|
22
|
Schrager J, Wheatley M, Georgiopoulou V, Osborne A, Kalogeropoulos A, Hung O, Butler J, Ross M. Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients. Acad Emerg Med 2013; 20:554-61. [PMID: 23758301 DOI: 10.1111/acem.12147] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/15/2012] [Accepted: 01/22/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objective was to compare readmission rates and hospital bed-days between acute decompensated heart failure (AHF) patients admitted or discharged following accelerated treatment protocol (ATP)-driven care in an emergency department observation unit (OU). METHODS This was a retrospective cohort study conducted at two urban university-affiliated hospitals. A total of 358 selected AHF patients received treatment on an ATP in the OU between October 1, 2007, and June 30, 2011. The comparison of interest was admission or discharge following OU treatment. The outcome of interest was readmission within 30 and 90 days of hospital discharge following care in the OU. We also examined resource use (inpatient, inpatient plus outpatient-days) between the admitted and discharged groups. Time to readmission analysis was performed with Cox proportional hazards regression. RESULTS Discharged and admitted patients were similar with respect to age, race, sex, ED length of stay (LOS), and OU LOS. Patients admitted from the OU had a higher median B-type natriuretic peptide (BNP; 1,063 pg/mL [interquartile range {IQR} = 552 to 2,067 pg/mL] vs. 708 pg/mL [IQR = 254 to 1,683 pg/mL]; p = 0.002) and blood urea nitrogen (BUN; 19 mg/dL [IQR = 14 to 26 mg/dL] vs. 17 mg/dL [IQR = 13 to 23 mg/dL]) than those discharged (p = 0.04) and a lower median ejection fraction (EF; 22.5% [15% to 43%] vs. 35% [IQR 20% to 55%]; p = 0.002). In models controlling for age, race, sex, clinical site, BNP, BUN, creatinine, and EF, the 30-day readmission rate (13.8% in the study population as a whole) was not significantly different between the patients discharged or admitted following OU care (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.47 to 2.10). The readmission rates were also not significantly different at 90 days (HR = 1.07; 95% CI = 0.65 to 1.77). Within 30 days of discharge from the OU, patients spent a median of 1.7 days (IQR = 0.0 to 5.1 days) as inpatients, compared to 3.5 days (IQR = 2.3 to 5.8 days) among patients admitted from the OU (p < 0.0001). Among readmitted patients, the total median inpatient time was not significantly different between the comparison groups at both 30 and 90 days of follow-up. CONCLUSIONS Selected acute heart failure (HF) patients managed by a rapid treatment protocol in the OU demonstrated favorable hospital use, with discharged patients using fewer bed-days and demonstrating readmission rates that were not higher than admitted patients.
Collapse
Affiliation(s)
- Justin Schrager
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta; GA
| | - Matthew Wheatley
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta; GA
| | | | - Anwar Osborne
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta; GA
| | | | - Olivia Hung
- Department of Cardiology; Emory University School of Medicine; Atlanta; GA
| | - Javed Butler
- Department of Cardiology; Emory University School of Medicine; Atlanta; GA
| | - Michael Ross
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta; GA
| |
Collapse
|
23
|
Jacob Rodríguez J, Losa FC, Roca LF, Pastor JA. [Short stay emergency unit, an aid in the adaptation of admission due to community acquired pneumonia]. Rev Clin Esp 2012; 212:51-2. [PMID: 21798533 DOI: 10.1016/j.rce.2011.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/02/2011] [Indexed: 10/17/2022]
|
24
|
González-del Castillo J, Fernández C, González-Armengol J, Martín-Sánchez F. La utilidad de la unidad de corta estancia en los pacientes con neumonía adquirida en la comunidad. Rev Clin Esp 2012; 212:50-1. [DOI: 10.1016/j.rce.2011.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 04/25/2011] [Indexed: 10/14/2022]
|
25
|
Jiménez S, Aguiló S, Antolín A, Coll-Vinent B, Miró O, Sánchez M. Hospitalización a domicilio directamente desde urgencias: una alternativa eficiente a la hospitalización convencional. Med Clin (Barc) 2011; 137:587-90. [DOI: 10.1016/j.medcli.2011.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/07/2011] [Accepted: 06/09/2011] [Indexed: 11/27/2022]
|
26
|
Damiani G, Pinnarelli L, Sommella L, Vena V, Magrini P, Ricciardi W. The Short Stay Unit as a new option for hospitals: a review of the scientific literature. Med Sci Monit 2011; 17:SR15-9. [PMID: 21629205 PMCID: PMC3539545 DOI: 10.12659/msm.881791] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The short stay unit (SSU) is a ward providing targeted care for patients requiring brief hospitalization and dischargeable as soon as clinical conditions are resolved. Therefore, SSU is an alternative to the ordinary ward (OW) for the treatment of selected patients. The SSU model has been tested in only a few hospitals, and the literature lacks systematic evaluation of the impact of SSU use. The aim of our study was to evaluate the use of SSUs in terms of length of hospital stay, mortality and readmission rate. Material/Methods A random effect meta-analysis was carried out by consulting electronic databases. Studies were selected that focused on comparison between use of SSUs and OWs. Mean difference of length of stay was calculated within 95% confidence intervals. Results Six articles were selected, for a total of 21 264 patients. The estimated mean difference was −3.06 days (95% CI −4.71, −1.40) in favor of the SSU. The selected articles did not show any differences in terms of mortality and readmission rate. Conclusions Use of SSUs could reduce patient length of stay in hospital, representing an alternative to the ordinary ward for selected patients. A shorter period of hospitalization could reduce the risk of hospital-acquired infections, increase patient satisfaction and yield more efficient use of hospital beds. Findings of this study are useful for institutional, managerial and clinical decision-makers regarding the implementation of the SSU in a hospital setting, and for better management of continuity of care.
Collapse
Affiliation(s)
- Gianfranco Damiani
- Department of Public Health Università Cattolica Sacro Cuore, Roma, Italy.
| | | | | | | | | | | |
Collapse
|
27
|
Keränen J, Keränen U. From Home To Operation (FHTO)--a new surgical admission centre: does the comprehensive initialisation of a new process harm surgery outcome? Scand J Surg 2011; 100:136-40. [PMID: 21737392 DOI: 10.1177/145749691110000213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS FHTO - From Home To Operation is a same day admission -model developed at Finland Hyvinkää Hospital from as early as year 2000. In September 2006, a new FHTO centre was opened, through which surgical patients walk into the operation room. This article describes how an extensive FHTO process transition effects patients operation outcome. METHODS The data was collected of all elective surgical patients between March and May in 2006 and in 2007, six months before and after the new FHTO centre was opened. Patient demographics and surgery outcome measurements were reported and analysed between the two study periods. One month postoperative follow-up was recorded. RESULTS Overall 1206 patients were included, 592 in 2006 and 614 in 2007. Before the extensive process change in 2006 54% of patients were admitted through old limited FHTO unit, and 46% through surgical ward. Six months after FHTO centre opening in 2007 same figures were 90,5% and 9,5% respectively. The baseline statistics differed statistically in kidney failure, that increased in 2007. Two deaths were recorded during postoperative follow-up each year. CONCLUSIONS FHTO process transition included different surgical specialities and did not have negative impact on surgery outcome. Preoperative process should be debated thoroughly in every public hospital. The preoperative process transition from preoperative hospital stay to same day admission through new centre can be accomplished without harming surgery outcome.
Collapse
Affiliation(s)
- J Keränen
- Department of Operative Specialties, Helsinki and Uusimaa Hospital District, Hyvinkää Hospital, Hyvinkää, Finland.
| | | |
Collapse
|
28
|
Juan Pastor A, Ferré Losa C, Llopis Roca F, Jacob Rodríguez J, Bardés Robles I, Salazar Soler A. [The short stay unit as an alternative to conventional hospitalisation in the treatment of community acquired pneumonia in the over 75 year-old population]. Rev Esp Geriatr Gerontol 2011; 46:213-6. [PMID: 21719153 DOI: 10.1016/j.regg.2011.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients. The short stay units can be an alternative for patients who need admission with acute illness. MATERIAL AND METHODS Descriptive and retrospective study in an Short-Stay Unit (SSU) of a 900-bed tertiary-care teaching hospital in the metropolitan area of Barcelona, Spain. PERIOD a total of 22 months from January 2004 to December 2006. PATIENTS all patients ≥ 75 years admitted to EDSSU with a diagnosis of CAP. Data were collected for demographic variables, Pneumonia Severity Index score (PSI), microbiological findings, antibiotic treatment, length of stay, mortality rates and new admissions during the 30 days following discharge. RESULTS 175 consecutive patients ≥ 75 years with pneumonia were admitted to the EDSSU. Mean age was 84.31 years (range 75-100, SD ± 5.76), 92 (52,5%) were men, with 24 being nursing home residents. According to the PSI, 64 cases (36.6%) were scored as III, 97 (55.4%) as IV and 14 (8%) as V. A positive microbiological result was obtained in 46 cases (26.2%). Length of stay on average was 3.29 days (range 1-10, SD ± 1.56) and 19 patients died (10.8%). Six (3.8%) attended the ED in the 30 days following discharge. CONCLUSIONS In view of our experience, the EDSSU can be an alternative to standard inpatient for elderly patients with pneumonia in PSI risk class III and IV.
Collapse
Affiliation(s)
- Antoni Juan Pastor
- Unidad de Corta Estancia, Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | |
Collapse
|
29
|
Nicholls D, Gaynor N, Shafiei T, Bosanac P, Farrell G. Mental health nursing in emergency departments: the case for a nurse practitioner role. J Clin Nurs 2011; 20:530-6. [PMID: 21219526 DOI: 10.1111/j.1365-2702.2010.03504.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This paper aims to explore the effectiveness of the mental health nurse practitioner role in the emergency department in the context of the growing use of special units or segregated areas to manage particular kinds of mental health presentations, often complicated by substance use. BACKGROUND In recent years, there has been a significant increase in mental health presentations to emergency departments, often complicated by substance abuse. Emergency departments have introduced a variety of mechanisms to address this growing problem. With the introduction of mental health nurse practitioners, opportunities arise to reconsider these mechanisms. DESIGN Discursive paper. METHODS In this discursive paper, contemporary practices are described in relation to 'special care areas', 'psychiatric emergency centres' and 'short-stay units'. The mental health nurse practitioner role in training and capacity building is also explored and the notion of 'locational processes' described. Rather than being presented as an alternative to short-stay units, the mental health nurse practitioner role is explored in its potential to enhance mental health nursing practice in a sometimes difficult clinical environment. RESULTS The paper provides evidence from literature and practice that the clinical outcome for consumers is enhanced through the mental health nurse practitioner role. CONCLUSIONS It is argued that the introduction of the mental health nurse practitioner role in the emergency department leads to increased staff competence and confidence in interacting with those presenting with mental health issues. The mental health nurse practitioner role also addresses the serious problem of stigma associated with those with a mental health issue. RELEVANCE TO CLINICAL PRACTICE It is expected that those presenting with mental health issues to the emergency department will benefit through the increased assessment and management skills of staff.
Collapse
Affiliation(s)
- Daniel Nicholls
- University of Western Sydney, Penrith South DC, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
30
|
Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
31
|
Abstract
Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health announced the imminent approval of an EM specialty, allowing the first EM resident to officially start in 2011. Spanish emergency physicians look forward to the final approval, which will complete the modernization of emergency health care provision in Spain.
Collapse
Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia Spain
| |
Collapse
|
32
|
O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
33
|
Jiménez S, Aguilò S, Gil V, Antolín A, Prieto S, Bragulat E, Coll-Vinent B, Mirò Ò, Sánchez M. Los factores psicosociales determinan la aceptación de la hospitalización a domicilio directamente desde el servicio de urgencias. GACETA SANITARIA 2010; 24:303-8. [DOI: 10.1016/j.gaceta.2010.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 02/17/2010] [Accepted: 03/11/2010] [Indexed: 11/30/2022]
|
34
|
Impacto de una unidad de corta estancia en un hospital de tercer nivel. Rev Clin Esp 2010; 210:279-83. [DOI: 10.1016/j.rce.2009.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 11/12/2009] [Accepted: 11/16/2009] [Indexed: 11/29/2022]
|
35
|
Ortiga B, Capdevila C, Salazar A, Viso MF, Bartolomé C, Corbella X. Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital. BMC Health Serv Res 2010; 10:23. [PMID: 20096114 PMCID: PMC2823739 DOI: 10.1186/1472-6963-10-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 01/22/2010] [Indexed: 11/17/2022] Open
Abstract
Background The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. Conclusions The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay.
Collapse
Affiliation(s)
- B Ortiga
- Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Feixa Llarga, s/n,08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
36
|
Pareja T, Hornillos M, Rodríguez M, Martínez J, Madrigal M, Mauleón C, Alvarez B. [Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits]. Rev Esp Geriatr Gerontol 2009; 44:175-179. [PMID: 19577343 DOI: 10.1016/j.regg.2009.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 01/23/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. MATERIAL AND METHODS We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. RESULTS A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. CONCLUSIONS Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.
Collapse
Affiliation(s)
- Teresa Pareja
- Sección de Geriatría, Hospital Universitario de Guadalajara, Universidad de Alcalá, España.
| | | | | | | | | | | | | |
Collapse
|
37
|
Salazar A, Cobalea N, Martin X, Del Solar C, Alvarez M, Casagran A. [Not Available]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2008; 23:248-252. [PMID: 23040270 DOI: 10.1016/s1134-282x(08)75031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 07/11/2008] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the effectiveness of a model centred in the admission unit that prioritises the daily assignment of available hospital beds. MATERIAL AND METHODS This model started on June 1st 2005 with the implementation of a series of interventions: 1) Definition of the proceedings of the admission unit; 2) A daily planning decision-making meeting; 3) Opening of a 24-hour emergency department holding unit; 4) Priority bed assignment system; and 5) Appropriateness of emergency medical and elective surgical admissions. We used 8 parameters obtained from the hospital automated database. The data have been analysed in three different annual periods: 2004 (before intervention), 2005 (intervention) and 2006 (after ntervention). RESULTS Number of emergencies seen: 2004 (124,301), 2005 (123,390),2006 (129,389); number emergency admissions: 2004 (13,629), 2005 (14,649), 2006 (11,690); number of elective admissions: 2004 (12,320), 2005 (12,791), 2006 (13,615); ED admission rate: 2004 (11.0 %), 2005 (11.9 %), 2006 (9.2 %), P=.004; emergency pressure: 2004 (52.5 %), 2005 (53.4 %), 2006 (46.2 %), P=.002; ED mean length of stay per patient: 2004 (9h 45m), 2005 (6h 46m), 2006 (5h 39m); number of emergency admissions waiting for a hospital bed at 8 a.m: 2004 (5341), 2005 (4484), 2006 (2787); elective surgical interventions cancellation rate: 2004 (3.4 %), 2005 (3.7 %), 2006 (2.6 %), P=.002. CONCLUSIONS Centralized assignment of hospital beds by the admission unit has proved to be an effective tool for hospital management.
Collapse
Affiliation(s)
- Albert Salazar
- Hospital Mútua de Terrassa. Terrassa. Barcelona. España.
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE The current pressure on conventional inpatient care units represents a very serious problem for respiratory medicine departments. The aim of this study was to analyze the impact of a new instrument --a short-stay respiratory unit-- on the quality of care delivered by the respiratory medicine department of a tertiary care hospital. MATERIAL AND METHODS The short-stay respiratory unit consisted of 4 conventional hospital beds managed by a pulmonologist. The beds were only used to treat patients diagnosed with exacerbation of chronic obstructive pulmonary disease or bronchial asthma, community-acquired pneumonia, or suspected lung cancer, and stays were intended to only last for up less than to 4 days. Analyzing a range of healthcare quality variables, we compared the quality of care delivered during the first 6 months the unit was in operation (October 2005 to March 2006) to that delivered in the same period 12 months earlier. RESULTS The study included 147 patients admitted to the short-stay unit. The mean (SD) age of the patients was 64 (17) years and 79% were men. The mean length of stay was 3.3 (1.6) days--only 1.4% of patients stayed for longer than 4 days--and the readmission rate was 2.7%. There were no deaths. The existence of the short-stay respiratory unit led to a 30% decrease in the overall mean length of stay in the respiratory medicine department (11.8 [4.6] vs 8.3 [2.6] days; P< .001), and the readmission rate fell from 21% to 15% (P< .05). While there were no differences in mortality between the 2 periods, the complexity of diseases treated by the respiratory medicine department showed an increase of 9.2% (P< .001). CONCLUSIONS A short-stay respiratory unit can improve the efficiency of care delivered by a respiratory medicine department by reducing both the mean duration of hospitalization and the readmission rate, without a reduction in the complexity of diseases treated or a need for additional resources.
Collapse
|
39
|
Maria Broquetas J, Pedreny R, María Martínez-Llorens J, Sellarés J, Gea J. Unidad neumológica de estancia corta: un nuevo dispositivo asistencial de hospitalización. Arch Bronconeumol 2008. [DOI: 10.1157/13119940] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
40
|
Salgado E, Antolín A, Rodríguez D, Bragulat E, Sánchez M, Miró Ò. Cuantificación de los efectos negativos de la sobrecarga invernal en urgencias y de la efectividad de las medidas extraordinarias invernales para paliarlos. Med Clin (Barc) 2008; 130:286-91. [DOI: 10.1157/13116572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
41
|
Abstract
“Acute physicians” herald the new specialty of acute medicine
Collapse
|