1
|
Affiliation(s)
| | - Stevan Bruijns
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| |
Collapse
|
2
|
Chung J, Sadeghzadeh K, Sibdari S. Psychiatric Hospitalization Associated with Emergency Department Visits. Issues Ment Health Nurs 2022; 43:552-559. [PMID: 35025714 DOI: 10.1080/01612840.2021.2013362] [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] [Indexed: 10/19/2022]
Abstract
Psychiatric boarding in an emergency department (ED) has personal and social consequences that can increase healthcare expenditure through a variety of inter-related mechanisms. This study aimed to compare health outcomes (e.g., length of stays, the severity of illness) between patients who stayed in an emergency department and those who did not visit an emergency department before the hospitalization. With the National Inpatient Sample dataset in the United States, we compared psychiatric inpatient service utilization outcomes between those who had stated in an emergency department and those who had not. Results: Among those with ED visits, the in-hospital mortality was 0.80 times lower (95% CI: 0.79-0.81). The length of hospital stays and the total charges were not significantly different from those without ED visits. The integration of primary care with psychiatric inpatient services can improve the management of psychiatric prevention and treatment, with the reduction of ED visits. This study provides an essential value in reducing emergency visits as the plan for psychiatric inpatient utilization to achieve more cost-effective and adequate healthcare outcomes.
Collapse
Affiliation(s)
- Joohyun Chung
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
| | - Keivan Sadeghzadeh
- D'Amore-McKim School of Business, Northeastern University Boston, Boston, MA, USA
| | - Soheil Sibdari
- Charlton College of Business, University of Massachusetts Dartmouth, Dartmouth, MA, USA
| |
Collapse
|
3
|
Kreindler SA, Star N, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M, Goertzen LN, Anwar MR, Aboud Z. "Working Against Gravity": The Uphill Task of Overcapacity Management. Health Serv Insights 2020; 13:1178632920929986. [PMID: 32587459 PMCID: PMC7294368 DOI: 10.1177/1178632920929986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
While most health systems have implemented interventions to manage situations in which patient demand exceeds capacity, little is known about the long-term sustainability or effectiveness of such interventions. A large multi-jurisdictional study on patient flow in Western Canada provided the opportunity to explore experiences with overcapacity management strategies across 10 diverse health regions. Four categories of interventions were employed by all or most regions: overcapacity protocols, alternative locations for emergency patients, locations for discharge-ready inpatients, and meetings to guide redistribution of patients. Two mechanisms undergirded successful interventions: providing a capacity buffer and promoting action by inpatient units by increasing staff accountability and/or solidarity. Participants reported that interventions demanded significant time and resources and the ongoing active involvement of middle and senior management. Furthermore, although most participants characterized overcapacity management practices as effective, this effectiveness was almost universally experienced as temporary. Many regions described a context of chronic overcapacity, which persisted despite continued intervention. Processes designed to manage short-term surges in demand cannot rectify a long-term mismatch between capacity and demand; solutions at the level of system redesign are needed.
Collapse
Affiliation(s)
- Sara A Kreindler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Noah Star
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Hastings
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Shannon Winters
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Keir Johnson
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Sara Mallinson
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Meaghan Brierley
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | | | | | - Zaid Aboud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|