1
|
Anderson M, Friebel R, Maynou L, Kyriopoulos I, McGuire A, Mossialos E. Patient outcomes, efficiency, and adverse events for elective hip and knee replacement in private and NHS hospitals: a population-based cohort study in England. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100904. [PMID: 38680249 PMCID: PMC11047790 DOI: 10.1016/j.lanepe.2024.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
Background Since the early 2000s, the National Health Service (NHS) in England has expanded provision of publicly funded care in private hospitals as a strategy to meet growing demand for elective care. This study aims to compare patient outcomes, efficiency and adverse events in private and NHS hospitals when providing elective hip and knee replacement. Methods We conducted a population-based cohort study including patients ≥18 years, undergoing a publicly funded elective hip or knee replacement in private and NHS hospitals in England between January 1st 2016 and March 31st 2019. Comparative probability was estimated for three patient outcome measures (in-hospital mortality, emergency readmissions with 28 days, hospital transfers), two efficiency measures (pre-operative length of stay (LOS) >0 day and post-operative LOS >2 days), and four adverse events (hospital-associated infection, adverse drug reactions, pressure ulcers, venous thromboembolism). Probit regression was used to adjust for observable confounding followed by instrumental variable (IV) analyses to also account for unobserved confounding at the patient-level. Propensity score matching was then used as a robustness check. Findings Our study sample included 169,232 patients in private hospitals, and 262,659 patients in NHS hospitals. Estimates from probit regression indicated that treatment in private hospital was associated with reduced probability of in-hospital mortality (-0.0009, 95% CI -0.0010, -0.0007), emergency readmissions (-0.0181, 95% CI -0.0191, -0.0172), hospital transfers (-0.0076, 95% CI -0.0084, -0.0068), prolonged post-operative LOS (-0.1174, 95% CI -0.1547, -0.0801), hospital-associated infection (-0.0115, 95% CI -0.0123, -0.0107), adverse drug reactions (-0.0051, 95% CI -0.0056, -0.0046), pressure ulcers (-0.0017, 95% CI -0.0019, -0.0014), and venous thromboembolism (-0.0027, 95% CI -0.0031, -0.0022). IV analyses produced no significant differences between private and NHS hospitals, except for lower probability in private hospitals of hospital-associated infection (-0.0057, 95% CI -0.0081, -0.0032), and greater probability in private hospitals of prolonged post-operative LOS (0.2653, 95% CI 0.1833, 0.3472). Propensity score matching produced similar results to probit regression. Interpretation Our findings indicate there is potentially important unobservable confounding at the patient-level between private and NHS hospitals not adjusted for when using probit regression or propensity score matching. Funding This research did not receive any dedicated funding.
Collapse
Affiliation(s)
- Michael Anderson
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester, United Kingdom
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Rocco Friebel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Laia Maynou
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Alistair McGuire
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Woodnutt S, Hall S, Libberton P, Flynn M, Purvis F, Snowden J. Analysis of England's incident and mental health nursing workforce data 2015-2022. J Psychiatr Ment Health Nurs 2024. [PMID: 38258945 DOI: 10.1111/jpm.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer-reviewed evidence examining recent trends. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service-provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: English mental health services report greater levels of patient-related factors such as self-harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic. ABSTRACT INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain. AIM Comparison of English national data for incidents and nursing workforce to examine recent trends. METHOD Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022. RESULTS A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals. DISCUSSION Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports. IMPLICATIONS FOR PRACTICE Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.
Collapse
Affiliation(s)
- Samuel Woodnutt
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Simon Hall
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Paula Libberton
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Matt Flynn
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Francesca Purvis
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jasmine Snowden
- School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7171. [PMID: 38131722 PMCID: PMC11080941 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
Collapse
|
4
|
Castro-Avila A, Merino-Osorio C, González-Seguel F, Camus-Molina A, Muñoz-Muñoz F, Leppe J. Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study. PLoS One 2023; 18:e0294631. [PMID: 37972091 PMCID: PMC10653414 DOI: 10.1371/journal.pone.0294631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. METHODS Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. RESULTS We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. CONCLUSIONS There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%). CLINICAL TRIAL REGISTRATION NCT04979897 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Ana Castro-Avila
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - Catalina Merino-Osorio
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Jaime Leppe
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | |
Collapse
|
5
|
Bosque-Mercader L, Siciliani L. The association between bed occupancy rates and hospital quality in the English National Health Service. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:209-236. [PMID: 35579804 PMCID: PMC9112248 DOI: 10.1007/s10198-022-01464-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/05/2022] [Indexed: 05/14/2023]
Abstract
We study whether hospitals that exhibit systematically higher bed occupancy rates are associated with lower quality in England over 2010/11-2017/18. We develop an economic conceptual framework to guide our empirical analysis and run regressions to inform possible policy interventions. First, we run a pooled OLS regression to test if high bed occupancy is associated with, and therefore acts as a signal of, lower quality, which could trigger additional regulation. Second, we test whether this association is explained by exogenous demand-supply factors such as potential demand, and unavoidable costs. Third, we include determinants of bed occupancy (beds, length of stay, and volume) that might be associated with quality directly, rather than indirectly through bed occupancy. Last, we use a within-between random-effects specification to decompose these associations into those due to variations in characteristics between hospitals and variations within hospitals. We find that bed occupancy rates are positively associated with overall and surgical mortality, negatively associated with patient-reported health gains, but not associated with other indicators. These results are robust to controlling for demand-supply shifters, beds, and volume. The associations reduce by 12%-25% after controlling for length of stay in most cases and are explained by variations in bed occupancy between hospitals.
Collapse
Affiliation(s)
- Laia Bosque-Mercader
- Department of Economics and Related Studies, University of York, York, YO10 5DD, UK.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| |
Collapse
|
6
|
Stock G, McDermott C. The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2023. [DOI: 10.1108/ijopm-07-2022-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PurposeThe authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.Design/methodology/approachThe authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.FindingsThe authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.Practical implicationsHospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.Originality/valueThis study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.
Collapse
|
7
|
Gridley K, Baxter K, Birks Y, Newbould L, Allan S, Roland D, Malisauskaite G, Jones K. Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of 'provider capacity' and 'patient choice'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4982-e4991. [PMID: 35841589 PMCID: PMC10084034 DOI: 10.1111/hsc.13911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.
Collapse
Affiliation(s)
- Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
| | | | | | | | | | | |
Collapse
|
8
|
Almutairi A, Alkhalaf H, Caswell A, Kolobe LE, Alatassi A, Alzughaibi N, Alnamshan M, Alqanatish J. Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital. Ann Med Surg (Lond) 2022; 81:104304. [PMID: 35991505 PMCID: PMC9386388 DOI: 10.1016/j.amsu.2022.104304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background A same day admission approach was established for pediatric patients undergoing elective surgery owing to an increase in demand for bed availability and the need for medical, logistical, psychological, and fiscal improvements. This study aimed to assess the effectiveness of the same day admission approach for reducing demand for preoperative bed occupancy in pediatric inpatient units. Method Data on elective surgery patients considered for same day admission were prospectively collected in an Excel spreadsheet. Results Same day admission patients numbered 269 (25.87%; n = 1040), 461 (41.7%; n = 1104), 382 (38.67%; n = 998), and 560 (44.20%; n = 1267) in 2018, 2019, 2020, and 2021, respectively. Over the 4-year period between 2018 and 2021, pediatric orthopedic surgeries accounted for the majority of same day admissions (29.72%; n = 497), followed by ear, nose, and throat (21.30%; n = 356), general (16.99%; n = 284), plastic (14.53%; n = 243); urology (9.87%; n = 165); optometry and ophthalmology (3.77%; n = 63); neuro (2.51%; n = 42), and dental (1.31%; n = 22) surgeries. The total number of days of saved preoperative beds over the 4-year period was 1672 days (an average of 418 hospital days per year). Conclusions This study showed that same day admission approach should be implemented in pediatrics institutions to reduce hospital bed demand. The implementation of this initiative is widely variable between specialties due to interlinked medical, operational, and logistical factors. Level of Evidence III. Same day admission is a model to reduce the average length of hospital stay for surgical patients and to reduce costs. The study is confirming the feasibility of applying the same day admissions' project in the pediatric population. This study compares the applicability of the same day admission’s project across pediatrics’ surgical subspecialties. This study proves the possibility of applying same day admission's project in the local region.
Collapse
Affiliation(s)
- Anqaa Almutairi
- Department of Nursing, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamad Alkhalaf
- Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Corresponding author. Department of Pediatrics, Chairman of Bed Management Department, Ministry of National Guard - Health Affairs, Riyadh, 13314 – 2861, Saudi Arabia.
| | - Angela Caswell
- Department of Nursing, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Litaba Efraim Kolobe
- Department of Nursing, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaleem Alatassi
- Department of Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nezar Alzughaibi
- Department of Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alnamshan
- Department of Pediatric Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jubran Alqanatish
- Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Friebel R, Fistein J, Maynou L, Anderson M. Emergency contracting and the delivery of elective care services across the English National Health Service and independent sector during COVID-19: a descriptive analysis. BMJ Open 2022; 12:e055875. [PMID: 35851029 PMCID: PMC9296998 DOI: 10.1136/bmjopen-2021-055875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Following a virtual standstill in the delivery of elective procedures in England, a national block contract between the NHS and the independent sector aimed to help restart surgical care. This study aims to describe subsequent changes in trends in elective care service delivery following implementation of the initial iteration of this contract. METHODS Population-based retrospective cohort study, assessing the delivery of all publicly funded and privately funded elective care delivered in England between 1 April 2020 and 31 July 2020 compared with the same period in 2019. Discharge data from the Hospital Episode Statistics and private healthcare data from the Private Health Information Network was stratified by specialty, procedure, length of stay and patient complexity in terms of age and Charlson Comorbidity Index. RESULTS COVID-19 significantly reduced publicly funded elective care activity, though changes were more pronounced in the independent sector (-65.1%) compared with the NHS (-52.7%), whereas reductions in privately funded elective care activity were similar in both independent sector hospitals (-74.2%) and NHS hospitals (-72.9%). Patient complexity increased in the independent sector compared with the previous year, with mixed findings in NHS hospitals. Most specialties, irrespective of sector or funding mechanisms, experienced a reduction in hospital admissions. However, some specialities, including medical oncology, clinical oncology, clinical haematology and cardiology, experienced an increase in publicly-funded elective care activity in the independent sector. CONCLUSION Elective care delivered by the independent sector remained significantly below historic levels, although this overlooks significant variation between regions and specialities. There may be opportunities to learn from regions which achieved more significant increases in publicly funded elective care in independent sector providers as a strategy to address the growing backlog of elective care.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Center for Global Development, Washington, District of Columbia, USA
| | - Jon Fistein
- Private Healthcare Information Network, London, UK
| | - Laia Maynou
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Center for Research in Health and Economics, University of Pompeu Fabra, Barcelona, Spain
| | - Michael Anderson
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Private Healthcare Information Network, London, UK
| |
Collapse
|
10
|
Malisauskaite G, Jones K, Allan S, Roland D, Birks Y, Baxter K, Gridley K. How local partnerships to improve urgent and emergency care have impacted delayed transfers of care from hospitals in England: an analysis based on a synthetic control estimation method. BMJ Open 2022; 12:e054568. [PMID: 35131830 PMCID: PMC8823209 DOI: 10.1136/bmjopen-2021-054568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Patients should be discharged from hospital when they are medically fit. However, discharges are often delayed for non-medical reasons including access to social care. One aim of local health and social care partnerships to improve urgent and emergency care in England (known as urgent and emergency care (UEC) vanguards) was to improve integration of health and social care, which could lead to fewer delays. Consequently, we aimed to assess the impact of UEC vanguards on delayed discharges from hospital (delayed transfers of care (DTOC)) in England. DESIGN Using a synthetic control estimation method 29 local authorities (LAs) that were UEC vanguards partners were averaged into a single 'treated' unit and compared with a unit created using data from LAs that were not UEC vanguards partners to estimate the impact of UEC vanguards on DTOC. Sensitivity analysis included fixed effects panel regressions and various placebo tests. SETTING 150 LAs in England (excluding city of London and Isles of Scilly); 29 LAs were partners in UEC vanguards between August 2015 and March 2018. PRIMARY OUTCOME MEASURE Quarterly data on days of DTOC at LA level for the period 2010-2017. RESULTS Synthetic control estimation showed a large difference in DTOC days between UEC vanguards partner LAs compared with those that were not, with on average 23.7% lower DTOC per quarter (491 DTOC days per quarter). Fixed effect panel regressions found DTOC rates lower by 43.1% (99% CI 13.8% to 72.4%) in UEC partner LAs after the start of the vanguards programme. We found no indication of UEC partner LAs having lower DTOC rates prior to initiation of vanguards. CONCLUSIONS The evidence indicates a sizeable statistically significant impact of UEC vanguards on DTOC; however, more research is required to explain the underlying reasons for this relationship.
Collapse
Affiliation(s)
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Daniel Roland
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Kate Baxter
- Social Policy Research Unit, University of York, York, UK
| | - Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| |
Collapse
|
11
|
Ranzani Rigotti A, Mara Zamarioli C, do Prado PR, Helena Pereira F, Gimenes FRE. Resiliência de Sistemas de Assistência à Saúde no enfrentamento da COVID-19: relato de experiência. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0210pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: relatar a experiência profissional de um enfermeiro gestor frente aos desafios da reestruturação de um serviço hospitalar diante da pandemia da COVID-19. Método: relato de experiência, baseado na perspectiva da resiliência do sistema em um hospital público. Resultados: os desafios enfrentados foram: reorganização do fluxo de serviço interno para atender os casos suspeitos de COVID-19; instituição de mudanças e adaptações estruturais, desde a entrada na urgência e emergência, até nas enfermarias e unidade de terapia intensiva; aquisição de equipamentos e insumos para o atendimento dos pacientes com foco na qualidade e funcionalidade destes; treinamento das equipes, com a reestruturação dos processos de trabalho; dimensionamento de pessoal, considerando o tempo de exposição ao vírus; qualificação profissional, absenteísmo, estresse, adoecimento físico e psicológico da equipe, com vistas à uma assistência segura e de qualidade; liderança da equipe de Enfermagem para lidar com os conflitos gerados pelo estresse e adoecimento dos profissionais. Conclusão: a resiliência do serviço de saúde é fundamental para a reestruturação hospitalar na pandemia da COVID-19, no entanto, devem-se considerar o cuidado dos pacientes e a saúde física e mental dos profissionais de saúde.
Collapse
|
12
|
Ranzani Rigotti A, Mara Zamarioli C, do Prado PR, Helena Pereira F, Gimenes FRE. Resilience of Healthcare Systems in the face of COVID-19: an experience report. Rev Esc Enferm USP 2022; 56:e20210210. [PMID: 35635792 PMCID: PMC10081586 DOI: 10.1590/1980-220x-reeusp-2021-0210en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to report the professional experience of a nurse manager facing the challenges of restructuring a hospital service in the face of the COVID-19 pandemic. Method: this is an experience report, based on the perspective of system resilience in a public hospital. Results: the challenges faced were: internal service flow reorganization to assist suspected cases of COVID-19; institution of structural changes and adaptations, from entry into the emergency room to the wards and intensive care unit; equipment and supply acquisition for patient care with a focus on their quality and functionality; staff training, with the restructuring of work processes; staff sizing, considering the time of exposure to the virus; staff’s professional qualification, absenteeism, stress, physical and psychological illness, with a view to safe and quality care; nursing staff leadership to deal with conflicts generated by professionals’ stress and illness. Conclusion: healthcare service resilience is critical for hospital restructuring in the COVID-19 pandemic; however, patient care and healthcare professionals’ physical and mental health must be considered.
Collapse
|
13
|
Bele S, Cassidy C, Curran J, Johnson DW, Bailey JAM. Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary-Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study. J Med Internet Res 2021; 23:e28610. [PMID: 34941561 PMCID: PMC8734914 DOI: 10.2196/28610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children’s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary–regional relationships. Conclusions This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers’ and family members’ perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID) RR2-10.1186/s12913-018-3859-2
Collapse
Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - David W Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada
| | - J A Michelle Bailey
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
14
|
Friebel R, Henschke C, Maynou L. Comparing the dangers of a stay in English and German hospitals for high-need patients. Health Serv Res 2021; 56 Suppl 3:1405-1417. [PMID: 34486105 PMCID: PMC8579208 DOI: 10.1111/1475-6773.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the risk of an avoidable adverse event for high-need patients in England and Germany and the causal impact that has on outcomes. DATA SOURCES We use administrative, secondary data for all hospital inpatients in 2018. Patient records for the English National Health Service are provided by the Hospital Episode Statistics database and for the German health care system accessed through the Research Data Center of the Federal Statistical Office. STUDY DESIGN We calculated rates of three hospital-acquired adverse events and their causal impact on mortality and length of stay through propensity score matching and estimation of average treatment effects. DATA COLLECTION/EXTRACTION METHODS Patients were identified based on diagnoses codes and translated Patient Safety Indicators developed by the Agency for Healthcare Research and Quality. PRINCIPAL FINDINGS For the average hospital stay, the risk of an adverse event was 5.37% in the English National Health Service and 3.26% in the German health care system. High-need patients are more likely to experience an adverse event, driven by hospital-acquired infections (2.06%-4.45%), adverse drug reactions (2.37%-2.49%), and pressure ulcers (2.25%-0.45%). Adverse event risk is particularly high for patients with advancing illnesses (10.50%-27.11%) and the frail elderly (17.75%-28.19%). Compared to the counterfactual, high-need patients with an adverse event are more likely to die during their hospital stay and experience a longer length of stay. CONCLUSIONS High-need patients are particularly vulnerable with an adverse event risking further deterioration of health status and adding resource use. Our results indicate the need to assess the costs and benefits of a hospital stay, particularly when care could be provided in settings considered less hazardous.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health PolicyThe London School of Economics and Political ScienceLondonUK
- Center for Global Development EuropeLondonUK
| | - Cornelia Henschke
- Department of Health Care ManagementBerlin University of TechnologyBerlinGermany
- Berlin Centre of Health Economics ResearchBerlin University of TechnologyBerlinGermany
| | - Laia Maynou
- Department of Health PolicyThe London School of Economics and Political ScienceLondonUK
- Department of Econometrics, Statistics and Applied EconomicsUniversitat de BarcelonaBarcelonaSpain
- Center for Research in Health and EconomicsUniversity of Pompeu FabraBarcelonaSpain
| |
Collapse
|
15
|
Kong KK, Ong SC, Ooi GS, Hassali MA. Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia. Pharm Pract (Granada) 2021; 19:2469. [PMID: 34621454 PMCID: PMC8456338 DOI: 10.18549/pharmpract.2021.3.2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The clinical pharmacy service to the ward was established in 2005 in
Malaysia, as the number of pharmacists working in the public service sector
began to grow. Yet, there has been little local research done on reporting
the range of work activities of clinical pharmacists and the amount of time
that they spent on their work activities. Objective: This study aimed to identify the range of work activities of clinical
pharmacists by observation and to estimate the proportion of time spent on
different work activities by using the work sampling technique. Methods: The time spent by clinical pharmacists on various activities was measured
using the work sampling technique over 30 working days. The work activities
of clinical pharmacists were pre-identified and customized into an activity
checklist. Two observers were placed at the study site and took turns
recording the activities performed by the clinical pharmacists by following
a randomly generated observation schedule. Results: 1,455 observations were made on five clinical pharmacists with a total of
3493 events recorded. Overall, clinical pharmacists spent 78.8%
(n=2751) of their time providing clinical services whereas 12.3%
(n=433) of their time was spent on non-clinical activities. They were found
to be idle from work for 8.9% of the time. There was no difference in
bed occupancy rate in the study site regardless of the presence of the
observer (p=0.384). Clinical pharmacists were found to report a higher
average daily cumulative work unit of 9.8 (SD=4.3) when under observation
compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no
observer was present (p=0.005). Conclusions: The results revealed that clinical pharmacists spent a significant amount of
time on non-clinical work. Their responsibilities with non-clinical work
should be properly taken care of so they can allocate more time to providing
patient care.
Collapse
Affiliation(s)
- Kian K Kong
- Clinical Research Centre, Duchess of Kent Hospital, Ministry of Health Malaysia. Malaysia.
| | - Siew C Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia. Penang (Malaysia).
| | - Guat S Ooi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia. Penang (Malaysia).
| | - Mohamed A Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia. Penang (Malaysia).
| |
Collapse
|
16
|
Xie M, Lao TT, Ma J, Zhu T, Liu D, Yu S, Du M, Sun Q, Ma R. Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning. BMC Pregnancy Childbirth 2021; 21:610. [PMID: 34493234 PMCID: PMC8424970 DOI: 10.1186/s12884-021-04074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. METHODS In a retrospective cohort study, temporal changes were examined in relation with maternal demographics, incidence of women with high risk pregnancies and resource statistics in our hospital in managing singleton viable pregnancies (birth from 28 weeks gestational age onwards) for the period 2005-2017. RESULTS During this 13-year period, the number of singleton livebirths from 28 weeks gestational age onwards was 49,479. Annual numbers of births increased from 1,941 to 2005 to 5,777 in 2017. There were concomitant and significant increases in the incidence of multiparous women (10.6-50.8 %), of age ≥35 years (6.5-24.3 %), with prior caesarean Sec. (2.6-23.6 %), with ≥3 previous pregnancy terminations (1.0-4.9 %), with pre-gestational diabetes (0.2-0.9 %), and with chronic hypertension (0.2-1.2 %). There were associated increases in beds and staff complement and reduced average hospital stay. Nevertheless, while the workload of medical staff remained stable with increasing staff complement, that of midwives increased significantly as reflected by the total births: midwife ratio which increased from 194.1:1 to 320.9:1 (p < 0.001). CONCLUSIONS In our hospital, progressively increasing numbers of annual births in combination with an increased incidence of women with high risk pregnancies took place following the revised national childbirth policy. Only the increase in medical and nursing, but not midwifery, staff was commensurate with workload. Remedial measures are urgently required before the anticipated progressive increase in care demand would overwhelm maternity care with potentially disastrous consequences.
Collapse
Affiliation(s)
- Min Xie
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Terence T Lao
- Department of Obstetrics and Gynecology, the Chinese University of Hong Kong, Hong Kong, China
| | - Junnan Ma
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Tianying Zhu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Dajin Liu
- Department of Medical Records, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan China
| | - Shengnan Yu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Mingyu Du
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Qian Sun
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
| | - Runmei Ma
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, China, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan China
- Kunming Angel Women and Children’s Hospital, Kunming, Yunnan China
| |
Collapse
|
17
|
Sharma N, Schwendimann R, Endrich O, Ausserhofer D, Simon M. Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels. J Med Internet Res 2021; 23:e27163. [PMID: 34420926 PMCID: PMC8414292 DOI: 10.2196/27163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background Variations in hospitals’ care demand relies not only on the patient volume but also on the disease severity. Understanding both daily severity and patient volume in hospitals could help to identify hospital pressure zones to improve hospital-capacity planning and policy-making. Objective This longitudinal study explored daily care demand dynamics in Swiss general hospitals for 3 measures: (1) capacity utilization, (2) patient turnover, and (3) patient clinical complexity level. Methods A retrospective population-based analysis was conducted with 1 year of routine data of 1.2 million inpatients from 102 Swiss general hospitals. Capacity utilization was measured as a percentage of the daily maximum number of inpatients. Patient turnover was measured as a percentage of the daily sum of admissions and discharges per hospital. Patient clinical complexity level was measured as the average daily patient disease severity per hospital from the clinical complexity algorithm. Results There was a pronounced variability of care demand in Swiss general hospitals. Among hospitals, the average daily capacity utilization ranged from 57.8% (95% CI 57.3-58.4) to 87.7% (95% CI 87.3-88.0), patient turnover ranged from 22.5% (95% CI 22.1-22.8) to 34.5% (95% CI 34.3-34.7), and the mean patient clinical complexity level ranged from 1.26 (95% CI 1.25-1.27) to 2.06 (95% CI 2.05-2.07). Moreover, both within and between hospitals, all 3 measures varied distinctly between days of the year, between days of the week, between weekdays and weekends, and between seasons. Conclusions While admissions and discharges drive capacity utilization and patient turnover variation, disease severity of each patient drives patient clinical complexity level. Monitoring—and, if possible, anticipating—daily care demand fluctuations is key to managing hospital pressure zones. This study provides a pathway for identifying patients’ daily exposure to strained hospital systems for a time-varying causal model.
Collapse
Affiliation(s)
- Narayan Sharma
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Olga Endrich
- Directorate of Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,College of Health-Care Professions Claudiana, Bozen, Italy
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital University Hospital Bern, Bern, Switzerland
| |
Collapse
|
18
|
Mateen BA, Wilde H, Dennis JM, Duncan A, Thomas N, McGovern A, Denaxas S, Keeling M, Vollmer S. Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis. BMJ Open 2021; 11:e042945. [PMID: 33500288 PMCID: PMC7843315 DOI: 10.1136/bmjopen-2020-042945] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. DESIGN Descriptive survey. SETTING All non-specialist secondary care providers in England from 27 March27to 5 June 2020. PARTICIPANTS Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). MAIN OUTCOME MEASURES Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. RESULTS At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. CONCLUSIONS Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
Collapse
Affiliation(s)
- Bilal Akhter Mateen
- Warwick Medical School, University of Warwick, Coventry, UK
- The Alan Turing Institute, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Harrison Wilde
- Department of Statistics, University of Warwick, Coventry, UK
| | - John M Dennis
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
| | - Andrew Duncan
- The Alan Turing Institute, London, UK
- Department of Statistics, Imperial College London, London, UK
| | - Nick Thomas
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
- Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew McGovern
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
- Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Spiros Denaxas
- The Alan Turing Institute, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Matt Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Sebastian Vollmer
- The Alan Turing Institute, London, UK
- Department of Statistics, University of Warwick, Coventry, UK
| |
Collapse
|
19
|
Boncea EE, Expert P, Honeyford K, Kinderlerer A, Mitchell C, Cooke GS, Mercuri L, Costelloe CE. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network. BMJ Qual Saf 2021; 30:457-466. [PMID: 33495288 PMCID: PMC8142451 DOI: 10.1136/bmjqs-2020-012124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Background Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. Objective This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI). Methods A retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Results Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Conclusion Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
Collapse
Affiliation(s)
- Emanuela Estera Boncea
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Paul Expert
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.,Department of Mathematics, Imperial College London, London, UK.,Tokyo Tech World Research Hub Initiative, Tokyo Institute of Technology, Tokyo, Japan
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Anne Kinderlerer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Mitchell
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Graham S Cooke
- Infectious Diseases Section, Imperial College London, London, UK
| | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
20
|
Mundt AP, Delhey Langerfeldt S, Rozas Serri E, Siebenförcher M, Priebe S. Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data. Front Psychiatry 2021; 12:745247. [PMID: 35002794 PMCID: PMC8738080 DOI: 10.3389/fpsyt.2021.745247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers. Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers. Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease. Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.
Collapse
Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - Enzo Rozas Serri
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Mathias Siebenförcher
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| |
Collapse
|
21
|
Friebel R, Juarez RM. Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England. Health Policy 2020; 124:1182-1191. [PMID: 32811683 DOI: 10.1016/j.healthpol.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1st June 2016 to 31st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts' probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom; Center for Global Development Europe, Abbey Gardens, Great College Street, London, SW1P 3SE, United Kingdom.
| | - Rosa M Juarez
- Department of Health Policy, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom
| |
Collapse
|