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Teale AL, Morgan C, Jenkins TA, Jacobsen P. Delayed discharge in inpatient psychiatric care: a systematic review. Int J Ment Health Syst 2024; 18:14. [PMID: 38582904 PMCID: PMC10998409 DOI: 10.1186/s13033-024-00635-9] [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: 07/28/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Delayed discharge is problematic. It is financially costly and can create barriers to delivering best patient care, by preventing return to usual functioning and delaying admissions of others in need. This systematic review aimed to collate existing evidence on delayed discharge in psychiatric inpatient settings and to develop understanding of factors and outcomes of delays in these services. METHODS A search of relevant literature published between 2002 and 2022 was conducted on Pubmed, PsycInfo and Embase. Studies of any design, which published data on delayed discharge from psychiatric inpatient care in high income countries were included. Studies examining child and adolescent, general medical or forensic settings were excluded. A narrative synthesis method was utilised. Quality of research was appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS Eighteen studies from England, Canada, Australia, Ireland, and Norway met the inclusion criteria. Six main reasons for delayed discharge were identified: (1) accommodation needs, (2) challenges securing community or rehabilitation support, (3) funding difficulties, (4) family/carer factors, (5) forensic considerations and (6) person being out of area. Some demographic and clinical factors were also found to relate to delays, such as having a diagnosis of schizophrenia or other psychotic disorder, cognitive impairment, and increased service input prior to admission. Being unemployed and socially isolated were also linked to delays. Only one study commented on consequences of delays for patients, finding they experienced feelings of lack of choice and control. Four studies examined consequences on services, identifying high financial costs. CONCLUSION Overall, the findings suggest there are multiple interlinked factors relevant in delayed discharge that should be considered in practice and policy. Suggestions for future research are discussed, including investigating delayed discharge in other high-income countries, examining delayed discharge from child and forensic psychiatric settings, and exploring consequences of delays on patients and staff. We suggest that future research be consistent in terms used to define delayed discharge, to enhance the clarity of the evidence base. REVIEW REGISTRATION NUMBER ON PROSPERO 292515. DATE OF REGISTRATION 9th December 2021.
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Affiliation(s)
| | - Ceri Morgan
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Tom A Jenkins
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Pamela Jacobsen
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
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Ghai S, Chassé K, Renaud MJ, Guicherd-Callin L, Bussières A, Zidarov D. Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation. BMC Health Serv Res 2024; 24:421. [PMID: 38570840 PMCID: PMC10993552 DOI: 10.1186/s12913-024-10818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home. METHODS A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults. RESULTS Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs. CONCLUSION Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program. CLINICAL TRIAL REGISTRATION Retrospectively registered NCT05915156 (22/06/2023).
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden.
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden.
| | - Kathleen Chassé
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Marie-Jeanne Renaud
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Lilian Guicherd-Callin
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montréal, Québec, Canada
- Departement Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Diana Zidarov
- Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
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Vinci A, Furia G, Cammalleri V, Colamesta V, Chierchini P, Corrado O, Mammarella A, Ingravalle F, Bardhi D, Malerba RM, Carnevale E, Gentili S, Damiani G, De Vito C, Maurici M. Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy. PLoS One 2024; 19:e0294785. [PMID: 38265995 PMCID: PMC10807762 DOI: 10.1371/journal.pone.0294785] [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: 07/05/2023] [Accepted: 11/09/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. MATERIAL AND METHODS Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. RESULTS 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. DISCUSSION AND CONCLUSIONS Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\system level) and social issues (on patient's level).
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Affiliation(s)
- Antonio Vinci
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Furia
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Colamesta
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Patrizia Chierchini
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Ornella Corrado
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Assunta Mammarella
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Fabio Ingravalle
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
- Hospital Health Management Area, Local Health Authority “ASL Roma 6”, Albano Laziale, Italy
| | - Dorian Bardhi
- Post-Graduate School of Hygiene and Preventive Medicine, University of L’Aquila, L’Aquila, Italy
| | - Rosa Maria Malerba
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Edoardo Carnevale
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Susanna Gentili
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
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Heltø ALK, Rosager EV, Aasbrenn M, Maule CF, Petersen J, Nielsen FE, Suetta C, Gregersen R. Predicting Short-Term Mortality in Older Patients Discharged from Acute Hospitalizations Lasting Less Than 24 Hours. Clin Epidemiol 2023; 15:707-719. [PMID: 37324726 PMCID: PMC10264096 DOI: 10.2147/clep.s405485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Over coming decades, a rise in the number of short, acute hospitalizations of older people is to be expected. To help physicians identify high-risk patients prior to discharge, we aimed to develop a model capable of predicting the risk of 30-day mortality for older patients discharged from short, acute hospitalizations and to examine how model performance changed with an increasing amount of information. Methods This registry-based study included acute hospitalizations in Denmark for 2016-2018 lasting ≤24 hours where patients were permanent residents, ≥65 years old, and discharged alive. Utilizing many different predictor variables, we developed random forest models with an increasing amount of information, compared their performance, and examined important variables. Results We included 107,132 patients with a median age of 75 years. Of these, 3.3% (n=3575) died within 30 days of discharge. Model performance improved especially with the addition of laboratory results and information on prior acute admissions (AUROC 0.835), and again with comorbidities and number of prescription drugs (AUROC 0.860). Model performance did not improve with the addition of sociodemographic variables (AUROC 0.861), apart from age and sex. Important variables included age, dementia, number of prescription drugs, C-reactive protein, and eGFR. Conclusion The best model accurately estimated the risk of short-term mortality for older patients following short, acute hospitalizations. Trained on a large and heterogeneous dataset, the model is applicable to most acute clinical settings and could be a useful tool for physicians prior to discharge.
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Affiliation(s)
- Amalia Lærke Kjær Heltø
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Vangsgaard Rosager
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Aasbrenn
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Cathrine Fox Maule
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Janne Petersen
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Rasmus Gregersen
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rogers B, Legaspi JP, Bastiampillai T. Hospital congestion: a market solution to address delayed transfers of care from hospital beds. Med J Aust 2023; 218:298-300. [PMID: 36966447 DOI: 10.5694/mja2.51876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 03/27/2023]
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Trevisan C, Noale M, Zatti G, Vetrano DL, Maggi S, Sergi G. Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy. BMC Geriatr 2023; 23:154. [PMID: 36941535 PMCID: PMC10029164 DOI: 10.1186/s12877-023-03884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. METHODS Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. RESULTS Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03). CONCLUSIONS The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.
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Affiliation(s)
- Caterina Trevisan
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy.
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44124, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giancarlo Zatti
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Stefania Maggi
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
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Görgülü B, Dong J, Hunter K, Bettio KM, Vukusic B, Ranisau J, Spencer G, Tang T, Sarhangian V. Association Between Delayed Discharge From Acute Care and Rehabilitation Outcomes and Length of Stay: A Retrospective Cohort Study. Arch Phys Med Rehabil 2023; 104:43-51. [PMID: 35760110 DOI: 10.1016/j.apmr.2022.05.017] [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: 01/18/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between discharge delays from acute to rehabilitation care because of capacity strain in the rehabilitation units, patient length of stay (LOS), and functional outcomes in rehabilitation. DESIGN Retrospective cohort study using an instrumental variable to remove potential biases because of unobserved patient characteristics. SETTING Two campuses of a hospital network providing inpatient acute and rehabilitation care. PARTICIPANTS Patients admitted to and discharged from acute care categories of Medicine and Neurology/Musculoskeletal (Neuro/MSK) and subsequently admitted to and discharged from inpatient rehabilitation between 2013 and 2019 (N=10486). INTERVENTIONS None. MAIN OUTCOME MEASURES Rehabilitation LOS, FIM scores at admission and discharge, and rehabilitation efficiency defined as FIM score improvement per day of rehabilitation. RESULTS The final cohort contained 3690 records for Medicine and 1733 for Neuro/MSK categories. For Medicine, 1 additional day of delayed discharge was associated with an average 5.1% (95% confidence interval [CI], 3%-7.3%) increase in rehabilitation LOS and 0.08 (95% CI, 0.03-0.13) reduction in rehabilitation efficiency. For Neuro/MSK, 1 additional day of delayed discharge was associated with an average 11.6% (95% CI, 2.8%-20.4%) increase in rehabilitation LOS and 0.08 (95% CI, -0.07 to 0.23) reduction in rehabilitation efficiency. CONCLUSIONS Delayed discharge from acute care to rehabilitation because of capacity strain in rehabilitation had a strong association with prolonged LOS in rehabilitation. An important policy implication of this "cascading" effect of delays is that reducing capacity strain in rehabilitation could be highly effective in reducing discharge delays from acute care and improving rehabilitation efficiency.
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Affiliation(s)
- Berk Görgülü
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Jing Dong
- Decision, Risk, and Operations Division, Columbia Business School, Columbia University, New York, NY
| | | | | | | | - Jonathan Ranisau
- Trillium Health Partners, Mississauga, Canada; Institute for Better Health, Mississauga, Canada
| | | | - Terence Tang
- Trillium Health Partners, Mississauga, Canada; Institute for Better Health, Mississauga, Canada
| | - Vahid Sarhangian
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada.
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Harhara T, Ibrahim H, Gaba WH, Kamour AM. Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates. BMC Health Serv Res 2022; 22:1447. [PMID: 36447224 PMCID: PMC9708119 DOI: 10.1186/s12913-022-08746-0] [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: 06/17/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hospitals worldwide are seeing an increased number of acute admissions, with resultant emergency department (ED) crowding and increased length of stay (LOS). Acute Medical Units (AMUs) have developed throughout the United Kingdom and other Western countries to reduce the burden on EDs and improve patient flow. Limited information is available on AMUs in the Middle East. The purpose of this study is to describe the development of the first AMU in the United Arab Emirates (UAE) for general medical patients and its impact on LOS, early discharges, ED boarders, and readmission rates. METHODS We established a consultant-led AMU in a tertiary hospital in the UAE. A retrospective comparative review of all general medical admissions to the AMU between August 1, 2020 and December 31, 2020 and all admissions to the traditional medical wards between August 1, 2019 and December 31, 2019 was conducted. RESULTS The average LOS reduced from 10 to 5 days (95% CI [4.14-6.25], p < 0.001) after the introduction of AMU. Early discharges increased by 22%. The number of outliers and number of patients boarding in ED reduced significantly (111 in 2019 vs. 60 in 2020, p < 0.05; 938 in 2019 vs. 104 in 2020, p < 0.001 respectively), with a decrease in ED waiting time from 394 min to 134 min (95% CI [229.25-290.75], p < 0.001). There was no increase in 30-day readmission rates. CONCLUSION Restructuring the system of care can reduce LOS, overcome discharge barriers and improve patient flow. Similar units can be developed in hospitals throughout the UAE and the region to reduce LOS and improve patient flow through acute care units.
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Affiliation(s)
- Thana Harhara
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- grid.440568.b0000 0004 1762 9729Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Waqar H. Gaba
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
| | - Ashraf M. Kamour
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
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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.
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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
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Rameli PM, Rajendran N. Outcomes of complex discharge planning in older adults with complex needs: a scoping review. J Int Med Res 2022; 50:3000605221110511. [PMID: 35903858 PMCID: PMC9340947 DOI: 10.1177/03000605221110511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
In this scoping review, we aimed to evaluate the effectiveness of integrated multidisciplinary team discharge planning and identify common outcomes among older adults with complex needs, focusing on a safe transition from the hospital to the community. We performed a literature search for relevant articles using seven electronic databases and agreed search terms. Only articles published in English were included. In total, 23,772 articles were identified, with 27 articles meeting the inclusion criteria. A preponderance of patients aged ≥65 years and women was inferred based on population demographics. Initiatives on complex discharge planning were noted across most Western countries. Common outcomes of complex discharge planning were functionality (n = 11) including frailty (n = 4), quality of life (n = 11), and patient-centered factors including psychosocial needs (n = 9). Various outcomes from complex discharge planning initiatives and pathways were explored in this scoping review. None of the selected studies covered all nine domains of outcome assessment. Further research is needed involving follow-up studies after complex discharge planning interventions to assess their true effectiveness or value.
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Walters S, Chakravorty M, McLachlan S, Odone J, Stevenson JM, Minshull J, Schiff R. Medication Compliance Aids Unpackaged: A National Survey. Br J Clin Pharmacol 2022; 88:4595-4606. [PMID: 35510733 PMCID: PMC9542868 DOI: 10.1111/bcp.15386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
Aims Sixty‐four million pharmacy‐filled multicompartment medication compliance aids (MCAs) are dispensed by pharmacies in England each year. Despite the widespread use of MCAs and evidence that their use may be associated with harm there is no national consensus regarding MCA provision by acute hospital Trusts in England. The aim was to determine current practice for initiation and supply of MCAs in acute hospital Trusts in England and the potential consequences for patients and hospitals. Methods A 26‐item survey was distributed to all acute hospital Trusts in England. The questionnaire covered: policy, initiation, supply and review of MCAs; alternatives offered; and pharmacy staffing and capacity related to MCAs. Results Seventy‐two out of 138 (52%) Trusts responded to the survey: 70 Trusts responded regarding policy for MCA provision, with 60 (86%) having a policy regarding this; 33/55 (60%) that supplied MCAs on discharge supplied a different prescription length for MCA vs. non‐MCA prescriptions; 49/55 (89%) Trusts provided only 1 brand of MCA; 47/55 (85%) MCA‐supplying Trusts identified frequent difficulties with MCAs and 13/55 (24%) reported employing staff specifically to complete MCAs; and 30/35 (86%) MCA‐initiating Trusts had an assessment process for initiation, with care agency request reportedly the most common reason for initiation. Conclusion There is a lack of a national approach to MCA provision and initiation by acute hospital Trusts in England. This leads to significant variation in care and has the potential to put MCA users at an increased risk of medication‐related harm.
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Affiliation(s)
- Sharmila Walters
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust
| | | | - Sophie McLachlan
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust
| | - Jessica Odone
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust
| | - Jennifer M Stevenson
- Institute of Pharmaceutical Science, King's College London.,Pharmacy Department, Guy's and St. Thomas' NHS Foundation Trust
| | - John Minshull
- London Medicines Information Service, Northwick Park Hospital
| | - Rebekah Schiff
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust
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12
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Hospital Access Block: A Scoping Review. J Emerg Nurs 2022; 48:430-454. [DOI: 10.1016/j.jen.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
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13
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Kuluski K, Cadel L, Marcinow M, Sandercock J, Guilcher SJT. Expanding our understanding of factors impacting delayed hospital discharge: Insights from patients, caregivers, providers and organizational leaders in Ontario, Canada. Health Policy 2022; 126:310-317. [DOI: 10.1016/j.healthpol.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
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14
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A Quality Improvement Approach to Early Patient Discharge. Pediatr Qual Saf 2021; 6:e497. [PMID: 34934880 PMCID: PMC8677894 DOI: 10.1097/pq9.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse-physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings. Methods By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, "Increasing Patient Discharge Before 12 pm" and "Midnight Rounds with Discharge Focus." Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted "Midnight Rounds" and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June-November 2018 baseline of 15%-20% by June 2019. Results Patient discharge percentage before 12 pm increased from 15% to 21% (P < 0.01) by June 2019, and as a result, bed availability increased by 16% (P < 0.01). Conclusions QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.
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15
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El-Abbassy I, Mohamed W, El-Hariri HM, El-Setouhy M, Hirshon JM, El-Shinawi M. Delay in hospital discharge of trauma patients in a University Hospital in Egypt: A prospective observational study. Afr J Emerg Med 2021; 11:459-463. [PMID: 34765432 PMCID: PMC8567154 DOI: 10.1016/j.afjem.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/12/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION "Delayed discharge" is defined as patients who remain hospitalised beyond the time of being fit for discharge after a decision of discharge has been made by the managing team. There is no standardised amount of time defining delayed discharge documented in the literature, and there is a lack of evidence about this topic in Egypt. This study is a quality improvement project aiming to identify the factors associated with discharge delays at a single centre in Egypt in order to address this issue. METHODS A prospective observational study included all trauma patients admitted to a University Hospital in Egypt over two months. The time of the decision of discharge and actual discharge time were recorded by reviewing patients' medical records. The patients and their caregivers were asked to fill in a questionnaire about the reasons for delayed discharge. Potential reasons for the delayed discharge were classified into system-related, medical and family-related factors. RESULTS The study included 498 patients with a median age of 41 years (9-72). The median time from discharge decision until actual discharge was 3 h. System-related factors were documented in 48.8% of cases, followed by medical factors (36.3%), and family-related factors (28.1%). When controlling for age, gender and injury severity score using a logistic regression analysis, longer time to discharge (≥3 h) showed a stronger association with medical factors [adjusted OR (95% CI) = 5.44 (2.73-10.85)] and family-related factors [adjusted OR (95% CI) = 7.94 (3.40-18.54)] compared to system-related factors [adjusted OR (95% CI) = 2.20 (1.12-4.29)]. DISCUSSION Although system-related factors were more prevalent, medical and family-related factors appear to be associated with longer discharge delays compared to system-related factors.
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Affiliation(s)
- Islam El-Abbassy
- General Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Raigmore Hospital, NHS Highland, Old Perth Road, Inverness, UK
- Institute of Medical Sciences, University of Aberdeen, King's College, Aberdeen, UK
| | - Wafaa Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | | | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mohamed El-Shinawi
- General Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Galala University for International Cooperation Community Services and Environmental Department, Galala University, Sokhna, Suez Governorate, The city of Galala Plateau, Governorate of Suez on the coast of the Red sea El Galala Maritime Plateau, Egypt
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16
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Nikbakht Nasrabadi A, Mardanian Dehkordi L, Taleghani F. Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211002166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.
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Affiliation(s)
| | - Leila Mardanian Dehkordi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Ogink PT, Groot OQ, Karhade AV, Bongers MER, Oner FC, Verlaan JJ, Schwab JH. Wide range of applications for machine-learning prediction models in orthopedic surgical outcome: a systematic review. Acta Orthop 2021; 92:526-531. [PMID: 34109892 PMCID: PMC8519550 DOI: 10.1080/17453674.2021.1932928] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Advancements in software and hardware have enabled the rise of clinical prediction models based on machine learning (ML) in orthopedic surgery. Given their growing popularity and their likely implementation in clinical practice we evaluated which outcomes these new models have focused on and what methodologies are being employed.Material and methods - We performed a systematic search in PubMed, Embase, and Cochrane Library for studies published up to June 18, 2020. Studies reporting on non-ML prediction models or non-orthopedic outcomes were excluded. After screening 7,138 studies, 59 studies reporting on 77 prediction models were included. We extracted data regarding outcome, study design, and reported performance metrics.Results - Of the 77 identified ML prediction models the most commonly reported outcome domain was medical management (17/77). Spinal surgery was the most commonly involved orthopedic subspecialty (28/77). The most frequently employed algorithm was neural networks (42/77). Median size of datasets was 5,507 (IQR 635-26,364). The median area under the curve (AUC) was 0.80 (IQR 0.73-0.86). Calibration was reported for 26 of the models and 14 provided decision-curve analysis.Interpretation - ML prediction models have been developed for a wide variety of topics in orthopedics. Topics regarding medical management were the most commonly studied. Heterogeneity between studies is based on study size, algorithm, and time-point of outcome. Calibration and decision-curve analysis were generally poorly reported.
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Affiliation(s)
- Paul T Ogink
- Department of Orthopedic Surgery, University Medical Center Utrecht – Utrecht University, Utrecht, The Netherlands,Correspondence:
| | - Olivier Q Groot
- Department of Orthopedic Surgery, Orthopedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, USA
| | - Aditya V Karhade
- Department of Orthopedic Surgery, Orthopedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, USA
| | - Michiel E R Bongers
- Department of Orthopedic Surgery, Orthopedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, USA
| | - F Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht – Utrecht University, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht – Utrecht University, Utrecht, The Netherlands
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Orthopedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, USA
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18
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-De Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179407. [PMID: 34502013 PMCID: PMC8431020 DOI: 10.3390/ijerph18179407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007–2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups’ weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia 31, 39340 Suances, Spain;
| | - Ana Fernández-Feito
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Avda. Julián Clavería s/n, 33006 Oviedo, Spain
- ISPA, Nursing Research Group, Health Research Institute of Asturias, Avda. del Hospital Universitario s/n, 33011 Oviedo, Spain
- Correspondence:
| | - David Cantarero
- Department of Economics, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, Research Group of Health Economics and Health Services Management, Research Institute Marqués de Valdecilla, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Joaquín Cayón-De Las Cuevas
- Faculty of Law, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - María Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
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19
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Kverndokk S, Melberg HO. Using fees to reduce bed-blocking: a game between hospitals and long-term care providers. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:931-949. [PMID: 33895904 DOI: 10.1007/s10198-021-01299-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
In several countries, a fee has been introduced to reduce bed-blocking in hospitals. This paper studies the implications of this fee for the strategic decisions of the hospitals and the long-term care providers. We introduce a Stackelberg game where the hospital is the leader and the care provider the follower. The policy reduces the treatment time at the hospital but does not necessarily lead to less bed-blocking, as this depends on the treatment time and bed-blocking before the reform. We test the results with data from the Norwegian Coordination Reform introduced in 2012 and find that this reform led to a large reduction in bed-blocking. The direct effect was even larger than a naïve comparison would suggest because hospitals began to report patients as ready to be discharged earlier than before the reform. Confronted with the theoretical predictions, this would mean that hospital services in average were set relatively close to the minimum levels before the reform.
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Affiliation(s)
- Snorre Kverndokk
- The Ragnar Frisch Centre for Economic Research, Gaustadallèen 21, 0349, Oslo, Norway.
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20
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Berger G, Epstein D, Rozen M, Miskin A, Halberthal M, Mekel M. Delayed discharges from a tertiary teaching hospital in Israel- incidence, implications, and solutions. Isr J Health Policy Res 2020; 9:66. [PMID: 33234151 PMCID: PMC7687840 DOI: 10.1186/s13584-020-00425-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/20/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives The Israeli health system is facing high workloads with average occupancy in certain hospital wards of around 100%. Since there is a shortage of hospitalization beds in institutions for continuous, long-term care, transferring patients from the general hospitals’ wards is often delayed. This situation has many significant ramifications, to the waiting patients themselves, to other patients who are waiting to be treated and to the entire organization. In this study, we describe the phenomenon of the “detained patients” - its extent, characteristics, significance, and possible solutions. Materials and methods Rambam Health Care Campus is a tertiary medical center serving the population of the northern part of Israel. In recent years, the hospital management documents data regarding the “detained patients”. We reviewed hospital data of detained patients over a period of nine months. The data concerning adult patients awaiting transfer to an institution for continuous care, between May 2019 and January 2020, were obtained retrospectively from the computerized database of the social service. Results During the study period, 12,723 adult patients were discharged. Of those, 857 patients (6.74%) were transferred to one of the facilities providing prolonged institutional care. For that group of patients, median inpatient waiting time from the decision to discharge until the transfer was 8 days (IQR 6–14), translating to 10,821 waiting days or 1202 hospitalization days per month. These hospitalization days account for 9.35% of the total hospitalization days during the study period. The “detained patients” were hospitalized in internal medicine wards (32%), orthopedic (30%), and neurology/neurosurgery (26%) departments. At any given moment, about 40 hospitalized patients were waiting for long-term care facilities. Conclusions Health-care systems must adapt to the current patients’ case-mix to achieve optimal utilization of hospital beds and maximal operational efficiency. The number of long-term care beds should be increased, the coordination between general hospitals, health maintenance organizations and long-term facilities improved, and patients that may require long term care after the acute phase of their illness should be early identified and addressed. Meanwhile, establishment of organic units for waiting patients and reorganization of the hospital structure should be considered.
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Affiliation(s)
- Gidon Berger
- Department of Internal Medicine "B", Rambam Health Care Campus, HaAliya HaShniya St. 8, 3109601, Haifa, Israel.,Hospital Management, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, HaAliya HaShniya St. 8, 3109601, Haifa, Israel.
| | - Meital Rozen
- Department of Internal Medicine "H", Rambam Health Care Campus, Haifa, Israel
| | - Avigdor Miskin
- Geriatric Medicine Service, Rambam Health Care Campus, Haifa, Israel
| | - Michael Halberthal
- Hospital Management, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Mekel
- Hospital Management, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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21
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Zeffiro V, Sanson G, Welton J, Maurici M, Malatesta A, Carboni L, Vellone E, Alvaro R, D'Agostino F. Predictive factors of a prolonged length of stay in a community Nursing-Led unit: A retrospective cohort study. J Clin Nurs 2020; 29:4685-4696. [PMID: 32956527 DOI: 10.1111/jocn.15509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/08/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold. BACKGROUND Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services. DESIGN Retrospective cohort study. METHODS Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines. RESULTS The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold. CONCLUSIONS The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients. RELEVANCE TO CLINICAL PRACTICE The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing-Led unit for each individual patient.
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Affiliation(s)
- Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - John Welton
- College of Nursing Education, University of Colorado, Aurora, CO, USA
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabio D'Agostino
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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22
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Klinge M, Aasbrenn M, Öztürk B, Christiansen CF, Suetta C, Pressel E, Nielsen FE. Readmission of older acutely admitted medical patients after short-term admissions in Denmark: a nationwide cohort study. BMC Geriatr 2020; 20:203. [PMID: 32527311 PMCID: PMC7291666 DOI: 10.1186/s12877-020-01599-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Knowledge of unplanned readmission rates and prognostic factors for readmission among older people after early discharge from emergency departments is sparse. The aims of this study were to examine the unplanned readmission rate among older patients after short-term admission, and to examine risk factors for readmission including demographic factors, comorbidity and admission diagnoses. Methods This cohort study included all medical patients aged ≥65 years acutely admitted to Danish hospitals between 1 January 2013 and 30 June 2014 and surviving a hospital stay of ≤24 h. Data on readmission within 30 days, comorbidity, demographic factors, discharge diagnoses and mortality were obtained from the Danish National Registry of Patients and the Danish Civil Registration System. We examined risk factors for readmission using a multivariable Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for readmission. Results A total of 93,306 patients with a median age of 75 years were acutely admitted and discharged within 24 h, and 18,958 (20.3%; 95% CI 20.1 - 20.6%) were readmitted with a median time to readmission of 8 days (IQR 3 - 16 days). The majority were readmitted with a new diagnosis. Male sex (aHR 1.15; 1.11 - 1.18) and a Charlson Comorbidity Index ≥3 (aHR 2.28; 2.20 - 2.37) were associated with an increased risk of readmission. Discharge diagnoses associated with increased risk of readmission were heart failure (aHR 1.26; 1.12 - 1.41), chronic obstructive pulmonary disease (aHR 1.33; 1.25 - 1.43), dehydration (aHR 1.28; 1.17 - 1.39), constipation (aHR 1.26; 1.14 - 1.39), anemia (aHR 1.45; 1.38 - 1.54), pneumonia (aHR 1.15; 1.06 - 1.25), urinary tract infection (aHR 1.15; 1.07 - 1.24), suspicion of malignancy (aHR 1.51; 1.37 - 1.66), fever (aHR 1.52; 1.33 - 1.73) and abdominal pain (aHR 1.12; 1.05 - 1.19). Conclusions One fifth of acutely admitted medical patients aged ≥65 were readmitted within 30 days after early discharge. Male gender, the burden of comorbidity and several primary discharge diagnoses were risk factors for readmission.
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Affiliation(s)
- M Klinge
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - M Aasbrenn
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C Suetta
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospitals, Copenhagen, Denmark.,CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - E Pressel
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - F E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. .,Department of Emergency Medicine, Slagelse Hospital, Bispebjerg and Frederiksberge, Denmark. .,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
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Landeiro F, Roberts K, Gray AM, Leal J. Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs. THE GERONTOLOGIST 2019; 59:e86-e97. [PMID: 28535285 DOI: 10.1093/geront/gnx028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To determine the prevalence of delayed discharges of elderly inpatients and associated costs. DESIGN AND METHODS We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP). RESULTS Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient. IMPLICATIONS Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Kenny Roberts
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Alastair Mcintosh Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
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24
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Coffey A, Leahy-Warren P, Savage E, Hegarty J, Cornally N, Day MR, Sahm L, O'Connor K, O'Doherty J, Liew A, Sezgin D, O'Caoimh R. Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2457. [PMID: 31295933 PMCID: PMC6678887 DOI: 10.3390/ijerph16142457] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/29/2019] [Accepted: 07/05/2019] [Indexed: 01/05/2023]
Abstract
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
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Affiliation(s)
- Alice Coffey
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick V94X5K6, Ireland.
| | - Patricia Leahy-Warren
- School of Nursing and Midwifery, University College Cork, Cork City T12AK54, Ireland
| | - Eileen Savage
- Nursing and Vice Dean of Graduate Studies and Inter Professional Learning, College of Medicine and Health, University College Cork, Cork City T12AK54, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork City T12AK54, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork City T12AK54, Ireland
| | - Mary Rose Day
- School of Nursing and Midwifery, University College Cork, Cork City T12AK54, Ireland
| | - Laura Sahm
- School of Pharmacy, University College Cork, Cork City T12T656, Ireland
| | - Kieran O'Connor
- Geriatric Medicine, Mercy University Hospital, Cork City T12WE28, Ireland
| | - Jane O'Doherty
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick V94X5K6, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland, and Portiuncula University Hospital, Ballinasloe Galway H53T971, Ireland
| | - Duygu Sezgin
- Clinical Sciences Institute, National University of Ireland, and Portiuncula University Hospital, Ballinasloe Galway H53T971, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway City, Mercy University Hospital, Grenville Place, Cork City T12WE28, Ireland
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25
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Everall AC, Guilcher SJT, Cadel L, Asif M, Li J, Kuluski K. Patient and caregiver experience with delayed discharge from a hospital setting: A scoping review. Health Expect 2019; 22:863-873. [PMID: 31099969 PMCID: PMC6803563 DOI: 10.1111/hex.12916] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Delayed hospital discharge occurs when patients are medically cleared but remain hospitalized because a suitable care setting is not available. Delayed discharge typically results in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital-related adverse events. Caregivers often take on an active role in hospital to mitigate these risks. OBJECTIVE This scoping review aimed to summarize the literature on patient and caregiver experiences with delayed hospital discharge. SEARCH STRATEGY Seven electronic databases and grey literature were searched using keywords including alternate level of care, delayed discharge, patients, caregivers and experiences. INCLUSION CRITERIA Included articles met the following criteria: (a) patient or caregiver population 18 years or older; (b) delayed discharge from a hospital setting; (c) included experiences with delayed discharge; (d) peer-reviewed or grey literature; and (e) published between 1 January 1998 and 16 July 2018. DATA EXTRACTION Data were extracted from the seven included articles using Microsoft Excel 2016 to facilitate a thorough analysis and comparison. MAIN RESULTS Study themes were grouped into five elements of the delayed discharge experience: (1) overall uncertainty; (2) impact of hospital staff and physical environment; (3) mental and physical deterioration; (4) lack of engagement in decision making and need for advocacy; and (5) initial disbelief sometimes followed by reluctant acceptance. CONCLUSION This review provides a foundation to guide future research, policies and practices to improve patient and caregiver experiences with delayed hospital discharge, including enhanced communication with patients and families and programmes to reduce deconditioning.
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Affiliation(s)
- Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Maliha Asif
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Li
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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26
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Levin KA, Crighton E. Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis. J Epidemiol Community Health 2019; 73:674-679. [PMID: 31005903 DOI: 10.1136/jech-2018-211628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed. METHODS Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality. RESULTS Prior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of -15.20 (95% CI -17.52 to -12.88) and a trend change of -0.29 (95% CI -0.55 to -0.02). This is equivalent to a predicted reduction due to IC of -16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%. CONCLUSION IC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.
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27
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Ambugo EA, Hagen TP. Effects of introducing a fee for inpatient overstays on the rate of death and readmissions across municipalities in Norway. Soc Sci Med 2019; 230:309-317. [PMID: 31027865 DOI: 10.1016/j.socscimed.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 02/19/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
The Norwegian healthcare coordination reform (Samhandlingsreformen) was implemented from January 1, 2012. In addition to providing municipalities with funding to strengthen their health infrastructure, it required municipalities to pay hospitals a daily fee for patients who, having been declared ready for discharge and in need of municipal health services, were not received by the municipalities on time. This study examines the effects of the reform on the rate of death and readmissions occurring within 60 days of hospitalization. We use aggregated municipal data for years 2009, 2010, 2012-2014 (N = 1646) for Norwegian patients (age 18+) hospitalized in the same years for COPD/asthma, heart failure, hip fracture, and stroke. We stratify our analyses of the municipal data by these patient groups. Our linear regression models test for moderated (interaction) effects whereby associations between the reform and the rate of death and readmissions vary by whether or not patients were classified as ready for discharge and in need of follow-up care in the municipality. The models adjust for municipal sociodemographic and health characteristics. We found no statistically significant moderated effects of the reform across the patient groups, except for patients with stroke (b = .027, SE = 0.109, p < .05). Specifically, compared to the pre-reform period (2009-2010), the post-reform period (2012-2014) was associated with a higher rate of readmissions at high predicted values of needing follow-up care. Even though our analyses of municipal data suggest that patients with stroke are vulnerable to the reform and its incentive scheme, there is no strong evidence overall to suggest that the Norwegian healthcare coordination reform is functioning in a manner that exacerbates the risk of death and readmissions.
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Affiliation(s)
- Eliva Atieno Ambugo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0318, Oslo, Norway.
| | - Terje P Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0318, Oslo, Norway
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28
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Ogink PT, Karhade AV, Thio QCBS, Gormley WB, Oner FC, Verlaan JJ, Schwab JH. Predicting discharge placement after elective surgery for lumbar spinal stenosis using machine learning methods. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1433-1440. [PMID: 30941521 DOI: 10.1007/s00586-019-05928-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE An excessive amount of total hospitalization is caused by delays due to patients waiting to be placed in a rehabilitation facility or skilled nursing facility (RF/SNF). An accurate preoperative prediction of who would need a RF/SNF place after surgery could reduce costs and allow more efficient organizational planning. We aimed to develop a machine learning algorithm that predicts non-home discharge after elective surgery for lumbar spinal stenosis. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program to select patient that underwent elective surgery for lumbar spinal stenosis between 2009 and 2016. The primary outcome measure for the algorithm was non-home discharge. Four machine learning algorithms were developed to predict non-home discharge. Performance of the algorithms was measured with discrimination, calibration, and an overall performance score. RESULTS We included 28,600 patients with a median age of 67 (interquartile range 58-74). The non-home discharge rate was 18.2%. Our final model consisted of the following variables: age, sex, body mass index, diabetes, functional status, ASA class, level, fusion, preoperative hematocrit, and preoperative serum creatinine. The neural network was the best model based on discrimination (c-statistic = 0.751), calibration (slope = 0.933; intercept = 0.037), and overall performance (Brier score = 0.131). CONCLUSIONS A machine learning algorithm is able to predict discharge placement after surgery for lumbar spinal stenosis with both good discrimination and calibration. Implementing this type of algorithm in clinical practice could avert risks associated with delayed discharge and lower costs. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Paul T Ogink
- UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Aditya V Karhade
- Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Quirina C B S Thio
- Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA
| | - Fetullah C Oner
- UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jorrit J Verlaan
- UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joseph H Schwab
- Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
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29
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Dewilde S, Annemans L, Peeters A, Hemelsoet D, Vandermeeren Y, Desfontaines P, Brouns R, Vanhooren G, Cras P, Michielsens B, Redondo P, Thijs V. The relationship between Home-time, quality of life and costs after ischemic stroke: the impact of the need for mobility aids, home and car modifications on Home-time. Disabil Rehabil 2018; 42:419-425. [DOI: 10.1080/09638288.2018.1501438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sarah Dewilde
- Department of Public Health, University of Ghent, Ghent, Belgium
- Services in Health Economics (SHE), Brussels, Belgium
| | - Lieven Annemans
- Interuniversity Centre for Health Economics Research, University of Ghent, VUB, Belgium
| | - Andre Peeters
- Department of Neurology Universitaires Saint Luc, Brussels, Belgium
| | | | | | | | - Raf Brouns
- ZorgSaam Hospital, Terneuzen, The Netherlands
| | | | - Patrick Cras
- Born Bunge Institute, University Hospital, Antwerp, Belgium
| | | | | | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne and Austin Health, Victoria, Australia
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30
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Cornes MP, Danks G, Elgaddal S, Jawad M, Tonks J, Ries E, Ford C, Gama R. Early availability of laboratory results increases same day ward discharge rates. ACTA ACUST UNITED AC 2018; 56:1864-1869. [DOI: 10.1515/cclm-2018-0261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Delayed discharge reduces hospital efficiency and inconveniences patients. Most hospitals discharge in the afternoon, whereas the most common admission time is mid-morning. Consequently, new patients wait for the beds of patients who are fit to be discharged. Earlier discharge may, therefore, improve patient flow. We investigated the impact of early phlebotomy with early availability of laboratory results on patient discharge rates and discharge time.
Methods:
Discharge rates, discharge time and sample turnaround time were assessed before (1 October 2014 to 31 December 2014) and after (1 October 2015 to 31 December 2015) introduction of earlier phlebotomy with availability of laboratory results prior to the ward rounds on two surgical wards.
Results:
Following the intervention, over 95% of results were available before 8:30 am in 2015 as compared to less than 1% in 2014. Specimen turnaround times were similar in both study periods. Even after adjustment for age, gender, admission type and length of admission, the same day discharge rate was higher in 2015 compared to 2014 (60% vs. 52%; p<0.002), but time of discharge was unchanged.
Conclusions:
Early availability of blood results prior to ward rounds increased ward discharges but did not affect discharge time.
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Affiliation(s)
- Michael P. Cornes
- Department of Clinical Biochemistry , Worcestershire Acute Hospitals NHS Trust , Worcestershire , United Kingdom of Great Britain and Northern Ireland , Phone: +01905 760843
| | - Graham Danks
- Department of Blood Sciences , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
| | - Sanna Elgaddal
- Surgical Wards , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London , Hammersmith, London , United Kingdom of Great Britain and Northern Ireland
| | - Jayne Tonks
- Surgical Wards , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
| | - Elisabeth Ries
- Information Department , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
| | - Clare Ford
- Department of Blood Sciences , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
| | - Rousseau Gama
- Department of Blood Sciences , The Royal Wolverhampton NHS Trust , Wolverhampton , United Kingdom of Great Britain and Northern Ireland
- Research Institute, Healthcare Sciences , Wolverhampton University , Wolverhampton, West Midlands , United Kingdom of Great Britain and Northern Ireland
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31
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Qin S, Thompson C, Bogomolov T, Ward D, Hakendorf P. Hospital occupancy and discharge strategies: a simulation-based study. Intern Med J 2018; 47:894-899. [PMID: 28485885 DOI: 10.1111/imj.13485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing demand for hospital services has resulted in more arrivals to emergency department (ED), increased admissions, and, quite often, access block and ED congestion, along with patients' dissatisfaction. Cost constraints limit an increase in the number of hospital beds, so alternative solutions need to be explored. AIMS To propose and test different discharge strategies, which, potentially, could reduce occupancy rates in the hospital, thereby improving patient flow and minimising frequency and duration of congestion episodes. METHODS We used a simulation approach using HESMAD (Hospital Event Simulation Model: Arrivals to Discharge) - a sophisticated simulation model capturing patient flow through a large Australian hospital from arrival at ED to discharge. A set of simulation experiments with a range of proposed discharge strategies was carried out. The results were tabulated, analysed and compared using common hospital occupancy indicators. RESULTS Simulation results demonstrated that it is possible to reduce significantly the number of days when a hospital runs above its base bed capacity. In our case study, this reduction was from 281.5 to 22.8 days in the best scenario, and reductions within the above range under other scenarios considered. CONCLUSION Some relatively simple strategies, such as 24-h discharge or discharge/relocation of long-staying patients, can significantly reduce overcrowding and improve hospital occupancy rates. Shortening administrative and/or some treatment processes have a smaller effect, although the latter could be easier to implement.
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Affiliation(s)
- Shaowen Qin
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia
| | - Campbell Thompson
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Tim Bogomolov
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia
| | - Dale Ward
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
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32
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Moore G, Hartley P, Romero-Ortuno R. Health and social factors associated with a delayed discharge amongst inpatients in acute geriatric wards: A retrospective observational study. Geriatr Gerontol Int 2017; 18:530-537. [PMID: 29230961 DOI: 10.1111/ggi.13212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 01/24/2023]
Abstract
AIM In the English National Health Service there is an increasing interest in understanding the factors associated with delayed discharges in older hospitalized adults. The present study sought to analyze whether clinical frailty was a significant and independent risk factor for having a delayed discharge when the data were controlled for potential health and social confounders. METHODS This was a retrospective observational study in an English National Health Service teaching hospital. We analyzed all first hospitalization episodes to the Department of Medicine for the Elderly between 1 May 2016 and 31 July 2016. A delayed discharge was operationally defined as a patient being discharged more than 24 h after his/her last recorded clinically fit date. RESULTS A total of 924 cases were analyzed. The independent risk factors for having a delayed discharge were: needing a new package of care (OR 4.05, 95% CI 2.68-6.10), new institutionalization (OR 2.78, 95% CI:1.67-4.62), living alone (OR 1.98, 95% CI 1.40-2.81), delirium (OR 1.79, 95% CI 1.17-2.74) and frailty (i.e. ≥5 on the Clinical Frailty Scale, OR 1.74, 95% CI 1.15-2.63). CONCLUSIONS The present results are consistent with previous reports that delayed discharges in older hospitalized patients are mainly related to new formal social care requirements in survivors of acute illness. Frailty was an independent risk factor for delay, but its effect might have been confounded by the unmeasured variable of informal care requirements. Our operational definition of delayed discharge does not mirror the legal definition of delayed transfer of care in England, and the results are not externally valid. Geriatr Gerontol Int 2018; 18: 530-537.
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Affiliation(s)
- George Moore
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Hartley
- Department of Physiotherapy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Shaw JA, Kontos P, Martin W, Victor C. The institutional logic of integrated care: an ethnography of patient transitions. J Health Organ Manag 2017; 31:82-95. [PMID: 28260413 DOI: 10.1108/jhom-06-2016-0123] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/methodology/approach The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community "hub" meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/value This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the "spread" of logics between macro-, meso-, and micro-level influences on inter-organizational change.
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Affiliation(s)
- James A Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network , Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Wendy Martin
- College of Health and Life Sciences, Brunel University , London, UK
| | - Christina Victor
- College of Health and Life Sciences, Brunel University , London, UK
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34
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Babu SC, Menon G, Vasu BK, George M, Thilak J, Iyer S. Postoperative Ultrasound Guided Continuous Femoral Nerve Blockade for Unilateral Total Knee Arthroplasty: A Comparison of 0.125% Bupivacaine and 0.2% Ropivacaine. Anesth Essays Res 2017; 11:1026-1029. [PMID: 29284869 PMCID: PMC5735444 DOI: 10.4103/aer.aer_155_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. AIMS The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. SETTINGS AND DESIGN One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. SUBJECTS AND METHODS Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. STATISTICAL ANALYSIS Student's t-test and Chi-square test were applied. RESULTS There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. CONCLUSION Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.
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Affiliation(s)
- Sruthi C. Babu
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
| | - Gokuldas Menon
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
| | - Bindu K. Vasu
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
| | - Mathew George
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
| | - Jai Thilak
- Department of Orthopaedics, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
| | - Sundaram Iyer
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
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Rojas-García A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R. Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expect 2017; 21:41-56. [PMID: 28898930 PMCID: PMC5750749 DOI: 10.1111/hex.12619] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background The impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized. Aim To systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs. Methods Four of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included. Results Thirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients. Conclusions The poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.
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Affiliation(s)
- Antonio Rojas-García
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Simon Turner
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Elena Pizzo
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Emma Hudson
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - James Thomas
- Institute of Education EPPI-Centre, University College London, London, UK
| | - Rosalind Raine
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
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Salonga-Reyes A, Scott IA. Stranded: causes and effects of discharge delays involving non-acute in-patients requiring maintenance care in a tertiary hospital general medicine service. AUST HEALTH REV 2017; 41:54-62. [DOI: 10.1071/ah15204] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
Objectives
The aims of the present study were to identify causes of prolonged discharge delays among non-acute in-patients admitted to a tertiary general medicine service, quantify occupied bed days (OBDs) and propose strategies for eliminating avoidable delays.
Methods
A retrospective study was performed of patients admitted between 1 January 2012 and 31 May 2015 and discharged as non-acute cases requiring maintenance care and who incurred a total non-acute length of stay (LOS) >7 days and total hospital LOS >14 days. Long-stay patients with non-acute LOS ≥28 days were subject to chart review in ascertaining serial causes of discharge delay and their attributable OBDs. Literature reviews and staff feedback identified potential strategies for minimising delays.
Results
Of the 406 patients included in the present study, 131 incurred long-stays; for these 131 patients, delays were identified that accounted for 5420 of 6033 (90%) non-acute OBDs. Lack of available residential care beds was most frequent, accounting for 44% of OBDs. Waits for outcomes of guardianship applications accounted for 13%, whereas guardian appointments, Public Trustee applications and funding decisions for equipment or care packages each consumed between 4% and 5% of OBDs. Family and/or carer refusal of care accounted for 7%. Waits for aged care assessment team (ACAT) assessments, social worker reports, geriatrician or psychiatrist reviews and confirmation of enduring power of attorney each accounted for between 1% and 3% of OBDs. Of 30 proposed remedial strategies, those rated as high priority were: greater access to interim care or respite care beds or supported accommodation, especially for patients with special needs; dedicated agency officers for hospital guardianship applications and greater interagency collaboration and harmonisation of assessment and decision processes; and formal requests from hospital administrators to patients and family to accept care options and attend mediation meetings.
Conclusions
Delayed discharge of non-acute maintenance care patients results principally from impaired access to residential care, administrative delays involving external agencies and patient or family refusal of care. Proposed remedial actions require concerted interjurisdictional advocacy.
What is known about this topic?
Delays in discharge of non-acute patients requiring maintenance care can occur for many reasons and incur inordinately long hospital stays.
What does this paper add?
The present detailed chart review of 131 long-stay non-acute patients identified causes of serial discharge delays and quantified their prevalence and attributable bed days. Waits for residential care accounted for less than half the bed days, administrative delays involving decisions by agencies external to the hospital accounted for one-quarter and patient or family refusal of care options accounted for one-tenth. Strategies are proposed that may minimise these delays.
What are the implications for practitioners?
Delayed discharge of non-acute patients requiring maintenance care threatens to consume an ever-increasing proportion of acute hospital bed days. Remedial action is required from stakeholders both within and outside hospitals to reverse this trend.
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Tracking Discharge Delays: Critical First Step Toward Mitigating Process Breakdowns and Inefficiencies. J Nurs Care Qual 2016; 31:17-23. [PMID: 26166435 DOI: 10.1097/ncq.0000000000000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reports on the development and evaluation of a mechanism designed for real-time tracking of discharge delays by bedside clinicians and the reporting of delays in a manner amenable to action. During the implementation phase, delay time totaled 23.6 days for 114 patients affected by a delay. More than one-half of delays (61.4%) occurred for patients whose discharge disposition was home to self-care.
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Moran V, Jacobs R, Mason A. Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:188-200. [PMID: 26749002 DOI: 10.1007/s10488-015-0711-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
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Affiliation(s)
- Valerie Moran
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rowena Jacobs
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Anne Mason
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
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Briggs R, Coary R, Collins R, Coughlan T, O'Neill D, Kennelly SP. Acute hospital care: how much activity is attributable to caring for patients with dementia? QJM 2016; 109:41-4. [PMID: 25956392 DOI: 10.1093/qjmed/hcv085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with dementia are among the most frequent service users in the acute hospital. Despite this, the acute hospital is not organized in a manner that best addresses their needs. METHODS We examined acute dementia care over a 3-year period from 2010 to 2012 in a 600-bed university hospital, to clarify the service activity and costs attributable to acute dementia care. RESULTS Nine hundred and twenty-nine patients with dementia were admitted during the study period, accounting for 1433/69 718 (2%) of all inpatient episodes, comprising 44 449/454 169 (10%) of total bed days. The average length of stay was 31.0 days in the dementia group and 14.1 days in those >65 years without dementia. The average hospital care cost was almost three times more (€13 832) per patient with dementia, compared with (€5404) non-dementia patients, accounting for 5% (almost €20 000 000) of the total hospital casemix budget for the period. DISCUSSION Service activity attributable to dementia care in the acute hospital is considerable. Moreover, given the fact that a significant minority of cognitive impairment goes unrecognized after acute admissions, it is likely that this is under-representative of the full impact of dementia in acute care. Although the money currently being spent on acute dementia care is considerable, it is being used to provide a service that does not meet its user needs adequately. It is clear that acute hospitals need to provide a more 'dementia friendly' service for acutely unwell older persons.
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Affiliation(s)
- R Briggs
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and
| | - R Coary
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and
| | - R Collins
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - T Coughlan
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - D O'Neill
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - S P Kennelly
- From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland and Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Probasco JC, Hawley G, Burnett M, Gibson L, Carter K, Harlow E, Russell H, Huffman L, Adams J, Ziegler T, Sporney H, Levy M, Puttgen HA. Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone: A Quality Improvement Project. Neurohospitalist 2015; 5:197-204. [PMID: 26425247 DOI: 10.1177/1941874415576206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone. METHODS We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment. The order set allowed providers to enter an accelerated dosing schedule of methylprednisolone, as appropriate, to ensure administration of the final dose of methylprednisolone in the morning on the anticipated day of discharge. We compared a prospective intervention cohort to a retrospective, preintervention baseline cohort. RESULTS At baseline (N = 25), 12.0% of patients were EIDD compared to 40.7% of intervention patients (N = 27; P = .03). In all, 85.2% of intervention patients compared to 64.0% of baseline patients were discharged on the same day as last methylprednisolone treatment (P = .11). No difference was observed in median length of stay and 30-day readmission rate between groups. CONCLUSIONS Use of a standard admission order set as well as provider and patient checklists can facilitate EIDD and hospital bed availability without compromising care quality for a select group of neurology inpatients.
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Affiliation(s)
- John C Probasco
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gina Hawley
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Margie Burnett
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lorrie Gibson
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kathryn Carter
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth Harlow
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Holly Russell
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Linda Huffman
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jane Adams
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Terry Ziegler
- Department of Medicine and Surgery Social Work, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hilary Sporney
- Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hans A Puttgen
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
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Goldman J, Reeves S, Wu R, Silver I, MacMillan K, Kitto S. Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation. J Gen Intern Med 2015; 30:1454-60. [PMID: 25869018 PMCID: PMC4579221 DOI: 10.1007/s11606-015-3306-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/24/2014] [Accepted: 03/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions. OBJECTIVE To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups. DESIGN A qualitative ethnographic approach using observations, interviews and documentary analysis. PARTICIPANTS AND SETTING Healthcare professionals working in a GIM unit in Canada. APPROACH Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data. KEY RESULTS The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness. CONCLUSIONS This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.
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Affiliation(s)
- Joanne Goldman
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Wilson Centre, University Health Network, Toronto, ON, Canada.
| | - Scott Reeves
- Center for Health & Social Care Research, Faculty of Health, Social Care & Education, Kingston University & St George's, University of London, London, UK
| | - Robert Wu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ivan Silver
- Centre for Addiction and Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Simon Kitto
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Busby J, Purdy S, Hollingworth W. A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. BMC Health Serv Res 2015; 15:324. [PMID: 26268576 PMCID: PMC4535775 DOI: 10.1186/s12913-015-0964-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/16/2015] [Indexed: 12/03/2022] Open
Abstract
Background Unplanned hospital admissions place a large and increasing strain on healthcare budgets worldwide. Many admissions for ambulatory care sensitive conditions (ACSCs) are thought to be preventable, a belief supported by significant geographic variations in admission rates. We conducted a systematic review of the evidence on the magnitude and correlates of geographic variation in ACSC admission rates and length of stay (LOS). Methods We performed a search of Medline and Embase databases for English language cross-sectional and cohort studies on 28th March 2013 reporting geographic variation in admission rates or LOS for patients receiving unplanned care across at least 10 geographical units for one of 35 previously defined ACSCs. Forward and backward citation searches were undertaken on all included studies. We provide a narrative synthesis of study findings. Study quality was assessed using a modified Newcastle-Ottawa scale. Results We included 39 studies comprising 25 on admission rates and 14 on LOS. Studies generally compared admission rates between regions (e.g. states) and LOS between hospitals. Most of the published research was undertaken in the US, UK or Canada and often focussed on patients with pneumonia, COPD or heart failure. 35 (90 %) studies concluded that geographic variation was present. Primary care quality and secondary care access were frequently suggested as drivers of admission rate variation whilst secondary care quality and adherence to clinical guidelines were often listed as contributors to LOS variation. Several different methods were used to quantify variation, some studies listed raw data, failed to control for confounders and used naive statistical methods which limited their utility. Conclusions The substantial geographical variations in the admission rates and LOS of potentially avoidable conditions could be a symptom of variable quality of care and should be a concern for clinicians and policymakers. Policymakers targeting a reduction in unplanned admissions could introduce initiatives to improve primary care access and quality or develop alternatives to admission. Those attempting to curb unnecessarily long LOS could introduce care pathways or guidelines. Methodological work on the quantification and reporting of geographic variation is needed to aid inter-study comparisons. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0964-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John Busby
- School of Social and Community Medicine, University of Bristol, Room 2.07, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sarah Purdy
- Professor of Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- Professor of Health Economics, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Stevens AK, Raphael H, Green SM. A qualitative study of older people with minimal care needs experiences of their admission to a nursing home with Registered Nurse care. QUALITY IN AGEING AND OLDER ADULTS 2015. [DOI: 10.1108/qaoa-09-2014-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care.
Design/methodology/approach
– A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development.
Findings
– Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident.
Research limitations/implications
– The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making.
Practical implications
– Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met.
Originality/value
– This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.
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Dahl U, Johnsen R, Sætre R, Steinsbekk A. The influence of an intermediate care hospital on health care utilization among elderly patients--a retrospective comparative cohort study. BMC Health Serv Res 2015; 15:48. [PMID: 25638151 PMCID: PMC4323014 DOI: 10.1186/s12913-015-0708-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/19/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND An intermediate care hospital (ICH) was established in a municipality in Central Norway in 2007 to improve the coordination of services and follow-up among elderly and chronically ill patients after hospital discharge. The aim of this study was to compare health care utilization by elderly patients in a municipality with an ICH to that of elderly patients in a municipality without an ICH. METHODS This study was a retrospective comparative cohort study of all hospitalized patients aged 60 years or older in two municipalities. The data were collected from the national register of hospital use from 2005 to 2012, and from the local general hospital and two primary health care service providers from 2008 to 2012 (approx. 1,250 patients per follow-up year). The data were analyzed using descriptive statistics and analysis of covariance (ANCOVA). RESULTS The length of hospital stay decreased from the time the ICH was introduced and remained between 10% and 22% lower than the length of hospital stay in the comparative municipality for the next five years. No differences in the number of readmissions or admissions during one year follow-up after the index stay at the local general hospital or changes in primary health care utilization were observed. In the year after hospital discharge, the municipality with an ICH offered more hour-based care to elderly patients living at home (estimated mean = 234 [95% CI 215-252] versus 175 [95% CI 154-196] hours per person and year), while the comparative municipality had a higher utilization of long-term stays in nursing homes (estimated mean = 33.3 [95% CI 29.0-37.7] versus 21.9 [95% CI 18.0-25.7] days per person and year). CONCLUSIONS This study indicates that the introduction of an ICH rapidly reduces the length of hospital stay without exposing patients to an increased health risk. The ICH appears to operate as an extension of the general hospital, with only a minor impact on the pattern of primary health care utilization.
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Affiliation(s)
- Unni Dahl
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
- Central Norway Health Authority, 7500, Stjørdal, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Rune Sætre
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
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Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry 2014; 29:160-8. [PMID: 23661304 DOI: 10.1002/gps.3983] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/09/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS). METHODS Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. RESULTS Data on two related measures--delayed discharge and LOS--were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge. CONCLUSION Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required.
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Affiliation(s)
- David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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Baillie L, Gallini A, Corser R, Elworthy G, Scotcher A, Barrand A. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study. Int J Integr Care 2014; 14:e009. [PMID: 24868193 PMCID: PMC4027893 DOI: 10.5334/ijic.1175] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. THEORY AND METHODS The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. FINDINGS THREE THEMES ARE PRESENTED: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. DISCUSSION AND CONCLUSIONS A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust.
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Affiliation(s)
- Lesley Baillie
- Faculty of Health and Social Care, Florence Nightingale Foundation Chair of Clinical Nursing Practice, London South Bank University and University College London Hospitals, London, UK
| | - Andrew Gallini
- Nursing for the Hospital of St John & St Elizabeth, London, UK
| | | | - Gina Elworthy
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
| | - Ann Scotcher
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
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Peden CJ, Grocott MPW. National Research Strategies: what outcomes are important in peri-operative elderly care? Anaesthesia 2013; 69 Suppl 1:61-9. [DOI: 10.1111/anae.12491] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 12/19/2022]
Affiliation(s)
- C. J. Peden
- Royal United Hospital; NHS Trust; Bath UK
- NIAA Health Services Research Centre; Royal College of Anaesthetists; London UK
| | - M. P. W. Grocott
- NIAA Health Services Research Centre; Royal College of Anaesthetists; London UK
- Integrative Physiology and Critical Illness Group; Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- Anaesthesia and Critical Care Research Unit; University Hospital Southampton; NHS Foundation Trust; Southampton UK
- NIHR Southampton Respiratory Biomedical Research Unit; Southampton UK
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Between two beds: inappropriately delayed discharges from hospitals. INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE AND ECONOMICS 2013; 13:201-17. [PMID: 24122364 DOI: 10.1007/s10754-013-9135-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
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MacPhail A, McDonough M, Ibrahim JE. Delayed discharge in alcohol-related dementia: consequences and possibilities for improvement. AUST HEALTH REV 2013; 37:482-7. [PMID: 23849991 DOI: 10.1071/ah13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/07/2013] [Indexed: 11/23/2022]
Abstract
Individuals with alcohol-related dementia (ARD) are over-represented among 'difficult to discharge' patients. ARD is associated with prolonged hospital stay and high rates of discharge at own risk. Risk factors for delayed discharge in patients with ARD include: a lack of appropriate medical and social support; multiple and complex needs; psychiatric symptoms; challenging behaviours; and an unmet need for appropriate residential care. Integration into present services is problematic and aged care is not an acceptable option for these patients. The present paper identifies three key possibilities to reduce the burden of prolonged hospitalisation of patients with ARD. These are: improved availability of specialised, multidisciplinary care pathways for patients with ARD, many of which could be developed out of existing services; the development of flexible supported-accommodation options, including harm minimisation, for the subset of patients who are not able to live independently; and improved practice in the emergency department (ED) to ensure timely administration of parenteral thiamine to all patients at risk of developing ARD.
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Affiliation(s)
- Aleece MacPhail
- Ballarat Health Services, 102 Ascot Street South, Ballarat, Vic. 3350, Australia
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Retraso del alta hospitalaria por motivos no médicos. Rev Clin Esp 2012; 212:229-34. [DOI: 10.1016/j.rce.2011.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/19/2011] [Indexed: 11/21/2022]
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