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Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7171. [PMID: 38131722 PMCID: PMC11080941 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
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Edwards N, Black S. Targets: unintended and unanticipated effects. BMJ Qual Saf 2023; 32:697-699. [PMID: 37669875 DOI: 10.1136/bmjqs-2023-016247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 09/07/2023]
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Thompkins S, Schaefer S, Toh D, Horwood C, Thompson CH. Outlier or handover: outcomes for General Medicine inpatients. AUST HEALTH REV 2023; 47:602-606. [PMID: 37640381 DOI: 10.1071/ah22242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Objective Patients admitted from the emergency department may be co-located on the treating team's 'home ward'. If no bed is available, patients may be sent to another ward, where they may remain under the admitting team as an 'outlier'. Conversely, care may be handed over to the team on whose home ward they are located. We conducted a retrospective analysis to understand the impact of outlier status and handovers of care on outcomes for General Medicine inpatients. Methods General Medicine admissions at the Royal Adelaide Hospital between September 2020 and November 2021 were analysed. We examined the rate of hospital-acquired complications, inpatient mortality rate, mortality within 48 h of admission, Relative Stay Index, time of discharge from hospital and rate of adverse events within 28 days of discharge. Results A total of 3109 admissions were analysed. Handovers within 24 h of admission were associated with a longer length of stay. There was a trend towards higher rates of adverse events within 28 days of discharge with handovers of care. Outlier status did not affect any outcome measures. Conclusions Handovers within the first 24 h of admission are associated with longer than expected length of stay.
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Affiliation(s)
- S Thompkins
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - S Schaefer
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - D Toh
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - C Horwood
- Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - C H Thompson
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Rowberry R, Mortimore G. Septic pulmonary emboli: a case discussion. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:832-838. [PMID: 37737857 DOI: 10.12968/bjon.2023.32.17.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.
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Affiliation(s)
- Rowena Rowberry
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
| | - Gerri Mortimore
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
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Mendelsohn E, Honeyford K, Brittin A, Mercuri L, Klaber RE, Expert P, Costelloe C. The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study. Sci Rep 2023; 13:15417. [PMID: 37723183 PMCID: PMC10507077 DOI: 10.1038/s41598-023-41966-w] [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: 01/18/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories. Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of 'regular transfers' between pairs of wards with shared specialities, 'atypical transfers' between pairs of wards with no shared specialities and 'site transfers' between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three in-depth interviews with site nurse practitioners and bed managers within the same hospital network. We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95% CI 2.56-3.12), compared to regular transfers, 1.92 days (95% CI 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents. Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
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Affiliation(s)
| | | | | | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Robert Edward Klaber
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Academic Centre for Paediatrics and Child Health, Imperial College London, London, UK
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Schwartz L, Rosenshtok O, Shalev L, Schneider E, Basok A, Vorobiov M, Romanjuk E, Rogachev B, El-Sayed I, Schwartz L, Menashe I, Regev O, Haviv YS. Admission of kidney patients to a closed staff nephrology department results in a better short-term survival. PLoS One 2023; 18:e0279172. [PMID: 36881606 PMCID: PMC9990939 DOI: 10.1371/journal.pone.0279172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/01/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The outcome of patients with chronic kidney disease (CKD) and acute kidney injury (AKI) is often dismal and measures to ameliorate their course are scarce. When admitted to the hospital, kidney patients are often hospitalized in general Medicine wards rather than in a specialized Nephrology department. In the current study, we compared the outcome of two cohorts of kidney patients (CKD and AKI) admitted either to general open-staff (with rotating physicians) Medicine wards or to a closed-staff (non-rotating Nephrologists) Nephrology ward. METHODS In this population-based retrospective cohort study, we enrolled 352 CKD patients and 382 AKI patients admitted to either Nephrology or General Medicine wards. Short-term (< = 90 days) and long-term (>90 days) outcomes were recorded for survival, renal outcomes, cardiovascular outcomes, and dialysis complications. Multivariate analysis was performed using logistic regression and negative binomial regression adjusting to potential sociodemographic confounders as well as to a propensity score based on the association of all medical background variables to the admitted ward, to mitigate the potential admittance bias to each ward. RESULTS One hundred and seventy-one CKD patients (48.6%) were admitted to the Nephrology ward and 181 (51.4%) were admitted to general Medicine wards. For AKI, 180 (47.1%) and 202 (52.9%) were admitted to Nephrology and general Medicine wards, respectively. Baseline age, comorbidities and the degree of renal dysfunction differed between the groups. Using propensity score analysis, a significantly reduced mortality rate was observed for kidney patients admitted to the Nephrology ward vs. general Medicine in short term mortality (but not long-term mortality) among both CKD patients admitted (OR = 0.28, CI = 0.14-0.58, p = 0.001), and AKI patients (or = 0.25, CI = 0.12-0.48, p< 0.001). Nephrology ward admission resulted in higher rates of renal replacement therapy (RRT), both during the first hospitalization and thereafter. CONCLUSIONS Thus, a simple measure of admission to a specialized Nephrology department may improve kidney patient outcome, thereby potentially affecting future health care planning.
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Affiliation(s)
- Lihi Schwartz
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Omer Rosenshtok
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Leah Shalev
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Schneider
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Basok
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Marina Vorobiov
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elvira Romanjuk
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Rogachev
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ismail El-Sayed
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lina Schwartz
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Menashe
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Ohad Regev
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Yosef S. Haviv
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel
- The Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
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Lilley D, Munthali P. Analysis of the management of ventriculitis cases at a UK neurosurgery centre. Infect Prev Pract 2022; 4:100240. [PMID: 36060478 PMCID: PMC9437802 DOI: 10.1016/j.infpip.2022.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
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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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Affiliation(s)
| | - Stevan Bruijns
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
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10
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Gómez-Palomo JM, Martínez-Crespo A, Víquez-da Silva R, Del Llano-Señarís JE, Zamora-Navas P. [Influence of medical outliers in patients with femoral neck fracture]. J Healthc Qual Res 2022; 37:390-396. [PMID: 35654723 DOI: 10.1016/j.jhqr.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.
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Affiliation(s)
- J M Gómez-Palomo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - A Martínez-Crespo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital de Montilla, Montilla, Córdoba, España
| | - R Víquez-da Silva
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - J E Del Llano-Señarís
- Fundación Gaspar Casal, Madrid, España; Universidad Pompeu Fabra (UPF), Barcelona, España
| | - P Zamora-Navas
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España; Universidad de Málaga (UMA), Málaga, España
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King Z, Farrington J, Utley M, Kung E, Elkhodair S, Harris S, Sekula R, Gillham J, Li K, Crowe S. Machine learning for real-time aggregated prediction of hospital admission for emergency patients. NPJ Digit Med 2022; 5:104. [PMID: 35882903 PMCID: PMC9321296 DOI: 10.1038/s41746-022-00649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/04/2022] [Indexed: 12/23/2022] Open
Abstract
Machine learning for hospital operations is under-studied. We present a prediction pipeline that uses live electronic health-records for patients in a UK teaching hospital’s emergency department (ED) to generate short-term, probabilistic forecasts of emergency admissions. A set of XGBoost classifiers applied to 109,465 ED visits yielded AUROCs from 0.82 to 0.90 depending on elapsed visit-time at the point of prediction. Patient-level probabilities of admission were aggregated to forecast the number of admissions among current ED patients and, incorporating patients yet to arrive, total emergency admissions within specified time-windows. The pipeline gave a mean absolute error (MAE) of 4.0 admissions (mean percentage error of 17%) versus 6.5 (32%) for a benchmark metric. Models developed with 104,504 later visits during the Covid-19 pandemic gave AUROCs of 0.68–0.90 and MAE of 4.2 (30%) versus a 4.9 (33%) benchmark. We discuss how we surmounted challenges of designing and implementing models for real-time use, including temporal framing, data preparation, and changing operational conditions.
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Affiliation(s)
- Zella King
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, UK. .,Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Joseph Farrington
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Martin Utley
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, UK
| | - Enoch Kung
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, UK
| | - Samer Elkhodair
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Steve Harris
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Richard Sekula
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Jonathan Gillham
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Kezhi Li
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London, WC1H 0BT, UK
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Albsoul RA, FitzGerald G, Alshyyab MA. Missed nursing care: a snapshot case study in a medical ward in Australia. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:710-716. [PMID: 35797073 DOI: 10.12968/bjon.2022.31.13.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed. AIM To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia. METHOD This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital. RESULTS The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences. CONCLUSION Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.
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Affiliation(s)
- Rania Ali Albsoul
- Assistant Professor in Healthcare Management, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Gerard FitzGerald
- Professor in Public Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Muhammad Ahmed Alshyyab
- Assistant Professor in Health Services Management, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Stylianou N, Young J, Peden CJ, Vasilakis C. Developing and validating a predictive model for future emergency hospital admissions. Health Informatics J 2022; 28:14604582221101538. [PMID: 35593747 DOI: 10.1177/14604582221101538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although many emergency hospital admissions may be unavoidable, a proportion of these admissions represent a failure of the care system. The adverse consequences of avoidable emergency hospital admissions affect patients, carers, care systems and substantially increase care costs. The aim of this study was to develop and validate a risk prediction model to estimate the individual probability of emergency admission in the next 12 months within a regional population. We deterministically linked routinely collected data from secondary care with population level data, resulting in a comprehensive research dataset of 190,466 individuals. The resulting risk prediction tool is based on a logistic regression model with five independent variables. The model indicated a discrimination of area under the receiver operating characteristic curve of 0.9384 (95% CI 0.9325-0.9443). We also experimented with different probability cut-off points for identifying high risk patients and found the model's overall prediction accuracy to be over 95% throughout. In summary, the internally validated model we developed can predict with high accuracy the individual risk of emergency admission to hospital within the next year. Its relative simplicity makes it easily implementable within a decision support tool to assist with the management of individual patients in the community.
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Affiliation(s)
- Neophytos Stylianou
- Centre for Health care Innovation and Improvement (CHI), School of Management, 1555University of Bath, Bath, UK; 112443RTD-Talos, Lefkosia, Cyprus
| | - Jason Young
- Bath and North East Somerset, Swindon & Wiltshire NHS Clinical Commissioning Group, Bath, UK
| | - Carol J Peden
- Gehr Family Center for Health System Sciences and Innovation, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Christos Vasilakis
- Centre for Health Care Innovation and Improvement (CHI), School of Management, 1555University of Bath, Bath, UK
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Asheim A, Nilsen SM, Aam S, Anthun KS, Carlsen F, Janszky I, Vatten LJ, Bjørngaard JH. High ward occupancy, bedspacing, and 60 day mortality for patients with myocardial infarction, stroke, and heart failure. ESC Heart Fail 2022; 9:1884-1890. [PMID: 35345059 PMCID: PMC9065853 DOI: 10.1002/ehf2.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Aims To study the consequences of crowded wards among patients with cardiovascular disease. Methods and results This is a cohort study among 201 801 patients with 258 807 admissions who were acutely admitted for myocardial infarction (N = 107 895), stroke (N = 87 336), or heart failure (N = 63 576) to any Norwegian hospital between 2008 and 2016. The ward admitting most patients with the given clinical condition was considered a patient's home ward. We compared patients with the same condition admitted when home ward occupancy was different, at the same hospital and during comparable time periods. Occupancy was standardized such that a one‐unit difference corresponded to the interquartile range in occupancy in the given month. One interquartile increase in home ward occupancy was associated with 7% higher odds of admission to an alternate ward [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.09 to 1.11], and length of stay was shorter (−0.10 days, 95% CI −0.18 to −0.09). Patients with heart failure had 15% higher odds of admission to alternate wards (OR 1.15, 95% CI 1.08 to 1.23) and increased mortality [hazard ratio (HR) 1.08, 95% CI 1.03 to 1.15]. We found no apparent effect on mortality for patients with myocardial infarction (HR 0.99, 95% CI 0.94 to 1.05) or stroke (HR 1.00, 95% CI 0.96 to 1.05). Conclusions Patients with heart failure had higher risk of admission to alternate wards when home ward occupancy was high. These patients may be negatively affected by full wards.
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Affiliation(s)
- Andreas Asheim
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Stina Aam
- Department of Geriatric Medicine, Clinic of Medicine, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Imre Janszky
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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15
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Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit. BMC Health Serv Res 2022; 22:17. [PMID: 34974842 PMCID: PMC8722290 DOI: 10.1186/s12913-021-07355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.
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16
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Patry C, Perozziello A, Pardineille C, Aubert C, de Malglaive P, Choquet C, Raynaud-Simon A, Sanchez M. Older medical outliers on surgical wards: impact on 6-month outcomes. Emerg Med J 2021; 39:181-185. [PMID: 34140319 DOI: 10.1136/emermed-2020-210192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medical patients are on occasion admitted transiently to surgical wards when more appropriate wards are at capacity, potentially leading to suboptimal care. The aim of this study was to compare 6-month outcomes in older adults diagnosed with medical conditions in the ED then admitted inappropriately to surgical wards (defined as outliers), with outcomes in comparable patients admitted to medical wards (controls). METHODS In a matched cohort study, 100 consecutive medical outliers from the ED aged 75 years and over were matched according to age, sex and diagnosis to 200 controls. Collected data included number of diagnoses reported in acute care, level of patient illness severity, length of stay, mortality and destination of patients discharged from acute care units (home, rehabilitation facility, nursing home or palliative care facility). An assessment was made of patient vital status and living environment (home, nursing home or hospital) at 6 months post-ED admission. RESULTS Mean age was 85.6 years. The most common ED diagnoses were gait disorders/falls (18%), neurological disorders (17%) and exhaustion (16%). Outliers displayed lower illness severity levels (0.001) and shorter lengths of stay from ED admission to acute care discharge (p=0.040). Subsequent to acute care, outliers were less commonly discharged home (45% vs 59%) and more commonly discharged to rehabilitation facilities (42% vs 28%). At 6 months post-ED admission, multivariable regression analysis showed that outlier status (OR=0.44 (0.25-0.83); p=0.011) and numbers of diagnoses reported in acute care (OR=0.87 (0.76-0.98); p=0.028) were independently associated with lower probability of living at home. CONCLUSION Outlying of older patients to surgical wards negatively affects their prospects of living at home at 6 months after hospital admission. Older patients hospitalised via the ED are entitled to appropriate medical care.
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Affiliation(s)
- Claire Patry
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Anne Perozziello
- Health Information Management Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Clio Pardineille
- Geriatric Department, Sainte-Périne University Hospital, Assistance Publqiue - Hopitaux de Paris (APHP), Paris, France
| | - Christiane Aubert
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Pauline de Malglaive
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Christophe Choquet
- Emergency Department - Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Agathe Raynaud-Simon
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France.,University of Paris, Paris, France
| | - Manuel Sanchez
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France .,University of Paris, Paris, France
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17
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La Regina M, Vertulli C, Gussoni G, Fontanella A, Ballardini G, Brucato A, Orlandini F, Murialdo G, Campanini M, Manfellotto D. Not-for-profit observational study to evaluate the quality and safety of care in <em>outliers</em> hospitalized with medical diseases - Study Protocol of Safety Issues and SurvIval For Medical Outliers (SISIFO study). ITALIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4081/itjm.2021.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The progressive cutting of hospital beds in some health systems, together with the increased needs related to the aging population, has led to the phenomenon of patients hospitalized outside the appropriate ward (outliers). This is particularly relevant in the context of Internal Medicine. Despite its relevance in daily clinical practice, available evidence for the potential impact of this phenomenon is limited. The aim of this study is to evaluate the effects of this situation on patients’ outcomes and possibly identify organizational and managerial aspects related to the presence of outliers. The multicenter, observational, prospective Study Protocol of Safety Issues and SurvIval For Medical Outliers (SISIFO) was promoted by the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI). The primary study endpoint is the evaluation of in-hospital mortality in outliers versus controls. A sample size of 2400 patients has been estimated by assuming a mortality rate of 12% and 8% in outliers and controls, respectively. By virtue of the multicentric dimension, the expected number of patients, and the controlled design, the FADOI-SISIFO study might provide interesting and useful findings to better manage the phenomenon of outliers.
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18
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Milevski SV, Lloyd M, Janus E, Maguire G, Karunajeewa H. Impact of weekend admission and changes in treating team on patient flow and outcomes in adults admitted to hospital with community-acquired pneumonia. Intern Med J 2021; 51:1681-1690. [PMID: 33647171 DOI: 10.1111/imj.15252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of workflow factors, such as timing of admission and changes in treating team, on patient outcomes remains inconclusive. AIMS To investigate the impact of weekend admission and changes in treating team on four pre-defined outcomes in patients admitted to hospital with community-acquired pneumonia (CAP). METHODS We performed an observational cohort study by utilising prospective longitudinal data collected during the IMPROVE-GAP trial, a stepped-wedge randomised study investigating an evidence-based bundle of care in the management of CAP. We assessed the effect of two exposure variables, day of admission and change of treating team, on four pre-specified outcomes: (i) length of stay; (ii) time to clinical stability; (iii) readmission within 30 days; and (iv) mortality at 30 days. Our analysis was restricted to patients with a primary diagnosis of CAP and employed multivariable Cox regression and logistic regression to adjust for potential measured confounders. RESULTS Of 753 participants, 224 (29.7%) were admitted on the weekend and 71 (9.4%) changed treating team during admission. Weekend admissions had significantly longer hospital stays than weekday admissions (hazard ratio (95% confidence interval; P-value) 0.82 (0.70-0.98; 0.03)) and took longer to reach clinical stability (0.80 (0.68-0.95; 0.01)). Change of treating team doubled the odds of readmission at 30 days (odds ratio 1.95 (1.08-3.58; 0.03)). CONCLUSIONS These results suggest workflow factors can negatively impact both health service and patient outcomes. Systems interventions aimed at improving out of hours service and reducing changes in treating team should be considered.
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Affiliation(s)
- Stefan V Milevski
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia
| | - Melanie Lloyd
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Graeme Maguire
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Harin Karunajeewa
- General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
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B Ramadhani F, Liu Y, Jing X, Qing Y, Xiong H, Zhang F, Wei P. Comparing the association of cardiovascular nursing care with blood pressure and length of stay of in-patients with coronary artery disease in Wuhan, China. Afr Health Sci 2020; 20:1716-1724. [PMID: 34394231 PMCID: PMC8351856 DOI: 10.4314/ahs.v20i4.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Coronary artery disease is a leading cause of morbidity and mortality worldwide. Comorbidity-like hypertension has been among the major risks of coronary artery disease. Recent evidence identified multiple benefits of cardiovascular nursing care to coronary patients. However, little has been appraised on benefits regarding patients' blood pressure control and length of hospitalisation. Objective To compare the association of cardiovascular nursing care delivered to coronary artery patients with patients' blood pressure and length of stay. Methods Records based retrospective design was applied at a large teaching hospital in Wuhan, China. SPSS 21 version was used for data entry and analysis with univariate and multivariate logistic regression models for comparing study variables. Results Of 300 patients, 224 (74.7%) were known to be hypertensive and admitted with subnormal blood pressure. Cardiovascular nursing care like “assess to grade pain severity on 1–10 scale” and “counsel patient to cope with stress” were six and three times more likely to contribute improved patients' blood pressure (AOR=5.8; 95%CI: 2.8–12.2, p=0.001) and (AOR=3.1; 95%CI: 1.2–7.8, p=0.015) respectively. No significant difference with length of stay (p>0.05). Conclusion There is a possibility of coronary artery patients to recover with normal blood pressure following reception of evidence-based cardiovascular nursing care.
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20
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Cheung J, West S, Boughton M. The Frontline Nurse's Experience of Nursing Outlier Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145232. [PMID: 32698431 PMCID: PMC7400079 DOI: 10.3390/ijerph17145232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
The frontline nurses' experience of nursing with overstretched resources in acute care setting can affect their health and well-being. Little is known about the experience of registered nurses faced with the care of a patient outside their area of expertise. The aim of this paper is to explore the phenomenon of nursing the outlier patient, when patients are nursed in a ward that is not specifically developed to deal with the major clinical diagnosis involved (e.g., renal patient in gynecology ward). Using a hermeneutic phenomenological approach, eleven individual face-to-face in-depth interviews were conducted with registered nurses in New South Wales, Australia. The study identified that each nurse had a specialty construct developed from nursing in a specialized environment. Each nurse had normalized the experience of specialty nursing and had developed a way of thinking and practicing theorized as a "care ladder". By grouping and analyzing various "care ladders" together, the nursing capacities common to nurses formed the phenomenological orientation, namely "the composite care ladder". Compared to nursing specialty-appropriate patients, nursing the outlier patient caused disruption of the care ladder, with some nurses becoming less capable as they were nursing the outlier patient. Nursing the outlier patient disrupted the nurses' normalized constructs of nursing. This study suggests that nursing patients in specialty-appropriate wards will improve patient outcomes and reduce impacts on the nurses' morale.
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Affiliation(s)
- Jasmine Cheung
- School of Nursing, Tung Wah College, Hong Kong, China
- Correspondence: ; Tel.: +852-3468-6824
| | - Sandra West
- Susan Wakil School of Nursing and Midwifery, University of Sydney, NSW 2006, Australia; (S.W.); (M.B.)
| | - Maureen Boughton
- Susan Wakil School of Nursing and Midwifery, University of Sydney, NSW 2006, Australia; (S.W.); (M.B.)
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21
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Ede J, Jeffs E, Vollam S, Watkinson P. A qualitative exploration of escalation of care in the acute ward setting. Nurs Crit Care 2020; 25:171-178. [PMID: 31833178 PMCID: PMC7217245 DOI: 10.1111/nicc.12479] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND "Failure to Rescue" includes failing to prevent avoidable patient deterioration and death. Despite its use, delays in care escalation still affect patient outcomes. AIMS AND OBJECTIVE The aim of this qualitative service evaluation was to map the barriers and facilitators to the escalation of care in the acute ward setting and identify those that are modifiable. DESIGN A total of 55 hours of qualitative observations were completed to capture care escalation events. These were conducted at two hospital sites in one National Health Service trust. METHODS Observations were iterative, with research team meetings being used to discuss the data and future methods. Field notes were analysed thematically by two researchers, extracting data on barriers and facilitators to escalation of care. RESULTS Clinical nursing staff challenged the sensitivity and specificity of Early Warning Scores, describing tool failings in certain clinical scenarios. Staff did not escalate based on the alerting Early Warning Scores alone but used other clinical factors, such as bleeding, which are not necessarily captured in the scoring systems. Staff frequently did not re-escalate low-level scores. Patient and non-patient factors identified as posing barriers to escalation were complex care needs, patient outlier status, and involvement of multiple care teams. Factors negatively affecting the chain of communication during escalation were team tension, staffing levels, and inadequate handover. CONCLUSION This service evaluation identified barriers and facilitators to the escalation of care in the acute ward setting. Unlike other studies, we found that re-escalation or tracking of deterioration was problematic. Patients identified as being at a higher risk of escalation failure included complex patients, outliers, and patients with multiple care teams. RELEVANCE TO CLINICAL PRACTICE This service evaluation demonstrates continuing health care communication barriers. Patient groups (complex patients and outliers) risk process failures during escalation. This can be applied in clinical practice by staff anticipating problems in these patients, documenting clear escalation pathways.
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Affiliation(s)
- Jody Ede
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordEngland
| | - Emma Jeffs
- Emergency DepartmentRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Sarah Vollam
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordEngland
| | - Peter Watkinson
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordEngland
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22
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Kohn R, Harhay MO, Bayes B, Song H, Halpern SD, Kerlin MP, Greysen SR. Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study. BMJ Qual Saf 2020; 30:116-122. [PMID: 32299956 DOI: 10.1136/bmjqs-2019-010675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Specialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are "bedspaced" to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services. METHODS We performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home. RESULTS Among 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses. CONCLUSION Bedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.
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Affiliation(s)
- Rachel Kohn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael O Harhay
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Bayes
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Hummy Song
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D Halpern
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meeta Prasad Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S Ryan Greysen
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brzezicki MA, Bridger NE, Kobetić MD, Ostrowski M, Grabowski W, Gill SS, Neumann S. Artificial intelligence outperforms human students in conducting neurosurgical audits. Clin Neurol Neurosurg 2020; 192:105732. [PMID: 32058200 DOI: 10.1016/j.clineuro.2020.105732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Neurosurgical audits are an important part of improving the safety, efficiency and quality of care but require considerable resources, time, and funding. To that end, the advent of the Artificial Intelligence-based algorithms offered a novel, more economically viable solution. The aim of the study was to evaluate whether the algorithm can indeed outperform humans in that task. PATIENTS & METHODS Forty-six human students were invited to inspect the clinical notes of 45 medical outliers on a neurosurgical ward. The aim of the task was to produce a report containing a quantitative analysis of the scale of the problem (e.g. time to discharge) and a qualitative list of suggestions on how to improve the patient flow, quality of care, and healthcare costs. The Artificial Intelligence-based Frideswide algorithm (FwA) was used to analyse the same dataset. RESULTS The FwA produced 44 recommendations whilst human students reported an average of 3.89. The mean time to deliver the final report was 5.80 s for the FwA and 10.21 days for humans. The mean relative error for factual inaccuracy for humans was 14.75 % for total waiting times and 81.06 % for times between investigations. The report produced by the FwA was entirely factually correct. 13 out of 46 students submitted an unfinished audit, 3 out of 46 made an overdue submission. Thematic analysis revealed numerous internal contradictions of the recommendations given by human students. CONCLUSION The AI-based algorithm can produce significantly more recommendations in shorter time. The audits conducted by the AI are more factually accurate (0 % error rate) and logically consistent (no thematic contradictions). This study shows that the algorithm can produce reliable neurosurgical audits for a fraction of the resources required to conduct it by human means.
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Affiliation(s)
| | | | | | | | | | - Simran S Gill
- St. George's, University of London Medical School, London, UK.
| | - Sandra Neumann
- Department of Physiology and Pharmacology, Clinical Research and Imaging Centre, University of Bristol, UK.
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24
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Davies A, Nyunt S. Streamlining communication between nursing staff and medical teams regarding patients who are ‘medical outliers’. Future Healthc J 2019. [DOI: 10.7861/futurehealth.6-2-s76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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La Regina M, Guarneri F, Romano E, Orlandini F, Nardi R, Mazzone A, Fontanella A, Campanini M, Manfellotto D, Bellandi T, Gussoni G, Tartaglia R, Squizzato A. What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review. J Gen Intern Med 2019; 34:1314-1321. [PMID: 31011980 PMCID: PMC6614225 DOI: 10.1007/s11606-019-05008-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/05/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wherever unoccupied beds are. The present work is aimed to systematically review literature about quality and safety of care for patients admitted to clinically inappropriate wards. METHODS We performed a systematic review of studies investigating outliers, published in peer-reviewed journals with no time restrictions. Search and screening were conducted by two independent researchers (MLR and ER). Studies were considered potentially eligible for this systematic review if aimed to assess the quality and/or the safety of care for patients admitted to clinically inappropriate units. Our search was supplemented by a hand search of references of included studies. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. RESULTS We collected 17 eligible papers and grouped them into six thematic categories. Despite their methodological limits, the included studies show increased trends in mortality and readmissions among outliers. Quality of care and patient safety are compromised as patients and health professionals declare and risk analysis displays. Reported solutions are often multicomponent, stress early discharge but have not been investigated in the control group. CONCLUSIONS Published literature cannot definitely conclude on the quality and safety of care for patients admitted to clinically inappropriate wards. As they may represent a serious threat for quality and safety, and moreover often neglected and under valued, well-designed and powered prospective studies are urgently needed.
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Affiliation(s)
| | - Francesca Guarneri
- Laboratorio Management e Sanita`, Institute of Management of Scuola Superiore Sant'Anna of Pisa, Pisa, Italy
| | - Elisa Romano
- SS Risk Management, ASL5 Liguria, La Spezia, Italy
| | | | | | - Antonino Mazzone
- Dipartimento Medico Ospedale di Legnano, Azienda Socio Sanitaria Territoriale Ovest Milanese, Legnano, MI, Italy
| | - Andrea Fontanella
- Dipartimento di Medicina Interna, Ospedale del Buonconsiglio - Fatebenefratelli Napoli, Naples, NA, Italy
| | - Mauro Campanini
- Dipartimento di Medicina Interna, Azienda Ospedaliera Maggiore della Carità, Novara, Italy
| | - Dario Manfellotto
- UO Medicina Interna, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Tommaso Bellandi
- Centro Gestione Rischio Clinico Regione Toscana, Florence, Italy
| | | | | | - Alessandro Squizzato
- Dipartimento di Medicina Clinica e Sperimentale, Università dell'Insubria, Varese, Italy
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Davies A, Nyunt S. Streamlining communication between nursing staff and medical teams regarding patients who are 'medical outliers'. Future Healthc J 2019; 6:76. [PMID: 31572966 PMCID: PMC6752474 DOI: 10.7861/futurehosp.6-2s-s76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Sandhi Nyunt
- University Hospitals Birmingham NHS
- RCP chief registrar
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McAlister FA, Shojania KG. Inpatient bedspacing: could a common response to hospital crowding cause increased patient mortality? BMJ Qual Saf 2017; 27:1-3. [DOI: 10.1136/bmjqs-2017-007524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/04/2022]
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