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Johnson DR, Ghosh D, Wagner BD, Carlton EJ. Did COVID-19 ICU patient mortality risk increase as Colorado hospitals filled? A retrospective cohort study. BMJ Open 2024; 14:e079022. [PMID: 38724053 PMCID: PMC11086500 DOI: 10.1136/bmjopen-2023-079022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To assess whether increasing levels of hospital stress-measured by intensive care unit (ICU) bed occupancy (primary), ventilators in use and emergency department (ED) overflow-were associated with decreasing COVID-19 ICU patient survival in Colorado ICUs during the pre-Delta, Delta and Omicron variant eras. DESIGN A retrospective cohort study using discrete-time survival models, fit with generalised estimating equations. SETTING 34 hospital systems in Colorado, USA, with the highest patient volume ICUs during the COVID-19 pandemic. PARTICIPANTS 9196 non-paediatric SARS-CoV-2 patients in Colorado hospitals admitted once to an ICU between 1 August 2020 and 1 March 2022 and followed for 28 days. OUTCOME MEASURES Death or discharge to hospice. RESULTS For Delta-era COVID-19 ICU patients in Colorado, the odds of death were estimated to be 26% greater for patients exposed every day of their ICU admission to a facility experiencing its all-era 75th percentile ICU fullness or above, versus patients exposed for none of their days (OR: 1.26; 95% CI: 1.04 to 1.54; p=0.0102), adjusting for age, sex, length of ICU stay, vaccination status and hospital quality rating. For both Delta-era and Omicron-era patients, we also detected significantly increased mortality hazard associated with high ventilator utilisation rates and (in a subset of facilities) states of ED overflow. For pre-Delta-era patients, we estimated relatively null or even protective effects for the same fullness exposures, something which provides a meaningful contrast to previous studies that found increased hazards but were limited to pre-Delta study windows. CONCLUSIONS Overall, and especially during the Delta era (when most Colorado facilities were at their fullest), increasing exposure to a fuller hospital was associated with an increasing mortality hazard for COVID-19 ICU patients.
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Affiliation(s)
- David R Johnson
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth J Carlton
- Department of Environmental & Occupational Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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2
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Moura A. Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal. J Health Econ 2022; 84:102640. [PMID: 35691072 DOI: 10.1016/j.jhealeco.2022.102640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Excessive length of hospital stay is among the leading sources of inefficiency in healthcare. When a patient is clinically fit to be discharged but requires support outside the hospital, which is not readily available, they remain hospitalized until a safe discharge is possible -a phenomenon called bed-blocking. I study whether the availability of subsidized nursing homes and home care teams reduces hospital bed-blocking. Using individual data on the universe of inpatient admissions at Portuguese hospitals during 2000-2015, I find that the entry of home care teams in a region reduces bed-blocking by 4 days per episode, on average. Nursing home entry only reduces bed-blocking among patients with high care needs or when the intensity of entry is high. Reductions in bed-blocking do not harm patients' health. The beds freed up by reducing bed-blocking are used to admit additional elective patients.
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Affiliation(s)
- Ana Moura
- OPEN Health, Rotterdam, The Netherlands.
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Béraud G, Timsit JF, Leleu H. Remdesivir and dexamethasone as tools to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact. PLoS One 2022; 17:e0262462. [PMID: 35020746 PMCID: PMC8754316 DOI: 10.1371/journal.pone.0262462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.
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Affiliation(s)
- Guillaume Béraud
- Infectious Diseases Department, University Hospital of Poitiers, Poitiers, France
| | - Jean-François Timsit
- APHP- Bichat Hospital—Medical and Infectious Diseases Intensive Care Unit, Paris, France
- IAME UMR 1137 Université de Paris (Paris-Diderot), Paris, France
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Hernandez G, Ramos FJ, Añon JM, Ortiz R, Colinas L, Masclans JR, De Haro C, Ortega A, Peñuelas O, Cruz-Delgado MDM, Canabal A, Plans O, Vaquero C, Rialp G, Gordo F, Lesmes A, Martinez M, Figueira JC, Gomez-Carranza A, Corrales R, Castellvi A, Castiñeiras B, Frutos-Vivar F, Prada J, De Pablo R, Naharro A, Montejo JC, Diaz C, Santos-Peral A, Padilla R, Marin-Corral J, Rodriguez-Solis C, Sanchez-Giralt JA, Jimenez J, Cuena R, Perez-Hoyos S, Roca O. Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study. Chest 2022; 161:121-129. [PMID: 34147502 PMCID: PMC8361308 DOI: 10.1016/j.chest.2021.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. RESEARCH QUESTION Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? STUDY DESIGN AND METHODS This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). RESULTS Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. INTERPRETATION Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.
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Affiliation(s)
- Gonzalo Hernandez
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain.
| | | | - José Manuel Añon
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
| | - Ramón Ortiz
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Laura Colinas
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | - Joan Ramón Masclans
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain; Mar Medical Research Institute, UPF, Departament de Ciències Experimentals i de la Salut-DCEXS, Barcelona, Spain
| | | | - Alfonso Ortega
- Intensive Care Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Alfonso Canabal
- Intensive Care Unit, La Princesa University Hospital, Madrid, Spain
| | - Oriol Plans
- Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Gemma Rialp
- Intensive Care Unit, Son Llatzer University Hospital, Mallorca, Spain
| | - Federico Gordo
- Intensive Care Unit, Henares University Hospital, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | - Amanda Lesmes
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - María Martinez
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Rocio Corrales
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen de la Salud, Toledo, Spain
| | - Andrea Castellvi
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain
| | | | | | - Jorge Prada
- Department of Otolaryngology-Head and Neck Surgery, La Princesa University Hospital, Madrid, Spain
| | - Raul De Pablo
- Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain; Critical Care Department, Alcala de Henares University, Alcala de Henares, Spain
| | - Antonio Naharro
- Intensive Care Unit, Henares University Hospital, Madrid, Spain
| | | | - Claudia Diaz
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - Alfonso Santos-Peral
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Rebeca Padilla
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | | | | | | | - Jorge Jimenez
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Santiago Perez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain; IDIBAPS, the Genetics, Microbiology and Statistics Department, University of Barcelona, Barcelona, Spain
| | - Oriol Roca
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
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French G, Hulse M, Nguyen D, Sobotka K, Webster K, Corman J, Aboagye-Nyame B, Dion M, Johnson M, Zalinger B, Ewing M. Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic - United States, July 2020-July 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1613-1616. [PMID: 34793414 PMCID: PMC8601411 DOI: 10.15585/mmwr.mm7046a5] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Khera R, Liu Y, de Lemos JA, Das SR, Pandey A, Omar W, Kumbhani DJ, Girotra S, Yeh RW, Rutan C, Walchok J, Lin Z, Bradley SM, Velazquez EJ, Churchwell KB, Nallamothu BK, Krumholz HM, Curtis JP. Association of COVID-19 Hospitalization Volume and Case Growth at US Hospitals with Patient Outcomes. Am J Med 2021; 134:1380-1388.e3. [PMID: 34343515 PMCID: PMC8325555 DOI: 10.1016/j.amjmed.2021.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn.
| | - Yusi Liu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Wally Omar
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Saket Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City
| | - Robert W Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass; Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | | | - Zhenqiu Lin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Steven M Bradley
- Healthcare Delivery Innovation Center, Minneapolis Heart Institute, Minn
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Keith B Churchwell
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
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Silva PJS, Pereira T, Sagastizábal C, Nonato L, Cordova MM, Struchiner CJ. Smart testing and critical care bed sharing for COVID-19 control. PLoS One 2021; 16:e0257235. [PMID: 34613981 PMCID: PMC8494319 DOI: 10.1371/journal.pone.0257235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
During the early months of the current COVID-19 pandemic, social distancing measures effectively slowed disease transmission in many countries in Europe and Asia, but the same benefits have not been observed in some developing countries such as Brazil. In part, this is due to a failure to organise systematic testing campaigns at nationwide or even regional levels. To gain effective control of the pandemic, decision-makers in developing countries, particularly those with large populations, must overcome difficulties posed by an unequal distribution of wealth combined with low daily testing capacities. The economic infrastructure of these countries, often concentrated in a few cities, forces workers to travel from commuter cities and rural areas, which induces strong nonlinear effects on disease transmission. In the present study, we develop a smart testing strategy to identify geographic regions where COVID-19 testing could most effectively be deployed to limit further disease transmission. By smart testing we mean the testing protocol that is automatically designed by our optimization platform for a given time period, knowing the available number of tests, the current availability of ICU beds and the initial epidemiological situation. The strategy uses readily available anonymised mobility and demographic data integrated with intensive care unit (ICU) occupancy data and city-specific social distancing measures. Taking into account the heterogeneity of ICU bed occupancy in differing regions and the stages of disease evolution, we use a data-driven study of the Brazilian state of Sao Paulo as an example to show that smart testing strategies can rapidly limit transmission while reducing the need for social distancing measures, even when testing capacity is limited.
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Affiliation(s)
- Paulo J. S. Silva
- Instituto de Matemática, Estatística e Computação Científica, Universidade de Campinas, São Paulo, Brazil
| | - Tiago Pereira
- Instituto de Ciências Matemáticas e Computação, Universidade de São Paulo, São Paulo, Brazil
- Department of Mathematics, Imperial College London, London, United Kingdom
- * E-mail:
| | - Claudia Sagastizábal
- Instituto de Matemática, Estatística e Computação Científica, Universidade de Campinas, São Paulo, Brazil
| | - Luis Nonato
- Instituto de Ciências Matemáticas e Computação, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo M. Cordova
- Departamento de Engenharia Elétrica, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Wilde H, Mellan T, Hawryluk I, Dennis JM, Denaxas S, Pagel C, Duncan A, Bhatt S, Flaxman S, Mateen BA, Vollmer SJ. The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study. BMC Med 2021; 19:213. [PMID: 34461893 PMCID: PMC8404408 DOI: 10.1186/s12916-021-02096-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The literature paints a complex picture of the association between mortality risk and ICU strain. In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain. METHODS A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease). RESULTS One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)]. CONCLUSION Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Thomas Mellan
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Iwona Hawryluk
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - John M Dennis
- Institute of Biomedical & Clinical Science, RILD Building, Royal Devon & Exeter Hospital, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK
| | - Spiros Denaxas
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
| | - Andrew Duncan
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Department of Mathematics, Imperial College, London, London, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Seth Flaxman
- Department of Mathematics, Imperial College, London, London, UK
| | - Bilal A Mateen
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK.
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK.
- The Wellcome Trust, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK.
| | - Sebastian J Vollmer
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
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Carod Pérez C, Carrau E, Sola J, De Alfonso N, Ávila A, Alonso G, Gené E. New health care facilities in the COVID-19 pandemic: health hotels. Emergencias 2021; 33:225-228. [PMID: 33978339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Elisenda Carrau
- Dirección, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Joan Sola
- Unidad de Hospitalización a Domicilio, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Natalia De Alfonso
- Dirección, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Antonio Ávila
- Gestión de pacientes, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Gilberto Alonso
- Servicio de Urgencias, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Emili Gené
- Servicio de Urgencias, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España. Institut d'Investigació i Innovació Parc Taulí I3PT. Sabadell, Barcelona, España. Universitat Autònoma de Barcelona, Departamento de Medicina, Universitat Internacional de Catalunya, Barcelona, España
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Affiliation(s)
- Mircea T Sofonea
- MIVEGEC, Université de Montpellier, CNRS, IRD - Montpellier, France; CREES, Montpellier 34394, France.
| | - Corentin Boennec
- MIVEGEC, Université de Montpellier, CNRS, IRD - Montpellier, France
| | - Yannis Michalakis
- MIVEGEC, Université de Montpellier, CNRS, IRD - Montpellier, France; CREES, Montpellier 34394, France
| | - Samuel Alizon
- MIVEGEC, Université de Montpellier, CNRS, IRD - Montpellier, France
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Temsah MHA, Al-Eyadhy AA, Al-Sohime FM, Hassounah MM, Almazyad MA, Hasan GM, Jamal AA, Alhaboob AA, Alabdulhafid MA, Abouammoh NA, Alhasan KA, Alwohaibi AA, Al Mana YT, Alturki AT. Long-stay patients in pediatric intensive care units. Five-years, 2-points, cross-sectional study. Saudi Med J 2021; 41:1187-1196. [PMID: 33130838 PMCID: PMC7804226 DOI: 10.15537/smj.2020.11.25450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources. Methods: This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included. Results: Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%). Conclusion: A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources.
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Affiliation(s)
- Mohamad-Hani A Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Abstract
Severe acute respiratory syndrome coronavirus 2, the virus causing the pandemic illness coronavirus disease 2019, was first detected in the United States in January 2020. As the illness spread across the country, all aspects and venues of health care were significantly impacted. This article explores the challenges and response of one children's emergency medicine division related to surge planning, personal protective equipment, screening, testing, staffing, and other operational challenges, and describes the impact and implications thus far. [Pediatr Ann. 2021;50(4):e172-e177.].
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13
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Hoogcarspel SJ, Doodeman HJ, Schakenraad D, de Nooij L. [Acute care during the first corona wave. Minor health damage for patients without covid-19 in a Dutch hospital]. Ned Tijdschr Geneeskd 2021; 165:D5650. [PMID: 33793135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
GOAL To study the effect of the first COVID-19 wave in combination with the lockdown on acute care in the Netherlands. DESIGN Retrospective cohort study METHOD: For this study, data was collected from patients who visited the emergency department (ED) and Cardiac Care Unit of Noordwest Ziekenhuisgroep in Alkmaar and Den Helder. This data collection took place from 1 February to 28 June in 2019 and during the same period in 2020. The number of visits per day was investigated. The outcome measures for hospital occupation were the number of admissions per day and the average length of stay. Outcome measures for health damage were length of stay and mortality. RESULTS The number of ED visits fell by 27% during the lockdown. For the specialties of internal medicine and pulmonary medicine, the number of admissions from the ED was the same during the lockdown, but the length of stay was longer. For all other specialties, the number of admissions from the ED was lower during the lockdown, but the admission duration was the same. Mortality was higher and hospital stay longer for patients admitted to the specialties of internal medicine and pulmonary medicine. In all other specialisms studied, there was no higher mortality or longer hospital stay. CONCLUSION From the start of the lockdown, there was a sharp drop in the number of ED visits. The number of ED visits recovered slowly after this drop. For specialties that did not treat COVID-19 patients, hospital occupation was lower than usual. The number of admissions from the ED had decreased for these specialties. Based on the outcome measures length of stay and mortality, we were unable to find any indications of health damage as a result of the drop in admissions.
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Affiliation(s)
- S J Hoogcarspel
- Noordwest Ziekenhuisgroep, afd. Spoedeisende Hulp, Alkmaar
- Contact: S. J. Hoogcarspel
| | - H J Doodeman
- Noordwest Ziekenhuisgroep, Noordwest Academie, Alkmaar
| | - D Schakenraad
- Noordwest Ziekenhuisgroep, afd. Spoedeisende Hulp, Alkmaar
| | - L de Nooij
- Noordwest Ziekenhuisgroep, afd. Spoedeisende Hulp, Alkmaar
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Martin BI, Brodke DS, Wilson FA, Chaiyakunapruk N, Nelson RE. The Impact of Halting Elective Admissions in Anticipation of a Demand Surge Due to the Coronavirus Pandemic (COVID-19). Med Care 2021; 59:213-219. [PMID: 33427797 PMCID: PMC7993651 DOI: 10.1097/mlr.0000000000001496] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions. OBJECTIVES To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, and to explore the scenario when demand remains below capacity. RESEARCH DESIGN An economic simulation to estimate the net financial impact of halting elective admissions, combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. Deterministic sensitivity analyses explored the results while varying assumptions for demand and capacity. SUBJECTS Inputs regarding disease prevalence and inpatient utilization were representative of the US population. Our base case relied on a hospital admission rate reported by the Center for Disease Control and Prevention of 137.6 per 100,000, with the highest rates in people aged 65 years and older (378.8 per 100,000) and 50-64 years (207.4 per 100,000). On average, elective admissions accounted for 20% of total hospital admissions, and the average rate of unoccupied beds across hospitals was 30%. MEASURES Net financial impact of halting elective admissions. RESULTS On average, hospitals COVID-19 demand for hospital bed-days fell well short of hospital capacity, resulting in a substantial financial loss. The net financial impact of a 90-day COVID surge on a hospital was only favorable under a narrow circumstance when capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions. CONCLUSIONS Hospitals that restricted elective care took on a substantial financial risk, potentially threatening viability. A sustainable public policy should therefore consider support to hospitals that responsibly served their communities through the crisis.
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Affiliation(s)
| | | | | | | | - Richard E. Nelson
- Internal Medicine, VA Salt Lake City Health Care System, University of Utah, Salt Lake City, UT
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15
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Almeida JFDF, Conceição SV, Pinto LR, Horta CJG, Magalhães VS, de Campos FCC. Estimating Brazilian states' demands for intensive care unit and clinical hospital beds during the COVID-19 pandemic: development of a predictive model. SAO PAULO MED J 2021; 139:178-185. [PMID: 33729421 PMCID: PMC9632516 DOI: 10.1590/1516-3180.2020.0517.r1.0212020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The fragility of healthcare systems worldwide had not been exposed by any pandemic until now. The lack of integrated methods for bed capacity planning compromises the effectiveness of public and private hospitals' services. OBJECTIVES To estimate the impact of the COVID-19 pandemic on the provision of intensive care unit and clinical beds for Brazilian states, using an integrated model. DESIGN AND SETTING Experimental study applying healthcare informatics to data on COVID-19 cases from the official electronic platform of the Brazilian Ministry of Health. METHODS A predictive model based on the historical records of Brazilian states was developed to estimate the need for hospital beds during the COVID-19 pandemic. RESULTS The proposed model projected in advance that there was a lack of 22,771 hospital beds for Brazilian states, of which 38.95% were ICU beds, and 61.05% were clinical beds. CONCLUSIONS The proposed approach provides valuable information to help hospital managers anticipate actions for improving healthcare system capacity.
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Affiliation(s)
- João Flávio de Freitas Almeida
- PhD. Assistant Professor, Department of Industrial Engineering, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Samuel Vieira Conceição
- PhD. Professor, Department of Industrial Engineering, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Luiz Ricardo Pinto
- PhD. Professor, Department of Industrial Engineering, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Cláudia Júlia Guimarães Horta
- PhD. Science and Technology Researcher, Directorate of Public Policy, Fundação João Pinheiro (FJP), Belo Horizonte (MG), Brazil.
| | - Virgínia Silva Magalhães
- MSc. Doctoral Student, Núcleo de Educação em Saúde Coletiva (NESCON), School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Francisco Carlos Cardoso de Campos
- MSc. Public Health Physician, Núcleo de Educação em Saúde Coletiva (NESCON), School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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AGNOLETTI V, RUSSO E, CIRCELLI A, BENNI M, BOLONDI G, MARTINO C, SANTONASTASO DP, BROGI E, PRATICÒ B, COCCOLINI F, FUGAZZOLA P, ANSALONI L, GAMBERINI E. From intensive care to step-down units: Managing patients throughput in response to COVID-19. Int J Qual Health Care 2021; 33:mzaa091. [PMID: 32780867 PMCID: PMC7454682 DOI: 10.1093/intqhc/mzaa091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE The on-going COVID-19 pandemic may cause the collapse of healthcare systems because of unprecedented hospitalization rates. INITIAL ASSESSMENT A total of 8.2 individuals per 1000 inhabitants have been diagnosed with COVID-19 in our province. The hospital predisposed 110 beds for COVID-19 patients: on the day of the local peak, 90% of them were occupied and intensive care unit (ICU) faced unprecedented admission rates, fearing system collapse. CHOICE OF SOLUTION Instead of increasing the number of ICU beds, the creation of a step-down unit (SDU) close to the ICU was preferred: the aim was to safely improve the transfer of patients and to relieve ICU from the risk of overload. IMPLEMENTATION A nine-bed SDU was created next to the ICU, led by intensivists and ICU nurses, with adequate personal protective equipment, monitoring systems and ventilators for respiratory support when needed. A second six-bed SDU was also created. EVALUATION Patients were clinically comparable to those of most reports from Western Countries now available in the literature. ICU never needed supernumerary beds, no patient died in the SDU, and there was no waiting time for ICU admission of critical patients. SDU has been affordable from human resources, safety and economic points of view. LESSONS LEARNED COVID-19 is like an enduring mass casualty incident. Solutions tailored on local epidemiology and available resources should be implemented to preserve the efficiency and adaptability of our institutions and provide the adequate sanitary response.
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Affiliation(s)
- Vanni AGNOLETTI
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Emanuele RUSSO
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Alessandro CIRCELLI
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Marco BENNI
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Giuliano BOLONDI
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Costanza MARTINO
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Domenico P SANTONASTASO
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Etrusca BROGI
- Department of Anesthesia and Intensive Care, University of Pisa, Via Piero Trivella, 56124, Pisa, Italy
| | - Beniamino PRATICÒ
- Department of Internal Medicine, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Federico COCCOLINI
- Department of Surgery, University of Pisa, Via Piero Trivella, 56124, Pisa, Italy, and
| | - Paola FUGAZZOLA
- General, Emergency and Trauma Department, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Luca ANSALONI
- General, Emergency and Trauma Department, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
| | - Emiliano GAMBERINI
- Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy
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Olivas-Martínez A, Cárdenas-Fragoso JL, Jiménez JV, Lozano-Cruz OA, Ortiz-Brizuela E, Tovar-Méndez VH, Medrano-Borromeo C, Martínez-Valenzuela A, Román-Montes CM, Martínez-Guerra B, González-Lara MF, Hernandez-Gilsoul T, Herrero AG, Tamez-Flores KM, Ochoa-Hein E, Ponce-de-León A, Galindo-Fraga A, Kershenobich-Stalnikowitz D, Sifuentes-Osornio J. In-hospital mortality from severe COVID-19 in a tertiary care center in Mexico City; causes of death, risk factors and the impact of hospital saturation. PLoS One 2021; 16:e0245772. [PMID: 33534813 PMCID: PMC7857625 DOI: 10.1371/journal.pone.0245772] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. Methods and findings In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34–3.12), obesity (RR 1.62, 95% CI 1.14–2.32)—in particular morbid obesity (RR 3.38, 95%CI 1.63–7.00)—and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26–7.31). Conclusions In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.
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Affiliation(s)
- Antonio Olivas-Martínez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - José Luis Cárdenas-Fragoso
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Víctor Jiménez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar Arturo Lozano-Cruz
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Edgar Ortiz-Brizuela
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Víctor Hugo Tovar-Méndez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carla Medrano-Borromeo
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra Martínez-Valenzuela
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carla Marina Román-Montes
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo Martínez-Guerra
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Fernanda González-Lara
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Thierry Hernandez-Gilsoul
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfonso Gulias Herrero
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Karla María Tamez-Flores
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eric Ochoa-Hein
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Department of Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- * E-mail:
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18
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Duarte R. [A Perspective about the "Health at a Glance 2020" OECD Report]. ACTA MEDICA PORT 2021; 34:84-86. [PMID: 33641701 DOI: 10.20344/amp.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Raquel Duarte
- Faculdade de Medicina. Universidade do Porto. Porto. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
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Mateen BA, Wilde H, Dennis JM, Duncan A, Thomas N, McGovern A, Denaxas S, Keeling M, Vollmer S. Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis. BMJ Open 2021; 11:e042945. [PMID: 33500288 PMCID: PMC7843315 DOI: 10.1136/bmjopen-2020-042945] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. DESIGN Descriptive survey. SETTING All non-specialist secondary care providers in England from 27 March27to 5 June 2020. PARTICIPANTS Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). MAIN OUTCOME MEASURES Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. RESULTS At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. CONCLUSIONS Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
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Affiliation(s)
- Bilal Akhter Mateen
- Warwick Medical School, University of Warwick, Coventry, UK
- The Alan Turing Institute, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Harrison Wilde
- Department of Statistics, University of Warwick, Coventry, UK
| | - John M Dennis
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
| | - Andrew Duncan
- The Alan Turing Institute, London, UK
- Department of Statistics, Imperial College London, London, UK
| | - Nick Thomas
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
- Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew McGovern
- The Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
- Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Spiros Denaxas
- The Alan Turing Institute, London, UK
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Matt Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Sebastian Vollmer
- The Alan Turing Institute, London, UK
- Department of Statistics, University of Warwick, Coventry, UK
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Castelnuovo F, Marchese V, Cristini G, Crosato V, Pennati F, Renisi G, Izzo I, Paraninfo G, Van Hauwermeiren E, Castelli F. Discharge ward during the SARS-CoV-2 pandemic: an effective way to increase patient turnover when human resources are scarce. Infez Med 2020; 28:539-544. [PMID: 33257628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the SARS-CoV-2 pandemic, the province of Brescia (Italy) had a significant number of COVID-19 cases, which led to a subversion of the ordinary structure of the university hospital ASST Spedali Civili, driven by the need to hospitalize as many patients as possible in a narrow period of time. At the peak of the epidemic, a rapid hospitalization discharge area, the Discharge Ward (DW), was set up with the aim of facilitating the rapid turnover of patients in the wards where the most severe patients had to be hospitalized. The organization and activities carried out are described in the results of this reproducible experience during epidemic events.
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Affiliation(s)
- Filippo Castelnuovo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Graziella Cristini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Verena Crosato
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Francesca Pennati
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giulia Renisi
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Ilaria Izzo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Paraninfo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Evelyn Van Hauwermeiren
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Kanai Y, Takagi H. Markov chain analysis for the neonatal inpatient flow in a hospital. Health Care Manag Sci 2020; 24:92-116. [PMID: 32997207 DOI: 10.1007/s10729-020-09515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 07/16/2020] [Indexed: 11/28/2022]
Abstract
Discrete-time Markov chain and queueing-theoretic models are used to quantitatively formulate the flow of neonatal inpatients over several wards in a hospital. Parameters of the models are determined from the operational analysis of the record of the numbers of admission/departure for each ward every day and the order log of patient movement from ward to ward for two years provided by the Medical Information Department of the University of Tsukuba Hospital in Japan. Our formulation is based on the analysis of the precise routes (the route of an inpatient is defined as a sequence of the wards in which he/she stays from admission to discharge) and their length-of-stay (LoS) in days in each ward on their routes for all neonatal inpatients. Our theoretical model calculates the probability distribution for the number of patients staying in each ward per day which agrees well with the corresponding histogram observed for each ward as well as for the whole hospital. The proposed method can be used for the long-term capacity planning of hospital wards with respect to the probabilistic bed utilization.
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Affiliation(s)
- Yuta Kanai
- Tsukuba Institute of Research, 1-7 Takezono, Tsukuba-shi, Ibaraki-ken, 305-0032, Japan
| | - Hideaki Takagi
- University of Tsukuba (Professor Emeritus), 747-3 Serizawa, Chigasaki-shi, Kanagawa-ken, 253-0008, Japan.
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Martins P. [Human Resources for Intensive Care Medicine in Portugal in the Post-COVID Era]. ACTA MEDICA PORT 2020; 33:537-539. [PMID: 32705980 DOI: 10.20344/amp.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Paulo Martins
- Serviço de Medicina Intensiva. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Abstract
Objectives The aim of the study was to assess the impact of social distancing interventions in Greece and to examine what would have happened if those interventions had not been implemented. Study design A dynamic, discrete time, stochastic individual-based model was developed to simulate coronavirus disease 2019 (COVID-19) transmission. Methods The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use in Greece. Results If Greece had not implemented social distancing interventions, the healthcare system would have been overwhelmed between March 30 and April 4. The combined social distancing interventions and increase in ICU beds averted 4360 (95% credible interval: 3050, 5700) deaths and prevented the healthcare system from becoming overwhelmed. Conclusions The quick and accurate interventions of the Greek government limited the burden of the COVID-19 outbreak. Without the social distancing (SD) interventions, the healthcare system would have been overwhelmed by early April. The early implementation of the SD interventions prevented 4360 (95% credible interval: 3050, 5700) deaths by April 27. Any interventions to boost health care capacity, without the simultaneous of SD interventions, would not have been effective. The decision of the Greek government to launch early SD measures resulted in limiting the burden of the COVID-19 outbreak.
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Affiliation(s)
- Ilias Gountas
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece.
| | - Georgios Hillas
- 5th Pulmonary Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece
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Abstract
Background Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.
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Affiliation(s)
- Camila Vantini Capasso Palamim
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, BR
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, BR
| | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, BR
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, BR
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Lemos DRQ, D’Angelo SM, Farias LABG, Almeida MM, Gomes RG, Pinto GP, Cavalcante JN, Feijão LX, Cardoso ARP, Lima TBR, Linhares PMC, Mello LP, Coelho TM, Cavalcanti LPDG. Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis. Rev Soc Bras Med Trop 2020; 53:e20200354. [PMID: 32638888 PMCID: PMC7341828 DOI: 10.1590/0037-8682-0354-2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.
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Affiliation(s)
| | - Sarah Mendes D’Angelo
- Secretaria de Saúde do Estado do Ceará, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
| | - Luis Arthur Brasil Gadelha Farias
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
- Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil
| | - Magda Moura Almeida
- Secretaria de Saúde do Estado do Ceará, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
| | | | | | | | | | | | | | - Pâmela Maria Costa Linhares
- Secretaria de Saúde do Estado do Ceará, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
| | | | - Tania Mara Coelho
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
- Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil
| | - Luciano Pamplona de Góes Cavalcanti
- Centro Universitário Christus, Faculdade de Medicina, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil
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Yoon J, Bui LN, Govier DJ, Cahn MA, Luck J. Determinants of Boarding of Patients with Severe Mental Illness in Hospital Emergency Departments. J Ment Health Policy Econ 2020; 23:61-75. [PMID: 32621726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Boarding of patients in hospital emergency departments (EDs) occurs routinely across the U.S. ED patients with behavioral health conditions are more likely to be boarded than other patients. However, the existing literature on ED boarding of psychiatric patients remains largely descriptive and has not empirically related mental health system capacity to psychiatric boarding. Nor does it show how the mental health system could better address the needs of populations at the highest risk of ED boarding. AIMS OF THE STUDY We examined extent and determinants of "boarding" of patients with severe mental illness (SMI) in hospital emergency departments (ED) and tested whether greater mental health system capacity may mitigate the degree of ED boarding. METHODS We linked Oregon's ED Information Exchange, hospital discharge, and Medicaid data to analyze encounters in Oregon hospital EDs from October 2014 through September 2015 by 7,103 persons aged 15 to 64 with SMI (N = 34,207). We additionally utilized Medicaid claims for years 2010-2015 to identify Medicaid beneficiaries with SMI. Boarding was defined as an ED stay over six hours. We estimated a recursive simultaneous-equation model to test the pathway that mental health system capacity affects ED boarding via psychiatric visits. RESULTS Psychiatric visits were more likely to be boarded than non-psychiatric visits (30.2% vs. 7.4%). Severe psychiatric visits were 1.4 times more likely to be boarded than non-severe psychiatric visits. Thirty-four percent of psychiatric visits by children were boarded compared to 29.6% for adults. Statistical analysis found that psychiatric visit, substance abuse, younger age, black race and urban residence corresponded with an elevated risk of boarding. Discharge destinations such as psychiatric facility and acute care hospitals also corresponded with a higher probability of ED boarding. Greater supply of mental health resources in a county, both inpatient and intensive community-based, corresponded with a reduced risk of ED boarding via fewer psychiatric ED visits. DISCUSSION Psychiatric visit, severity of psychiatric diagnosis, substance abuse, and discharge destinations are among important predictors of psychiatric ED boarding by persons with SMI. A greater capacity of inpatient and intensive community mental health systems may lead to a reduction in psychiatric ED visits by persons with SMI and thereby decrease the extent of psychiatric ED boarding. IMPLICATIONS FOR HEALTH POLICIES Continued investment in mental health system resources may reduce psychiatric ED visits and mitigate the psychiatric ED boarding problem.
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Affiliation(s)
- Jangho Yoon
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 464 Waldo Hall, Corvallis, OR 97331, USA,
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Luciani LG, Mattevi D, Giusti G, Proietti S, Gallo F, Schenone M, Malossini G. Guess Who's Coming to Dinner: COVID-19 in a COVID-free Unit. Urology 2020; 142:22-25. [PMID: 32425267 PMCID: PMC7233200 DOI: 10.1016/j.urology.2020.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
Objective To assess the impact of the pandemic on surgical activity and the occurrence and features of Covid-19 in a Covid-free urologic unit in a regional hospital in Northern Italy. Materials and Methods Our Department is the only urologic service in the Trento Province, near Lombardy, the epicenter of Covid-19 in our Country. We reviewed the surgical and ward activities during the 4 weeks following the national lockdown (March 9 to April 5, 2020). The following outcomes were investigated: surgical load, rate of admissions and bed occupation, and the rate and characteristics of unrecognized Covid-positive patients. Data were compared with that of the same period of 2019 (March 11 to April 7). Results and Conclusion About 63%, 70%, 64%, and 71%, decline in surgery, endoscopy, bed occupation, and admission, respectively, occurred during the 4 weeks after the lockdown, as compared to 2019. Urgent procedures also declined by 32%. Three (8%) of 39 admissions regarded unrecognized Covid-19 overlapping or misinterpreted with urgent urologic conditions such as fever-associated urinary stones or hematuria. In spite of a significant reduction of activity, a non-negligible portion of admissions to our Covid-free unit regarded unrecognized Covid-19. In order to preserve its integrity, we propose an enhanced triage prior to the admission to a Covid-free unit including not only routine questions on fever and respiratory symptoms but also nonrespiratory symptoms, history of exposure, and a survey about the social and geographic origin of the patient.
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Affiliation(s)
| | - Daniele Mattevi
- Department of Urology, Santa Chiara Hospital, Trento, Italy.
| | - Guido Giusti
- Department of Urology, Ville Turro Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvia Proietti
- Department of Urology, Ville Turro Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabrizio Gallo
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
| | - Maurizio Schenone
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
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Ofoma UR, Montoya J, Saha D, Berger A, Kirchner HL, McIlwaine JK, Kethireddy S. Associations between hospital occupancy, intensive care unit transfer delay and hospital mortality. J Crit Care 2020; 58:48-55. [PMID: 32339974 DOI: 10.1016/j.jcrc.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Hospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes. MATERIALS AND METHODS 7-year retrospective cohort study of 8500 alive discharge encounters from 4 adult ICUs of a tertiary hospital. We estimated associations between i) HospOcc and ICU transfer delay; and ii) ICU transfer delay and hospital mortality. RESULTS Median (IQR) ICU transfer delay was 4.8 h (1.6-11.7), 1.4% (119) suffered in-hospital death, and 4% (341) were readmitted. HospOcc was non-linearly related with ICU transfer delay, with a spline knot at 80% (mean transfer delay 8.8 h [95% CI: 8.24, 9.38]). Higher HospOcc level above 80% was associated with longer transfer delays, (mean increase 5.4% per % HospOcc increase; 95% CI, 4.7 to 6.1; P < .001). Longer ICU transfer delay was associated with increasing odds of in-hospital death or ICU readmission (odds ratio 1.01 per hour; 95% CI 1.00 to 1.01; P = .04) but not with ICU readmission alone (OR 1.01 per hour; 95% CI 1.00 to 1.01, P = .14). CONCLUSIONS ICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.
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Affiliation(s)
- Uchenna R Ofoma
- Division of Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Juan Montoya
- Division of General Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Debdoot Saha
- Division of Critical Care Medicine, Geisinger Health System, Danville, PA, USA
| | - Andrea Berger
- Department of Population Health Sciences, Geisinger Health System, Danville, PA, USA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Health System, Danville, PA, USA
| | - John K McIlwaine
- Division of Critical Care Medicine, Geisinger Health System, Danville, PA, USA
| | - Shravan Kethireddy
- Department of Critical Care Medicine, Northeast Georgia Health System, Atlanta, GA, USA
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29
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Lefèvre M, Van den Heede K, Camberlin C, Bouckaert N, Beguin C, Devos C, Van de Voorde C. Impact of shortened length of stay for delivery on the required bed capacity in maternity services: results from forecast analysis on administrative data. BMC Health Serv Res 2019; 19:637. [PMID: 31488147 PMCID: PMC6729074 DOI: 10.1186/s12913-019-4500-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We examine the implications of reducing the average length of stay (ALOS) for a delivery on the required capacity in terms of service volume and maternity beds in Belgium, using administrative data covering all inpatient stays in Belgian general hospitals over the period 2003-2014. METHODS A projection model generates forecasts of all inpatient and day-care services with a time horizon of 2025. It adjusts the observed hospital use in 2014 to the combined effect of three evolutions: the change in population size and composition, the time trend evolution of ALOS, and the time trend evolution of the admission rates. In addition, we develop an alternative scenario to evaluate the impact of an accelerated reduction of ALOS. RESULTS Between 2014 and 2025, we expect the number of deliveries to increase by 4.41%, and the number of stays in maternity services by 3.38%. At the same time, a reduction in ALOS is projected for all types of deliveries. The required capacity for maternity beds will decrease by 17%. In case of an accelerated reduction of the ALOS to reach international standards, this required capacity for maternity beds will decrease by more than 30%. CONCLUSIONS Despite an expected increase in the number of deliveries, future hospital capacity in terms of maternity beds can be considerably reduced in Belgium, due to the continuing reduction of ALOS.
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Affiliation(s)
- Mélanie Lefèvre
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Cécile Camberlin
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Nicolas Bouckaert
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Claire Beguin
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carl Devos
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carine Van de Voorde
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
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Smith E, Synnott K. A Prospective Audit of Inappropriately Occupied Hospital Beds in Patients with Newly Acquired Traumatic Spinal Cord Injury. Ir Med J 2019; 112:971. [PMID: 31642645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aim To quantify the inappropriate bed occupancy amongst patients with traumatic spinal cord injury (TSCI) awaiting transfer of care from the acute to community. Methods A prospective audit was carried out, of all newly acquired cases of TSCI in 2017, who progressed through acute care and specialist rehabilitation. Results Forty-four patients who were audited spent a total of 3915 days occupying a hospital bed, inappropriate for their phase of care, 78 awaiting admission to specialist acute care, 3126 awaiting admission to rehabilitation and 711 awaiting discharge from rehabilitation. Conclusion Valuable health-care resources are being wasted because TSCI patients cannot move seamlessly from one phase of care to the next. This impacts negatively on the quality of care being delivered to this patient cohort.
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Affiliation(s)
- E Smith
- National Rehabilitation Hospital
- Mater Misericordiae University Hospital
| | - K Synnott
- National Rehabilitation Hospital
- Mater Misericordiae University Hospital
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Heinsbroek E, Hungerford D, Cooke RPD, Chowdhury M, Cargill JS, Bar-Zeev N, French N, Theodorou E, Standaert B, Cunliffe NA. Do hospital pressures change following rotavirus vaccine introduction? A retrospective database analysis in a large paediatric hospital in the UK. BMJ Open 2019; 9:e027739. [PMID: 31097487 PMCID: PMC6530452 DOI: 10.1136/bmjopen-2018-027739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Hospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated changes in 'hospital pressures' (demand on healthcare resources and staff) following rotavirus vaccine introduction in a paediatric setting in the UK. DESIGN Retrospective hospital database analysis between July 2007 and June 2015. SETTING A large paediatric hospital providing primary, secondary and tertiary care in Merseyside, UK. PARTICIPANTS Hospital admissions aged <15 years. Outcomes were calculated for four different patient groups identified through diagnosis coding (International Classification of Disease, 10th edition) and/or laboratory confirmation: all admissions; any infection, acute gastroenteritis and RVGE. METHODS Hospital pressures were compared before and after rotavirus vaccine introduction: these included bed occupancy, hospital-acquired infection rate, unplanned readmission rate and outlier rate (medical patients admitted to surgical wards due to lack of medical beds). Interrupted time-series analysis was used to evaluate changes in bed occupancy. RESULTS There were 116 871 admissions during the study period. Lower bed occupancy in the rotavirus season in the postvaccination period was observed for RVGE (-89%, 95% CI 73% to 95%), acute gastroenteritis (-63%, 95% CI 39% to 78%) and any infection (-23%, 95% CI 15% to 31%). No significant overall reduction in bed occupancy was observed (-4%, 95% CI -1% to 9%). No changes were observed for the other outcomes. CONCLUSIONS Rotavirus vaccine introduction was not associated with reduced hospital pressures. A reduction in RVGE hospitalisation without change in overall bed occupancy suggests that beds available were used for a different patient population, possibly reflecting a previously unmet need. TRIALS REGISTRATION NUMBER NCT03271593.
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Affiliation(s)
- Ellen Heinsbroek
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
| | - Daniel Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- Field Service-North West, National Infection Service, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - Richard P D Cooke
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Margaret Chowdhury
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - James S Cargill
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neil French
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, UK
| | | | | | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
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Longo F, Siciliani L, Moscelli G, Gravelle H. Does hospital competition improve efficiency? The effect of the patient choice reform in England. Health Econ 2019; 28:618-640. [PMID: 30815943 DOI: 10.1002/hec.3868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/27/2018] [Accepted: 11/19/2018] [Indexed: 05/27/2023]
Abstract
We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences-in-differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/2003 to 2010/2011. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%.
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Affiliation(s)
| | - Luigi Siciliani
- Centre for Health Economics, University of York, York, UK
- Department of Economic and Related Studies, University of York, York, UK
| | | | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
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Kahloul M, Nakhli MS, Jebali C, Zaied H, Chaouch A, Naija W. Assessment of the operating room efficiency by the real time of room occupancy. Tunis Med 2019; 97:675-680. [PMID: 31729739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The operating room is the most cost consuming area of hospitals. However, it still suffers from a non-optimized organization. AIM To evaluate the performance of our operating rooms by the real room occupancy time (RROT), to identify the main causes of its alteration and to analyze the problem of deprogramming. METHODS This is an observational and descriptive study conducted in two operating rooms in Sahloul teaching Hospital during August 2016. For the two studied rooms, a pre-established data sheet was filled during the days of scheduled activity. Collected parameters were total RROT, different periods of RROT, room occupancy rate, room overflow rate, incidence and causes of non-compliance with the surgical program and causes of RROT alteration. RESULTS The mean start time of the activity was 41.93 min/day. The mean overflow time was 11.51 min/day. The RROT was 246.56 min/day, corresponding to an average occupancy rate of 68.49%. On average 1.86 acts were performed per room and per morning with a total of 86 interventions. The deprogramming problem was noted in 38 cases. Its main causes were the overshoot of the vacation time offered to surgeons (36.84%), the emergencies (18.42%) and the non-respect of the anesthesia instructions (15.78%). CONCLUSION The occupancy rate in our structures is relatively acceptable but should not hide the need to optimize the use of available resources. Corrective actions focusing primarily on delayed start-up and periodic reassessments are essential.
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Poon CM, Wong ELY, Chau PYK, Yau SY, Yeoh EK. Management decision of hospital surge: assessing seasonal upsurge in inpatient medical bed occupancy rate among public acute hospitals in Hong Kong. QJM 2019; 112:11-16. [PMID: 30295857 DOI: 10.1093/qjmed/hcy217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There were recurrent upsurges in demand for public hospital services in Hong Kong. An understanding of the contribution of some possible factors for the rise in health care burden would help to inform hospital management strategies. AIM To evaluate the utilization patterns of hospitalizations in medical wards among public acute hospitals in Hong Kong during surge periods. DESIGN Retrospective study. METHODS By extracting the information in press releases between 2014 and 2018, descriptive statistics about medical ward occupancy situation during six surge periods were generated. A time series model was constructed to estimate the occupancy rate at each hospital and assess its relationship with the intensity of seasonal influenza activity, extreme weather, day of week and long holidays. RESULTS There was a significant increase in the number of admissions to medical wards in all six surge periods. A significant variation in occupancy rate between weekdays and geographic regions was observed. The occupancy rate in 10, out of 15, hospitals was significantly associated with the influenza activity, while there was limited effect of weather on the occupancy rate. A significant holiday effect was observed during Christmas and Chinese New Year, resulting in a lower bed occupancy rate. CONCLUSIONS A differential burden in public hospitals during surge periods was reported. Contingency bed and staff management shall be tailored to individual hospitals, given their differences in the determinants for inpatient bed occupancy.
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Affiliation(s)
- C M Poon
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - E L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - P Y K Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - S Y Yau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
OBJECTIVE To evaluate the use of a small municipality acute bed unit (MAU) in rural Norway resulting from the Coordination reform regarding occupancy-rate, patient characteristics and healthcare provided during the first four years of operation. Further, to investigate whether implementation of the new municipal service avoided acute hospital admissions. DESIGN Observational study. SETTING A two-bed municipal acute bed unit. SUBJECTS All patients admitted to the unit between 2013 and 2016. MAIN OUTCOME MEASURES Demographics, comorbidity, main diagnoses and level of municipal care on admission and discharge, diagnostic and therapeutic initiatives, MAU occupancy rate, and acute hospital admission rate. RESULTS Altogether, 389 admissions occurred, 215 first-time admissions and 174 readmissions. The mean MAU bed occupancy rate doubled from of 0.26 in 2013 to 0.50 in 2016, while acute hospital admission rates declined. The patients (median age 84.0 years, 48.9% women at first time admission) were most commonly admitted for infections (28.0%), observation (22.1%) or musculoskeletal symptoms (16.2%). Some 52.7% of the patients admitted from home were discharged to a higher care level; musculoskeletal problems as admission diagnosis predicted this (RR =1.43, 95% CI 1.20-1.71, adjusted for age and sex). CONCLUSION Admission rates to MAU increased during the first years of operation. In the same period, there was a reduction in acute hospital admissions. Patient selection was largely in accordance with national and local criteria, including observational stays. Half the patients admitted from home were discharged to nursing home, suggesting that the unit was used as pathway to a higher municipal care level. Key Points Evaluation of the first four years of operation of a municipality acute bed unit (MAU) in rural Norway revealed: • Admission rates to MAU increased, timely coinciding with decreased acute admission rates to hospital medical wards. • Most patients were old and had complex health problems. • Only half the patients were discharged back home; musculoskeletal symptoms were associated with discharge to a higher care level.
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Affiliation(s)
- Anne Kjær Schmidt
- Research Unit for General Practice, Uni Research Health, Bergen, Norway;
- Luster Legekontor, Luster, Norway;
| | | | | | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Sabine Ruths Research Unit for General Practice, Uni Research Health, P. O. Box 7804, N-5020Bergen, Norway
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Abir M, Goldstick J, Malsberger R, Setodji CM, Dev S, Wenger N. The Association of Inpatient Occupancy with Hospital-Acquired Clostridium difficile Infection. J Hosp Med 2018; 13:698-701. [PMID: 29964276 PMCID: PMC6655472 DOI: 10.12788/jhm.2976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 03/03/2018] [Indexed: 11/20/2022]
Abstract
Few studies have evaluated the relationship between high hospital occupancy and hospital-acquired complications. We evaluated the association between inpatient occupancy and hospital-acquired Clostridium difficile infection (CDI) using a novel measure of hospital occupancy. We analyzed administrative data from California hospitals from 2008-2012 for Medicare recipients aged 65 years with a discharge diagnosis of acute myocardial infarction, heart failure, or pneumonia. Using daily census data, we constructed patient-level measures of occupancy on admission day and average occupancy during hospitalization (range: 0-1), which were split into 4 groups. We used logistic regression with cluster standard errors to estimate the adjusted and unadjusted relationship of occupancy with hospital-acquired CDI. Across 327 hospitals, 558,344 discharges met our inclusion criteria. Higher admission day occupancy was associated with significantly lower adjusted likelihood of CDI. Compared to the 0-0.25 occupancy group, patients admitted on a day of 0.51-0.75 occupancy had 0.86 odds of CDI (95% CI 0.75-0.98). The 0.76-1.00 admission occupancy group had 0.87 odds of CDI (95% CI 0.75-1.01). With regard to average occupancy, intermediate levels of occupancy 0.26-0.50 (odds ratio [OR] = 3.04, 95% CI 2.33-3.96) and 0.51-0.75 (OR = 3.28, 95% CI 2.51-4.28) had over 3-fold increased adjusted odds of CDI relative to the low occupancy group; the high occupancy group did not have signifcantly different odds of CDI compared to the low occupancy group (OR = 0.96, 95% CI 0.70-1.31). These findings should prompt exploration of how hospitals react to occupancy changes and how those care processes translate into hospital-acquired complications in order to inform best practices.
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Affiliation(s)
- Mahshid Abir
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.
- Innovation, Ann Arbor, Michigan, USA
- RAND Corporation, Santa Monica, California, USA
| | - Jason Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Acute Care Research Unit, Institute of Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Sharmistha Dev
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Neil Wenger
- Acute Care Research Unit, Institute of Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- RAND Corporation, Santa Monica, California, USA
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Huang D, Bastani A, Anderson W, Crabtree J, Kleiman S, Jones S. Communication and bed reservation: Decreasing the length of stay for emergency department trauma patients. Am J Emerg Med 2018; 36:1874-1879. [PMID: 30104090 DOI: 10.1016/j.ajem.2018.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prolonged emergency department (ED) length of stay (LOS) is associated with poorer clinical outcomes and patient experience. At our community hospital, trauma patients were experiencing extended ED LOS incommensurate with their clinical status. Our objective was to determine if operational modifications to patient flow would reduce the LOS for trauma patients. METHOD We conducted a retrospective chart review of admitted trauma patients from January 1, 2015 to June 30, 2016 to study two interventions. First, a communication intervention [INT1], which required the ED provider to directly notify the trauma service, was studied. Second, a bed intervention [INT2], which reserved two temporary beds for trauma patients, was added. The primary outcome was the average ED LOS change across three time periods: (1) Baseline data [BASE] collected from January 1, 2015 to June 30, 2015, (2) INT1 data collected from July 1, 2015 to October 18, 2015, and (3) INT2 data collected from October 19, 2015 to June 30, 2016. Data was analyzed using descriptive statistics, two-sample t-tests, and multivariate linear regression. RESULTS A total of 777 trauma patients were reviewed, with 151, 150 and 476 reviewed during BASE, INT1, and INT2 time periods, respectively. BASE LOS for trauma patients was 389 min. After INT1, LOS decreased by 74.35 min (±31.92; p < 0.0001). After INT2 was also implemented, LOS decreased by 164.56 min (±22.97; p < 0.0001) from BASE LOS. CONCLUSION Direct communication with the trauma service by the ED provider and reservation of two temporary beds significantly decreased the LOS for trauma patients.
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Affiliation(s)
- Derrick Huang
- Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, United States of America.
| | - Aveh Bastani
- Department of Emergency Medicine, Troy Beaumont Hospital, 44201 Dequindre Rd, Troy, MI 48085, United States of America
| | - William Anderson
- Department of Emergency Medicine, Troy Beaumont Hospital, 44201 Dequindre Rd, Troy, MI 48085, United States of America
| | - Janice Crabtree
- Management Engineering, Beaumont Health System, 44201 Dequindre Rd, Troy, MI 48085, United States of America
| | - Scott Kleiman
- Department of Emergency Medicine, Troy Beaumont Hospital, 44201 Dequindre Rd, Troy, MI 48085, United States of America
| | - Shanna Jones
- Department of Emergency Medicine, Troy Beaumont Hospital, 44201 Dequindre Rd, Troy, MI 48085, United States of America
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Mathews KS, Durst M, Vargas-Torres C, Olson AD, Mazumdar M, Richardson LD. Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients. Crit Care Med 2018; 46:720-727. [PMID: 29384780 PMCID: PMC5899025 DOI: 10.1097/ccm.0000000000002993] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. DESIGN A retrospective cohort study. SETTING Single academic tertiary care hospital. PATIENTS Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). CONCLUSIONS ICU admission decisions for critically ill emergency department patients are affected by medical ICU bed availability, though higher emergency department volume and other ICU occupancy did not play a role. Prolonged emergency department boarding times were associated with worse patient outcomes, suggesting a need for improved throughput and targeted care for patients awaiting ICU admission.
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Affiliation(s)
- Kusum S. Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Matthew Durst
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | | | - Ashley D. Olson
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
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Abstract
Community hospitals have been supported by the general public and by professionals as one means of increasing choice between local, low technology, care and high technology care at the district general hospital. However, there is no information on the impact of community hospitals on district general hospital use subsequent to NHS and community care reforms. Examination of routinely gathered activity data in the Bath Health District revealed that availability of community hospital beds was associated with reduced use of central inpatient services in the city of Bath. The reduction was most apparent for medical and geriatric beds. Decrease in the use of surgical beds was small. However, total inpatient bed use (including central and community hospital beds) was higher in the population with access to community hospital beds. We conclude that community hospitals offer one option for accessible health care and, as such, merit systematic evaluation of costs and benefits. This study presents some evidence that savings could be achieved through improved efficiency.
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Affiliation(s)
- C Hine
- Health Commission for Wiltshire and Bath, Devizes, England
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O'Brien C, McMorrow J, O'Dwyer E, Govender P, Torreggiani WC. Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting. Ir Med J 2018; 111:670. [PMID: 29869851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.
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Affiliation(s)
- C O'Brien
- Department of Radiology, Tallaght Hospital and Trinity College, Dublin 24
| | - J McMorrow
- Department of Radiology, Tallaght Hospital and Trinity College, Dublin 24
| | - E O'Dwyer
- Department of Radiology, Tallaght Hospital and Trinity College, Dublin 24
| | - P Govender
- Department of Radiology, Tallaght Hospital and Trinity College, Dublin 24
| | - W C Torreggiani
- Department of Radiology, Tallaght Hospital and Trinity College, Dublin 24
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Fedosiuk RN, Kovalova OM. Major trends of the last decade in the number of icu beds, the number of icu patients, and the rates of icu mortality in Ukraine. Wiad Lek 2018; 71:1320-1324. [PMID: 30448804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Introduction: At present, the world faces an extremely heterogeneous situation in providing population with access to intensive care. In healthcare systems of different countries, there are significant differences in the number of available ICU beds per 10 thousand population. Even in the united Europe, the indicator is extremely variable and ranges from 0.42 ICU beds per 10.000 population in Portugal to 2.92 ICU beds per 10.000 population in Germany (a difference of almost 7 times), amounting to an average of 1.15 ICU beds per 10 thousand population The aim: To identify major trends in the number of ICU beds, the number of ICU patients and the rates of ICU mortality in Ukraine over the period of time from 2007 to 2015 based on the analysis of available data on the national intensive care service. PATIENTS AND METHODS Materials and methods: The data from the 2007 nationwide audit of the domestic intensive care service and the summarized 2015 annual reports from the regional intensive care services, encompassing all the healthcare facilities that provide intensive care to population (819 hospitals in total) and represent 22 out of 26 administrative territories (regions) of the country, have been used to carry out comparative, 2015 vs. 2007, analysis and establish major trends in the indicators of interest. RESULTS Results: The negligible increase in the number of ICU beds on referential territories in absolute (from 4.765 to 5.049) and relative (from 1.4 to 1.5 per 10 thousand population) figures have been found within the period of time from 2007 to 2015. In contrast, more prominent increase in the number of ICU patients (from 385.068 to 462.395 in absolute figures and from 111.6 to 138.2 per 10 thousand population) and in ICU mortality rates (from 8.4% to 8.7%) have been established. The average Ukrainian figure of the number of ICU beds per 10 thousand population for the year 2015 (1.5) seems to be roughly comparable with the corresponding European one for the year 2012 (1.15). CONCLUSION Conclusions: The inclining trends in the number of ICU patients and ICU mortality rates, against the background of negligible growth in the bed capacity of the national intensive care service, indicate the need in the increase in the number of ICU beds in Ukraine.
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Affiliation(s)
- Roman N Fedosiuk
- Ukrainian Institute Of Strategic Studies Of The Ministry Of Health Of Ukraine, Kyiv, Ukraine
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Abstract
This study characterizes trends in the use by nursing homes of nursing home specialists (defined as generalist physicians, nurse practitioners, and physician assistants) who billed at least 90% of their clinical episodes from nursing home settings between 2012 ans 2015.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Rachel M Werner
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Urizzi F, Tanita MT, Festti J, Cardoso LT, Matsuo T, Grion CM. Caring for critically ill patients outside intensive care units due to full units: a cohort study. Clinics (Sao Paulo) 2017; 72:568-574. [PMID: 29069261 PMCID: PMC5629747 DOI: 10.6061/clinics/2017(09)08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/13/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.
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Affiliation(s)
- Fabiane Urizzi
- Pos-graduacao, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR
| | - Marcos T. Tanita
- Unidade de Terapia Intensiva Adulto, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR
| | - Josiane Festti
- Departamento de Medicina Interna, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR
| | - Lucienne T.Q. Cardoso
- Departamento de Medicina Interna, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR
| | - Tiemi Matsuo
- Departamento de Estatistica, Universidade Estadual de Londrina, Londrina, PR, BR
| | - Cintia M.C. Grion
- Departamento de Medicina Interna, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR
- *Corresponding author. E-mail:
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Shin S, Lee SH, Kim DH, Kim SC, Kim TY, Kang C, Jeong JH, Lim D, Park YJ, Lee SB. The impact of the improvement in internal medicine consultation process on ED length of stay. Am J Emerg Med 2017; 36:620-624. [PMID: 28970026 DOI: 10.1016/j.ajem.2017.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy. METHOD This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine. RESULTS Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94min to 706.62min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59min to 180.38min and from 481.89min to 362.37min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar. CONCLUSION The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department.
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Affiliation(s)
- Sangheon Shin
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea.
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
| | - Seong Chun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-Do, Republic of Korea
| | - Tae Yun Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
| | - Jin Hee Jeong
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-Do, Republic of Korea
| | - Yong Joo Park
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-Do, Republic of Korea
| | - Sang Bong Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea
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Longo F, Siciliani L, Gravelle H, Santos R. Do hospitals respond to rivals' quality and efficiency? A spatial panel econometric analysis. Health Econ 2017; 26 Suppl 2:38-62. [PMID: 28940914 DOI: 10.1002/hec.3569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 05/27/2023]
Abstract
We investigate whether hospitals in the English National Health Service change their quality or efficiency in response to changes in quality or efficiency of neighbouring hospitals. We first provide a theoretical model that predicts that a hospital will not respond to changes in the efficiency of its rivals but may change its quality or efficiency in response to changes in the quality of rivals, though the direction of the response is ambiguous. We use data on eight quality measures (including mortality, emergency readmissions, patient reported outcome, and patient satisfaction) and six efficiency measures (including bed occupancy, cancelled operations, and costs) for public hospitals between 2010/11 and 2013/14 to estimate both spatial cross-sectional and spatial fixed- and random-effects panel data models. We find that although quality and efficiency measures are unconditionally spatially correlated, the spatial regression models suggest that a hospital's quality or efficiency does not respond to its rivals' quality or efficiency, except for a hospital's overall mortality that is positively associated with that of its rivals. The results are robust to allowing for spatially correlated covariates and errors and to instrumenting rivals' quality and efficiency.
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Affiliation(s)
- Francesco Longo
- Department of Economic and Related Studies, University of York, York, UK
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Department of Economic and Related Studies, University of York, York, UK
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Rita Santos
- Centre for Health Economics, University of York, York, UK
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Abstract
OBJECTIVE The Coordination reform was implemented in Norway from 2012, aiming at seamless patient trajectories. All municipalities are required to establish emergency care beds (MEBs) to avoid unnecessary hospital admissions. We aimed to examine occupancy rate, patient characteristics, diagnoses and discharge level of municipal care in a small MEB unit. DESIGN Cross-sectional, observational study. SETTING A two-bed emergency care unit. SUBJECTS All patients admitted to the unit during one year. MAIN OUTCOME MEASURES Patients' age and gender, comorbidity, main diagnoses and municipal care level on admission and discharge, diagnostic and therapeutic initiatives, occupancy rate. RESULTS Sixty admissions were registered, with total bed occupancy 194 days, and an occupancy rate of 0.27. The patients (median age 83 years, 57% women) had mostly infections, musculoskeletal symptoms or undefined conditions. Some 48% of the stays exceeded three days and 43% of the patients were subsequently transferred to nursing homes or hospitals. CONCLUSION Occupancy rate was low. Patient selection was not according to national standards, and stays were longer. Many patients were transferred to nursing homes, indicating that the unit was an intermediate pathway or a short cut to institutional care. It is unclear whether the unit avoided hospital admissions.
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Affiliation(s)
- Heidi Nilsen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Sabine Ruths Research Unit for General Practice, Uni Research Health, PO Box 7804, N-5020 Bergen, Norway
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Camenzind M. [in process]. Krankenpfl Soins Infirm 2017; 110:11. [PMID: 30300507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Flimban MA, Abduljabar DF, Dhafar KO, Deiab BA, Gazzaz ZJ, Bansuan AU, Balbed AA, Al-Shaikhi AM, Al-Motari SS, Suliman MI. Analysis of patient falls among hospitalised patients in Makkah region. J PAK MED ASSOC 2016; 66:994-998. [PMID: 27524535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the frequency and its correlation of patient fall with preventing or precipitating factors among inpatients. METHODS The observational study was conducted in Makkah Region, Saudi Arabia from October 15 2012 to November 4, 2013. Data was collected using a questionnaire from 16 hospitals in four districts of Makkah province. The material was sampled through systematic randomisation from inpatient files and data was collected for those who had fallen inside the hospital. The questionnaire, validated through a pilot study run under the Directorate of Quality and Patient Safety in Makkah, was used to see whether the hospitals had adopted and applied international standards for assessment of adult and paediatric patients for falls as well as effectiveness of these applications. RESULTS Of 4,799 beds, occupancy rates ranged from 1680(35%) to 4,799(100%). Out of 291 falls in all, 144(49.48%) were in Jeddah. Besides, 116(40%) of the falls occurred in the last quarter of the Islamic calendar. Statistically significant difference was found in fall episodes in different months (p=0.007). Statistical analysis indicated that the factors that significantly raised the number of patient falls were increase in hospital beds and their occupancy rate (Spearman's correlation: 0.621 and 0.579 respectively). CONCLUSIONS The frequency of falls varied from hospital to hospital and factors like higher number of bed capacity and occupancy rate increased the falls.
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Affiliation(s)
- Mohammed Abdulwahab Flimban
- General Director: Quality and Patient Safety Department. General Directorate of Makkah Region Health Affairs
| | - Dalal Fouad Abduljabar
- Patient Safety Supervisor, Quality and Patient Safety Administration in General Directorate of Makkah Region Health Affairs, Makkah Al-Mukkaramah
| | | | - Basma Abdulhameed Deiab
- Nursing Department Makkah Region General Directorate of Healthcare Affair Makkah Region-Nursing Department, Makkah Al-Mukkaramah
| | - Zohair Jamil Gazzaz
- Assistant Professor of Medicine /Consultant Medicine (Diabetes) Rabigh Medical College King Abdulaziz University, Jeddah
| | - Abasra Usman Bansuan
- Nursing Department, King Abdul Aziz Specialist Hospital / Taif, Directorate of Healthcare Affair Taif, Kingdom of Saudi Arabia
| | - Abeer Ahmad Balbed
- General Directorate of Healthcare Affair Makkah Region-Quality and Patient Safety Department, Kingdom of Saudi Arabia
| | - Ahmad Mohammed Al-Shaikhi
- Nursing Department Al-Qunfotha Hospital Directorate of Healthcare Affair Al-Qunfotha, Kingdom of Saudi Arabia
| | - Sultan Saad Al-Motari
- Nursing Department Al-Qunfotha Hospital Directorate of Healthcare Affair Al-Qunfotha,Kingdom of Saudi Arabia
| | - Muhammad Imran Suliman
- Clinical Skills, Department of Medicine, Faculty of Medicine at Rabigh, King Abdul Aziz University, Kingdom of Saudi Arabia
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Rice N, Nugent A, Byrne D, Normand C. Potential of Earlier Detection and Treatment of Disease-Related Malnutrition with Oral Nutrition Supplements to Release Acute Care Bed Capacity. Ir Med J 2016; 109:422. [PMID: 27814439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A recent systematic review and meta-analysis shows that appropriate use of oral nutrition supplements (ONS) in community patients is associated with a significant reduction in hospitalisations. Given higher use of acute care resource by malnourished versus normally nourished patients, this paper examines the potential to reduce bed utilisation by applying these results to Irish inpatient and malnutrition prevalence data. In 2013, adults admitted to hospital with medium or high malnutrition risk scores used an estimated 36% of adult acute inpatient bed days. Targeted use of ONS in community patients might reduce hospitalisation by 168,438 adult bed days per year, equivalent to 460 beds per day. This is particularly important, given high bed occupancy rates and twelve month daily averages of 254 patients on trolleys. Relevant stakeholders should consider strategies to ensure effective ONS use with a view to improving outcomes and reducing pressure on the acute care system.
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Affiliation(s)
| | - A Nugent
- UCD Institute of Food and Health
| | - D Byrne
- St James Hospital, James Street, Dublin 8
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