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Hospital Resources (hospital + resource)
Selected AbstractsObese Patients with Abdominal Pain Presenting to the Emergency Department Do Not Require More Time or Resources for Evaluation Than Nonobese PatientsACADEMIC EMERGENCY MEDICINE, Issue 8 2005Timothy F. Platts-Mills MD Abstract Objectives: The authors describe the evaluation of obese and nonobese adult patients with abdominal pain presenting to an emergency department (ED). The hypothesis was that more ED and hospital resources are used to evaluate and treat obese patients. Methods: A prospective observational study of obese (n= 98; body mass index ,30 kg/m2) and nonobese (n= 176; body mass index < 30 kg/m2) adults presenting to the ED with abdominal pain was performed. ED length of stay (LOS) was the primary outcome. Secondary outcomes included use of laboratory tests, computed tomography, and ultrasonography, and rates of consultations, operations, and admissions. ED diagnoses were compared between the two groups. Results: Obese patients were older (41.9 vs. 38.3 years; p = 0.027) and more often female (69% vs. 51%; p = 0.003) than nonobese patients. There were no significant differences between obese and nonobese patients in either the primary or the secondary outcome measures. Obese patients were similar to nonobese patients in regard to LOS (457 vs. 486 minutes), laboratory studies (3.2 vs. 2.9 tests), abdominopelvic computed tomographic scans (30% vs. 31%), and abdominal ultrasounds (16% vs. 13%). Obese and nonobese patients were also similar in their rates of consultations (27% vs. 31%), operations (14% vs. 12%), and admissions (18% vs. 24%). No difference was found for LOS between obese and nonobese patients as evaluated by the Wilcoxon rank-sum test (p = 0.81). Logistic regression analysis controlling for baseline characteristics revealed no significant differences between obese and nonobese patients for secondary outcome variables. ED diagnoses for obese and nonobese patients were similar except that genitourinary diagnoses were less common in obese patients (8% vs. 21%; p = 0.01). Conclusions: In contradiction to the hypothesis, the results suggest that LOS and ED resource use in obese patients with abdominal pain are not increased when compared with nonobese patients. [source] Simplifying head and neck microvascular reconstructionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004Eben Rosenthal MD Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source] Variables impacting on patients' perceptions of discharge from short-stay hospitalisation or same-day surgeryHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000William S. Rowe DSW PSW Abstract The paper presents components of a study (n = 929) that was designed to examine, at one specific point in time, the hospital experience of the patient and the patient's corresponding recovery at home. Variables that captured the hospitalization and recovery experience relate to the degree of patient involvement in decisions about their treatment and discharge plans. Levels of health and recovery-related information reported by patients and their level of confidence in ability to resume regular activities once home were also measured. In general, individuals reported what many would consider having received less than optimal levels of information about their illness and recovery at home. Many patients also reported that they neither participated, nor were consulted on their needs or perceptions during their hospitalization. Expectations were that problems that patients might experience once home would have their origins in problems from within the community. However, the community resources were found to be less implicated and hospital resources more so. This suggests the importance of examining institutional issues even when one is focusing on the delivery of community services. [source] Role of volume outcome data in assuring quality in HPB surgeryHPB, Issue 5 2007BERNARD LANGER Abstract Many studies have shown an association between both surgeon and hospital operative procedure volumes and outcomes, particularly operative mortality. It is also recognized that volume is only one of a number of factors, including 1) surgeon training and experience, and 2) hospital resources, organization, and processes of care, which can also influence outcomes. The Surgical Oncology Program at Cancer Care Ontario has included hospital volumes in a set of standards for the conduct of major pancreatic cancer surgery, along with recommendations for surgeon training and hospital resources, organization, support services, and processes of care to encourage regionalization of major HPB surgery. Cooperation with these recommendations was encouraged by the public reporting of mortality data and by an educational program directed at both surgeons and senior administrators in Ontario hospitals with the support of the provincial health ministry. The provincial mortality rate from major pancreatic cancer surgery has decreased by more than 50% since the introduction of this program. [source] Obesity and under-nutrition in a tertiary paediatric hospitalJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2004J O'Connor Objective: (i) To determine the prevalence of over- and under-nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over-nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital. Methods: Patients aged over 12 months were proportionately sampled from medical and surgical wards and outpatient clinics. Data were collected for 245 inpatients (54% male) and 272 outpatients (55% male). Children's height, weight and body mass index (kg/m2) were measured. Overweight, obesity and under-nutrition were defined according to international criteria. Prevalence of overweight and obesity was compared with that in the 1995 Australian National Nutrition Survey (NNS). Results: Similar proportions of inpatients and outpatients were underweight (6%) and wasted (4%). The prevalence of overweight and obesity in inpatients (22%) was similar to the NNS but was significantly higher in outpatients (32%, P < 0.0001). In a regression model to predict inpatient length of stay, nutritional status (P = 0.004) and the interaction between age and nutritional status (P = 0.009) were significant predictors. For over-nourished inpatients, length of stay increased significantly with age. For normally nourished and under-nourished inpatients, length of stay was relatively constant, regardless of age. Conclusions: There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources. [source] Effect of an Independent-capacity Protocol on Overcrowding in an Urban Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 12 2009Won Chul Cha MD Abstract Objectives:, The authors hypothesized that a new strategy, termed the independent-capacity protocol (ICP), which was defined as primary stabilization at the emergency department (ED) and utilization of community resources via transfer to local hospitals, would reduce ED overcrowding without requiring additional hospital resources. Methods:, This is a before-and-after trial that included all patients who visited an urban, tertiary care ED in Korea from July 2006 to June 2008. To improve ED throughput, introduction of the ICP gave emergency physicians (EPs) more responsibility and authority over patient disposition, even when the patients belonged to another specific clinical department. The ICP utilizes the ED as a temporary, nonspecific place that cares for any patient for a limited time period. Within 48 hours, EPs, associated specialists, and transfer coordinators perform secondary assessment and determine patient disposition. If the hospital is full and cannot admit these patients after 48 hours, the EP and transfer coordinators move the patients to other appropriate community facilities. We collected clinical data such as sex, age, diagnosis, and treatment. The main outcomes included ED length of stay (LOS), the numbers of admissions to inpatient wards, and the mortality rate. Results:, A total of 87,309 patients were included. The median number of daily patients was 114 (interquartile range [IQR] = 104 to 124) in the control phase and 124 (IQR = 112 to 135) in the ICP phase. The mean ED LOS decreased from 15.1 hours (95% confidence interval [CI] = 14.8 to 15.3) to 13.4 hours (95% CI = 13.2 to 13.6; p < 0.001). The mean LOS in the emergency ward decreased from 4.5 days (95% CI = 4.4 to 4.6 days) to 3.1 days (95% CI = 3.0 to 3.2 days; p < 0.001). The percentage of transfers from the ED to other hospitals decreased from 3.5% to 2.5% (p < 0.001). However, transfers from the emergency ward to other hospitals increased from 2.9% to 8.2% (p < 0.001). Admissions to inpatient wards from the ED were significantly reduced, and admission from the emergency ward did not change. The ED mortality and hospital mortality rates did not change (p = 0.15 and p = 0.10, respectively). Conclusions:, After introduction of the ICP, ED LOS decreased without an increase in hospital capacity. [source] Theatre times and delays in elective oral and maxillofacial listsORAL SURGERY, Issue 4 2009W. Aleid Abstract Aim:, Cancelled operations are a major drain on hospital resources. The maxillofacial department at the Leicester Royal Infirmary (LRI) performs at least 14 elective operating sessions each week. A study reported that our cancellation rate or performance indicator (PI) was 0.3% at LR1. The most common reasons for cancellation of procedures at that time were lack of post-operative beds and insufficient operating time. This study aimed to continue to develop a methodology for looking at this complex issue and to further investigate the reasons for delay to assess whether the system could be managed more efficiently. Material and Methods:, In this study, the computerised theatre records system has been utilised to investigate the reasons for theatre delays. A retrospective analysis of data for 1212 patients treated in the 1 year period between December 2006 and December 2007 was performed. Results and Conclusions:, Eight hundred and forty-nine patients were treated on a day-surgery basis, of which 710 were dentoalveolar procedures and 139 were other operations. The remaining 363 patients were treated as in-patients of which 97 were oncological patients, 84 orthognathic, 35 salivary gland surgery, 65 traumas, and 82 other operations. Sixty-four (5.28%) of these treatment episodes were logged as delayed. The main reasons for delays were related to the ward (17%) or anaesthetist (22%). The operating time consumed 74% of the overall time in theatre complex. The utilisation of operating time was much better for in-patient operations (81%) than day-surgery procedures (64%). Suggestions have been made to reduce theatre delays. [source] Rural-Urban Differences in Health Risks, Resource Use and Expenditures Within Three State Medicaid Programs: Implications for Medicaid Managed CareTHE JOURNAL OF RURAL HEALTH, Issue 1 2002Janet M. Bronstein Ph.D. This study uses Medicaid claims data for income-eligible enrollees in California, Georgia and Mississippi to compare expenditures, resource usage and health risks between residents of rural and urban areas of the states. Resource use is measured using the Resource Based Relative Value Scale (RBRVS) system for professional services, hospital days and outpatient facility visits; it also is valued at private insurance reimbursement rates for the states. Health risks are measured using the diagnosis-based Adjusted Clinical Group system. Resource use is compared on a risk-adjusted basis with the use of urban Medicaid enrollees as the benchmark. We find that actual expenditures for rural care users are lower than for urban care users. However, because the proportion of Medicaid enrollees who use care is higher in rural than in urban areas in all three states, expenditures per rural enrollee are not consistently lower. Case mix is more resource intensive for rural compared to urban residents in all three states. Although resource usage is not systematically lower owerall for rural enrollees, on a risk-adjusted basis they tend to use less hospital resources than urban enrollees. Capitation rates based on historical per enrollee expenditures would not appear to under-reimburse managed care organizations for the care of rural as opposed to urban residents in the study states. [source] SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIAANZ JOURNAL OF SURGERY, Issue 4 2005Kenneth Wong Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15,82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed , laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1,107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma. [source] Hospital Costs and Revenue Are Similar for Resuscitated Out-of-hospital Cardiac Arrest and ST-segment Acute Myocardial Infarction PatientsACADEMIC EMERGENCY MEDICINE, Issue 6 2010Robert Swor DO Abstract Objectives:, Care provided to patients who survive to hospital admission after out-of-hospital cardiac arrest (OOHCA) is sometimes viewed as expensive and a poor use of hospital resources. The objective was to describe financial parameters of care for patients resuscitated from OOHCA. Methods:, This was a retrospective review of OOHCA patients admitted to one academic teaching hospital from January 2004 to October 2007. Demographic data, length of stay (LOS), and discharge disposition were obtained for all patients. Financial parameters of patient care including total cost, net revenue, and operating margin were calculated by hospital cost accounting and reported as median and interquartile range (IQR). Groups were dichotomized by survival to discharge for subgroup analysis. To provide a reference group for context, similar financial data were obtained for ST-segment elevation myocardial infarction (STEMI) patients admitted during the same time period, reported with medians and IQRs. Results:, During the study period, there were 72 admitted OOCHA patients and 404 STEMI patients. OOCHA and STEMI groups were similar for age, sex, and insurance type. Overall, 27 (38.6%) OOHCA patients survived to hospital discharge. Median LOS for OOHCA patients was 4 days (IQR = 1,8 days), with most of those hospitalized for ,4 days (n = 34, 81.0% dying or discharged to hospice care). Median net revenue ($17,334 [IQR $7,015,$37,516] vs. $16,466 [IQR = $14,304,$23,678], p = 0.64) and operating margin ($7,019 [IQR = $1,875,$15,997] vs. $7,098 [IQR = $3,767,$11,138], p = 0.83) for all OOHCA patients were not different from STEMI patients. Net income for OOCHA patients was not different than for STEMI patients (,$322 vs. $114, p = 0.72). Conclusions:, Financial parameters for OOHCA patients are similar to those of STEMI patients. Financial issues should not be a negative incentive to providing care for these patients. ACADEMIC EMERGENCY MEDICINE 2010; 17:612,616 © 2010 by the Society for Academic Emergency Medicine [source] Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control studyCLINICAL TRANSPLANTATION, Issue 6 2005Michelle Gearhart Abstract:, Background:, Liver transplant recipients are at high risk for multi-drug resistant infections because of broad-spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients. Methods:, Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co-infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls. Results:, Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty-eight non-VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4,348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non-VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group ($6500 vs. 1750; p = 0.02) as well. Conclusion:, VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non-VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival. [source] A Multicasualty Event: Out-of-hospital and In-hospital Organizational AspectsACADEMIC EMERGENCY MEDICINE, Issue 10 2004Malka Avitzour MPH Abstract In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. Objectives: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. Methods: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. Results: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. Conclusions: During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions. [source] | ||||||||||||||||||||||