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Bed Days (bed + day)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Surgery & Surgical Specialties	25%
Nursing General	18%

Selected Abstracts

10-Year trends in the treatment and outcomes of patients with first-episode schizophrenia

ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010
J. Nielsen
Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU. 10-Year trends in the treatment and outcomes of patients with first-episode schizophrenia. Objective:, The first episode of schizophrenia is a critical period for illness course and outcomes. We aimed to investigate treatments and outcomes during the first year after the diagnosis of schizophrenia. Method:, Pharmacoepidemiologic inception cohort study of all newly diagnosed patients with schizophrenia in Denmark (n = 13 600) 1996,2005. Results:, From 1996 to 2005, the mean age at first diagnosis decreased significantly (29.2,26.1 years), more patients received antipsychotics (67.2,80.7%, annual OR = 1.07, CI: 1.06,1.09, P < 0.001) and antipsychotic polypharmacy for >4 months (16.7,37.1%, OR = 1.14, CI: 1.12,1.57, P < 0.001). The antipsychotic defined daily dosage (DDD) doubled (150,332 DDD, P < 0.001), use of antidepressants (24.3,40.6%, P < 0.001). Bed days [89.9 days (CI: 81.8,98.8) to 71.8 days, CI: 63.7,80.8, P < 0.0001] decreased, whereas outpatient contacts [10.2 (CI: 9.5,11.0) to 21.4 (CI: 19.9,21.0), P < 0.0001] doubled. Conclusion:, Between 1996 and 2005, there was an earlier recognition of schizophrenia, intensified outpatient treatment, increased use and dosing of antipsychotics and antidepressants, but also more antipsychotic polypharmacy. [source]

Evaluation of a falls prevention programme in an acute tertiary care hospital

JOURNAL OF CLINICAL NURSING, Issue 2 2007
M Hth Sci, PG Dip Clin Epi, Teresa A Williams BN
Aims and objectives., To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. Background., Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. Methods., A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six-month period. Patients' risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. Results., In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1,10), 58% (n = 774) medium risk (score = 11,20) and 5% (n = 63) high risk (score = 21,33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0·95 to 0·80 (95% CI for the difference ,0·14 to ,0·16, P < 0·001). Conclusion., We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. Relevance to clinical practice., Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls. [source]

Impact of introducing a sedation management guideline in intensive care

ANAESTHESIA, Issue 3 2006
C. Adam
Summary To ensure that sedative agents in the intensive care unit are used for maximum benefit, a guideline that promotes the accurate and continuous assessment of patients' needs is indicated. This observational 24-month prospective study investigated the effect of introducing a sedation management guideline into a 10-bedded multidisciplinary intensive care unit on length of stay, severity of illness, mortality and the number of bed days provided. Costs for all sedative drugs were calculated as cost per bed day. Intensive care unit mortality remained constant before and after guideline introduction. The length of stay of non-cardiac surgery patients was mean (SD) 4.6 (4.4) and 5.1 (4.3) days, respectively (p = 0.2). Monthly sedative cost before guideline introduction was £6285 compared to £3629 afterwards (p,0.0001), representing a real saving of £63 759 in sedative costs over the 2 years following introduction of the guideline. Guideline-directed management for sedation significantly reduces the cost of sedative drugs per bed day without any negative effect on length of ICU stay and outcome. [source]

Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service

DIABETIC MEDICINE, Issue 9 2006
M. J. Sampson
Abstract Aims, To compare diabetes bed occupancy and inpatient length of stay, before and after the introduction of a dedicated diabetes inpatient specialist nurse (DISN) service in a large UK Hospital. Methods, We analysed bed occupancy data for medical or surgical inpatients for 6 years (1998,2004 inclusive), with a DISN service in the final 2 years. Excess bed days per diabetes patient were derived from age band, specialty, and seasonally matched data for all inpatients without diabetes. We also analysed the number of inpatients with known diabetes who did not have diabetes recorded as a discharge diagnosis. Results, There were 14 722 patients with diabetes (9.7% of all inpatients) who accounted for 101 564 occupied bed days (12.4% of total). Of these, 18 161 days (17.8%) were excess compared with matched patients without diabetes, and were concentrated in those < 75 years old. Mean excess bed days per diabetes inpatient under 60 years of age was estimated to be 1.9 days before the DISN appointment, and this was reduced to 1.2 bed days after the appointment (P = 0.03). This is equivalent to 700 bed days saved per year per 1000 inpatients with diabetes under 60 years old, with an identical saving for those aged 61,75 years (P = 0.008), a saving of 1330 diabetes bed days per year by one DISN. Excess diabetes bed occupancy was 167 excess bed days per year per 1000 patients with diabetes in the local population after the DISN appointment. One quarter of the known Type 2 diabetes population were admitted annually, but one quarter of patients had no diagnostic code for diabetes. Conclusions, Diabetes excess bed occupancy was concentrated in patients < 75 years old, and this was reduced notably following the introduction of a DISN service. [source]

Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

HEALTH SERVICES RESEARCH, Issue 5 2003
Chuan-Fen Liu
Objective. To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings. Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions. Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. [source]

The Effect of Changing Practice on Fall Prevention in a Rehabilitative Hospital: The Hospital Injury Prevention Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004
Michael Vassallo FRCP
Objectives: To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital. Design: A quasi-experimental study. Setting: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. Participants: Eight hundred twenty-five consecutive patients. Intervention: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. Measurements: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. Results: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). Conclusion: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients. [source]

Evaluation of a falls prevention programme in an acute tertiary care hospital

Assertive community treatment: development of the team, selection of clients, and impact on length of hospital stay

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2002
A. Jones bn(hons) rmn rn(adult)
Mental health services have been criticized for the lack of focus and response to people suffering from a serious mental illness (SMI). Assertive community treatment (ACT) offers the potential for greater partnership working between the user and provider of mental health services. The author describes one approach in developing ACT in the UK. Four criteria were developed to identify the most appropriate service users for ACT: those with SMI, illness instability, illness disability and risk to self or others. Fifty-five clients were identified using these criteria and tracked for their length of hospital stay and frequency of admission 2 years before acceptance to an ACT team and for 12 months after. Duration of hospital stay was unchanged although both the frequency and total numbers of bed days were reduced. [source]

Impact of introducing a sedation management guideline in intensive care

Delays in discharge of vascular surgical patients: a prospective audit

ANZ JOURNAL OF SURGERY, Issue 6 2010
Senarath Edirimanne
Abstract Aim:, To quantify delays in discharge for vascular surgical patients and identify causes of such delays. Methods:, A prospective audit of delays in discharge of vascular surgical admissions over a 6-month period was performed. Expected date and time of discharge was compared with actual date and time of discharge. Day-case patients, patients who died during admission and patients not under the direct care of the vascular team were excluded. Results:, There were 99 elective and 51 acute admissions accounting for 729 hospital bed days. The median (range) age was 72 years (21,92) and 94% of patients were living independently in the community. Forty-seven percent of patients were discharged on the planned day and time, 21% on the planned day but at a later-than-predicted time and 32% were delayed by more than 1 day. Delays identified in this audit accounted for 135 bed days. Fifteen percent of delays were due to causes that can be improved by internal organization (e.g. delayed paperwork). The majority of the delays (85%) were due to external factors such as lack of rehabilitation beds or lack of placement facilities in nursing homes. Elderly patients and acute admissions were more likely to have long delays in discharge. Conclusion:, Delays in discharge of vascular surgical patients use a lot of acute surgical bed days. Strategies to prevent delays in discharge should include not only improving internal organization and early identification and referral of patients who require rehabilitation/placement but also increased funding for such essential non-acute services. [source]

The impact of the evolution of invasive surgical procedures for low back pain: a population based study of patient outcomes and hospital utilization

ANZ JOURNAL OF SURGERY, Issue 9 2009
Rachael Elizabeth Moorin
Abstract Background:, Low back pain (LBP) is a ubiquitous health problem in Western societies, and while clinical decision making for patients requiring hospitalization for LBP has changed significantly over the past two decades, knowledge of the net impact on patient outcomes and health care utilization is lacking. The aim of this study was to evaluate the effectiveness of changes in the medical control of lumbar back pain in Western Australia in terms of the rate of patient readmission and the total bed days associated with readmissions. Methods:, A record linkage population-based study of hospitalization for LBP from 1980,2003 in Western Australia was performed. The rate of admission for LBP, changes in re-admission rates and number of bed days accrued 1 and 3 years post-initial admission over time adjusted for potential confounders was evaluated. Results:, The annual rate of first-time hospitalization for LBP halved. The proportion of females admitted increased (+6%). The disease severity increased and the proportion of individuals having an invasive procedure also increased (+75%) over the study period. While rate of readmission for non-invasive procedures fell, readmission for invasive procedures increased over the study period. Overall, the number of bed days associated with readmission reduced over time. Conclusion:, Between 1980 and 2003, there has been a shift from non-invasive procedural treatments towards invasive techniques both at the time of initial hospitalization and upon subsequent readmission. While overall readmission rates were unaffected, there was a reduction in the number of bed days associated with readmissions. [source]

CONGESTIVE CARDIAC FAILURE: URBAN AND RURAL PERSPECTIVES IN VICTORIA

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2003
Mohammad Z. Ansari
ABSTRACT Objective:,Effective and timely care for congestive cardiac failure (CCF) should reduce the risks of hospitalisation. The purpose of this study is to describe variations in rates of hospital admissions for CCF in Victoria as an indicator of the adequacy of primary care services. Detailed analyses identify trends in hospitalisations, urban/rural differentials and variations by the Primary Care Partnerships (PCP). Setting:,Acute care hospitals in Victoria. Design:,Routine analyses of age and sex standardised admission rates of CCF in Victoria using the Victorian Admitted Episodes Dataset from 1993,1994 to 2000,2001. Subjects:,All patients admitted to acute care hospitals in Victoria with the principal diagnosis of CCF between 1993,1994 and 2000,2001. Results:,There were 8359 admissions for CCF in Victoria with an average of 7.37 bed days in 2000,2001. There was a significantly higher admission rate for CCF in rural areas compared to metropolitan in 2000/2001 ,(2.53/1000 (2.44,2.62) and 1.80/1000 (1.75,1.85)) , respectively. Small area analyses identified 17 PCP (14 of which were rural) with significantly higher admission rate ratios of CCF compared to Victoria. Conclusion:,Small area analyses of CCF have identified significant gaps in the management of CCF in the community. This may be a reflection of deficit in primary care availability, accessibility, or appropriateness. Detailed studies may be needed to determine the relative importance of these factors in Victoria for targeting specific interventions at the PCP level. What does this study add?:,Congestive cardiac failure is a major public health problem. In Australia, there is a lack of studies identifying long-term hospitalisation trends of CCF, as well as small area analyses, especially in regard to rural and urban variations. This study has identified significant variations over an eight year period in admission rates of CCF in rural and urban Victoria. Small area analyses (e.g. at the level of primary care partnerships) have identified rural communities with significantly higher admission rates of CCF compared to the Victorian average. For the first time in Australia, this study has provided a new approach for generating evidence on quality of primary care services in rural and urban areas, and offers opportunities for targeting public health and health services interventions that can decrease access barriers, improve the adequacy of primary care, and reduce demand on the hospital system in Victoria. [source]

Day case management of sickle pain: 3 years experience in a UK sickle cell unit

BRITISH JOURNAL OF HAEMATOLOGY, Issue 6 2004
J. Wright
Summary A day centre was established to determine whether an alternative approach to the management of uncomplicated sickle pain would improve the quality of care and reduce hospital admissions in patients with sickle cell disease. Since the centre opened there has been a 43% decrease in hospital admissions and 49% decrease in occupied bed days. In the third year, 84% of patients treated for severe sickle pain were managed without the need for hospital admission. A centre offering day case management of painful crisis reduced unnecessary hospital admissions for uncomplicated pain. This approach is safe and cost-effective. [source]

Laparoscopic colectomy is cheaper than conventional open resection

COLORECTAL DISEASE, Issue 9 2007
P. F. Ridgway
Abstract Objective, International randomized trials have endorsed the routine use of laparoscopic techniques in colorectal surgery. The authors hypothesize that the overall care pathway in minimal access resection was cheaper than conventional open resection. Method, This was a case-matched study of consecutive patients undergoing laparoscopic resection between July 2005 and February 2006. Intraoperative (costs, duration, incision length) and postoperative [morbidity, length of stay (LOS), readmission] parameters were examined. Institutional retrospective open controls and national validated figures were used for costings. Results, Thirty-five laparoscopic and 53 open resections were evaluated. Median LOS was 5 days in the laparoscopic group vs 12 in the open group (P = 0.001). There were two conversions (5.7%) and two readmissions. Mean operative cost of laparoscopic resection was ,1557.08, therefore 2.4 bed days need to be saved to recoup the increased cost compared with open resection. The actual median save is 7 days (P = 0.031). A mean of ,4591.38 and 7 bed days per case is saved by performing the resection laparoscopically. Subgroup analysis of laparoscopic resections clearly demonstrates similar trends. Conclusion, The institutional saving is over ,150 000 and 245 bed days during the study period. Despite higher operative spending, laparoscopic colorectal resections are significantly cheaper than conventional open resections. [source]