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Hospital Beds (hospital + bed)
Selected AbstractsHospital beds and the quality of a national health systemAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2010Andrew Phillips No abstract is available for this article. [source] Developing Models for Patient Flow and Daily Surge Capacity ResearchACADEMIC EMERGENCY MEDICINE, Issue 11 2006Brent R. Asplin MD Between 1993 and 2003, visits to U.S. emergency departments (EDs) increased by 26%, to a total of 114 million visits annually. At the same time, the number of U.S. EDs decreased by more than 400, and almost 200,000 inpatient hospital beds were taken out of service. In this context, the adequacy of daily surge capacity within the system is clearly an important issue. However, the research agenda on surge capacity thus far has focused primarily on large-scale disasters, such as pandemic influenza or a serious bioterrorism event. The concept of daily surge capacity and its relationship to the broader research agenda on patient flow is a relatively new area of investigation. In this article, the authors begin by describing the overlap between the research agendas on daily surge capacity and patient flow. Next, they propose two models that have potential applications for both daily surge capacity and hospitalwide patient-flow research. Finally, they identify potential research questions that are based on applications of the proposed research models. [source] Older patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] Does Deinstitutionalization Increase Suicide?HEALTH SERVICES RESEARCH, Issue 4 2009Jangho Yoon Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds,separately for not-for-profit and for-profit,can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state-level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982,1998. We categorize psychiatric beds separately for public, not-for-profit, and for-profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not-for-profit or for-profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising. [source] Supply of inpatient geriatric medical services in AustraliaINTERNAL MEDICINE JOURNAL, Issue 4 2007L. Gray Abstract This study summarizes the findings of a national survey of inpatient geriatric services in Australia conducted in 2001. These data are unique as there are no uniform administrative data systems available to provide this information. Eight hundred and eighty-eight hospitals were surveyed and full responses were received from 690, representing 78% of hospitals and 85% of all hospital beds. The results illustrated wide variation in the style and level of provision of services among hospitals and across regional and state jurisdictions. [source] Factors Associated with Home Versus Institutional Death Among Cancer Patients in ConnecticutJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001William T. Gallo PhD OBJECTIVE: To assess the relationships between home death and a set of demographic, disease-related, and health-resource factors among individuals who died of cancer. DESIGN: Prospective cohort study. SETTING: All adult deaths from cancer in Connecticut during 1994. PARTICIPANTS: Six thousand eight hundred and thirteen individuals who met all of the following criteria: died of a cancer-related cause in 1994, had previously been diagnosed with cancer in Connecticut, and were age 18 and older at the time of death. MEASUREMENT: Site of death. RESULTS: Twenty-nine percent of the study sample died at home, 42% died in a hospital, 17% died in a nursing home, and 11% died in an inpatient hospice facility. Multivariate analysis indicated that demographic characteristics (being married, female, white, and residing in a higher income area), disease-related factors (type of cancer, longer survival postdiagnosis), and health-resource factors (greater availability of hospice providers, less availability of hospital beds) were associated with dying at home rather than in a hospital or inpatient hospice. CONCLUSIONS: The implications of this study for clinical practice and health planning are considerable. The findings identify groups (men, unmarried individuals, and those living in lower income areas) at higher risk for institutionalized death,groups that may be targeted for possible interventions to promote home death when home death is preferred by patients and their families. Further, the findings suggest that site of death is influenced by available health-system resources. Thus, if home death is to be supported, the relative availability of hospital beds and hospice providers may be an effective policy tool for promoting home death. J Am Geriatr Soc 49:771,777, 2001. [source] Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospitalJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2007Ömer Dizdar MD Abstract Aim, To assess the appropriateness of utilization of beds in the internal medicine department of a university hospital. Methods, The appropriateness of hospital stay was evaluated using the Appropriateness Evaluation Protocol. A random sample of 402 days of stay was assessed. Results, One hundred and thirty-nine days of stay (34.6%) were classified as inappropriate. The inappropriate stays were mostly secondary to hospital-related factors. The two major factors for inappropriate stays were ,inappropriate timing/delay in diagnostic procedures/consultations' (27%) and ,delay in obtaining test results' (27%). None of the factors including age, gender, residence and inpatient period was significantly related to inappropriate stay in univariate analysis. Conclusion, This study indicated that a significant portion of stays were inappropriate. Efforts to decrease particularly hospital-related factors associated with inappropriate stay are needed. [source] An explanatory model of medical practice variation: a physician resource demand perspectiveJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2002Michael J. Long MA PhD Abstract Practice style variation, or variation in the manner in which physicians treat patients with a similar disease condition, has been the focus of attention for many years. The research agenda is further intensified by the unrealistic assumption that by reducing variation, quality will be improved, costs will be reduced, or both. There is a wealth of literature that identifies differences in health care use of many kinds, in apparently similar communities. Attempts have been made by many scholars to identify the determinants of variation in terms of differences in the population characteristics (e.g. age, sex, insurance, etc.) and geographical characteristics (e.g. distance to provider, number of physicians, number of hospital beds, etc.). When significant differences in use rates prevail after controlling for differences in population characteristics, it is often attributed to ,uncertainty', or the fact that there is no consensus on what constitutes the optimum treatment process. It is suggested by this literature that the greatest variation can be found in the circumstances where there is the most ,uncertainty'. In this work, a physician resource demand model is proposed in which it is suggested that, during the diagnosis and treatment process, physicians demand resources consistent with the clinical needs of the patients, modified by the intervening forces under which they practice. These intervening forces, or constraints, are categorized as patient agency constraints, organizational constraints and environmental constraints, which are characterized as ,induced variation'. It is suggested that when all of the variables that constitute these constraints are identified, the remaining variance represents ,innate variance', or practice style differences. It is further suggested that the more completely this model is specified, the more likely area differences will be attenuated and the smaller will be the residual variance. [source] Regulating hospital use: length of stay, beds and whiteboardsNURSING INQUIRY, Issue 1 2005Marie Heartfield This paper presents part of a larger study of contemporary nursing practice and the rationalisation of hospital length of stay. Informed by Michel Foucault's work on governmentality, length of hospital stay and the re-engineering of surgical services are examined, not in terms of numerical representations of hospital use, but as part of social and political processes through which certain concepts are made susceptible to measurement and practices are organised. Using data generated through fieldwork in a hospital surgical division this analysis offers understandings of how social practices around length of hospital stay are translated and how they pattern contemporary hospital nursing practice. Nursing practice is explored through the reconstitution of hospital beds and the demands of local administration of hospital length of stay. [source] Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return VisitsACADEMIC EMERGENCY MEDICINE, Issue 5 2007DrPH, Jane McCusker MD ObjectivesTo explore hospital characteristics and indicators of emergency department (ED) care of older patients associated with return visits to the ED. MethodsProvincial databases in the province of Quebec, Canada, and a survey of ED geriatric services were linked at the individual and hospital level, respectively. All general acute care adult hospitals with at least 100 eligible patients who visited an ED during 2001 were included (N= 80). The study population (N= 140,379) comprised community-dwelling individuals aged 65 years and older who made an initial ED visit in 2001 and were discharged home. Characteristics of the hospitals included location, number of ED beds, ED resources, and geriatric services in the hospital and the ED. Indicators of ED care at the initial visit included day of the visit, availability of hospital beds, and relative crowding. The main outcome was time to first return ED visit; the authors also analyzed the type of return visit (with or without hospital admission at return visit, and return visits within seven days). ResultsIn multilevel multivariate analyses adjusting for patient characteristics (sociodemographic, ED diagnosis, comorbidity, prior health services utilization), the following variables were independently associated (p < 0.05) with a shorter time to first return ED visit: more limited ED resources, fewer than 12 ED beds, no geriatric unit, no social worker in the ED, fewer available hospital beds at the time of the ED visit, and an ED visit on a weekend. ConclusionsIn general, more limited ED resources and indicators of ED care (weekend visits, fewer available hospital beds) are associated with return ED visits in seniors, although the magnitude of the effects is generally small. [source] Deaths of children occurring at home in six European countriesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2010G. Pousset Abstract Objectives Until now there have been no population-based European data available regarding place of death of children. This study aimed to compare proportions of home death for all children and for children dying from complex chronic conditions (CCC) in six European countries and to investigate related socio-demographic and clinical factors. Methods Data were collected from the death certificates of all deceased children aged 1,17 years in Belgium, the Netherlands, Norway, England, Wales (2003) and Italy (2002). Gender, cause and place of death (home vs. outside home) and socio-demographic factors (socio-economic status, degree of urbanization and number of hospital beds in the area) were included in the analyses. Data were analysed using frequencies and multivariate logistic regression. Results In total 3328 deaths were included in the analyses; 1037 (31.2%) related to CCC. The proportion of home deaths varied between 19.6% in Italy and 28.6% in the Netherlands and was higher for children dying from CCC in all the countries studied, varying between 21.7% in Italy and 50% in the Netherlands. Among children dying from CCC, home death was more likely for cancer patients and those aged over 10 years. After controlling for potentially related clinical and socio-demographic factors, differences in the proportion of home deaths between countries remained significant, with higher proportions in Belgium and the Netherlands as compared with Italy. Conclusions Although home deaths comprise a substantial proportion of all deaths of children with CCCs, variation among disease categories and across countries suggest that considerable potential still exists for further improvements in facilitating end-of-life care in the home for those children and families who desire to be in this location. [source] | ||||||||||