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Inpatient Wards (inpatient + ward)
Selected AbstractsEstimating Observation Unit Profitability with Options ModelingACADEMIC EMERGENCY MEDICINE, Issue 5 2008Christopher W. Baugh MD Abstract Background:, Over the past two decades, the use of observation units to treat such common conditions as chest pain, asthma, and others has greatly increased. These units allow patients to be directed out of emergency department (ED) acute care beds while potentially avoiding inpatient admission. Many studies have demonstrated the clinical effectiveness of care delivered in such a setting compared to the ED or inpatient ward. However, there are limited data published about observation unit finance. Methods:, Using the economic principles of stock options, opportunity costs, and net present value (NPV), a model that captures the value generated by admitting a patient to an observation unit was derived. In addition, an appendix is included showing how this model can be used to calculate the dollar value of an observation unit admission. Results:, A model is presented that captures more complexity of observation finance than the simple difference between payments and costs. The calculated estimate in the Appendix suggests that the average value of a single observation unit admission was about $2,908, which is about 40% higher than expected. Conclusion:, Subtraction of costs from payments may significantly underestimate the financial value of an observation unit admission. However, the positive value generated by an observation unit bed must be considered in the context of other projects available to hospital administrators. [source] Violence in a general hospital: comparison of assailant and other assault-related factors on accident and emergency and inpatient wardsACTA PSYCHIATRICA SCANDINAVICA, Issue 2002S. Winstanley Objective:, This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors. Method:, A prospective interview-based survey design was adopted. Forty-eight assaulted staff were interviewed about 69 incidents within 7 days on average of the incident occurring. The presence or absence of various assailant, employee, situation, interaction and outcome factors derived from the UK Health Services Advisory Committee's model was compared between the two settings. Results:, Inpatient ward incidents were significantly more likely to have the following characteristics: female perpetrator, perpetrator aged over 70 years, daytime occurrence in a restricted area, resolved by support from other health care staff. Conclusion:, Aggression frequently occurs on inpatient (medical and surgical) wards of a general hospital. Aggression management training for staff working in both accident and emergency and inpatient settings should be cognisant of the similarities and differences within general health care specialisms. [source] Development and implementation of a noise reduction intervention programme: a pre- and postaudit of three hospital wardsJOURNAL OF CLINICAL NURSING, Issue 23 2009Annette Richardson Aims., By developing, implementing and delivering a noise reduction intervention programme, we aimed to attempt to reduce the high noise levels on inpatient wards. Background., Sleep is essential for human survival and sleep deprivation is detrimental to health and well being. Exposure to noise has been found to disrupt sleep in hospitalised patients which is to be expected as noise levels have been measured and reported as high. Design., A primarily nursing focused, multi-method approach, involving development of clinical guidelines, ward environment review and a staff noise awareness and education programme, was used to target mainly nursing staff plus other healthcare staff on three wards within one hospital. Methods., This practice development initiative was carried out in three key phases (1) Preaudit of ward noise levels, (2) The development, implementation and delivery of a noise reduction intervention programme, (3) Postaudit of ward noise levels. Results., Preintervention average peak decibel levels over 24 hours were found to be 96·48 dB(A) and postintervention average peak decibel levels were measured at 77·52 dB(A), representing an overall significant reduction in noise levels (p < 0·001). Conclusions., This study describes one way to reduce peak noise levels on inpatient hospital wards. Relevance to clinical practice., Sleep deprivation is detrimental to patients with acute illness, so any developments to improve patients' sleep are important. Nurses have a key role in leading, developing and implementing changes to reduce peak noise levels on inpatient wards in hospitals. This nurse-led practice development programme has demonstrated how improvements can be achieved by significantly reducing peak noise levels using simple multi-method change strategies. [source] Best practice from admission to discharge in acute inpatient care: considerations and standards from a whole system perspectiveJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2005A. JONES phd bn (hons) rmn Effective mental health care and promotion involves numerous agencies and individuals. Hence, practice development for people with acute mental health needs requires a systemic (or whole system) perspective. Whilst a policy imperative, this is unfamiliar practice for many health and social care workers. In a previous paper published within this journal, the authors argued that admission to acute inpatient care may sometimes be occasioned by the need to contain worker anxiety within the whole system, rather than being clinically justified or necessary. In this paper the authors seek to follow up this premise with proposals for purposeful admission and standards to assure the quality throughout the patient journey, into and out of acute inpatient wards. [source] Training in cognitive behavioural interventions on acute psychiatric inpatient wardsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2005E. McCANN phd msc rmn dip psi pgdip (academic practice) There has been a drive towards addressing the types of care and therapeutic interventions available to people with serious mental illness, which is reflected in the latest government mental health policy initiatives. Recent evidence strongly supports the implementation of psychological and social interventions for people with psychosis, and in particular the use of cognitive behavioural techniques. Until now, the main focus has been on people living in the community. This study examines the delivery of psychosocial interventions training to qualified psychiatric nurses and unqualified staff on seven acute psychiatric admission wards in London, UK. The approach had the strength of on-site delivery, follow-up role modelling of the interventions and clinical supervision. Despite this, in some cases the training was less successful, mainly because of staffing and leadership weaknesses. The impact of training in these methods and the implications for mental health education and practice development are discussed. [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] 11 Dawn Patrol Patient Follow-up ProtocolACADEMIC EMERGENCY MEDICINE, Issue 2008Justin Williams Follow-up of patients after their emergency department course provides a rich educational experience for residents, but due to time and logistical constraints, is infrequently performed in a scheduled and rigorous manner. The Dawn Patrol initiative was added to our residency curriculum to facilitate and protocolize patient follow-up for education and feedback on patient care. It also strives to improve communication with inpatient services, and provides a means of collection for morbidity / mortality and risk management cases. Our process functions by charging the clinical senior resident who is going off-shift, with reviewing the admission record for the past 24 hours. Interesting, clinically important, or cryptic case presentations are selected via our electronic medical record for review at the end of Morning Report. Generally, 1-3 new cases are selected for review each weekday morning. These cases are then recorded on a dry erase board in the Morning Report room, and the cases are followed until inpatient discharge, or are no longer of clinical interest. Visits to the inpatient wards are encouraged. Patient callbacks of outpatients are also eligible for inclusion. The cases are updated daily, and generally 5-10 cases are reviewed per day in approximately 10 minutes. The staff member attending Morning Report is responsible for providing bulleted teaching points on each case. The Dawn Patrol patient follow-up initiative seeks to improve emergency medicine resident education by facilitating and protocolizing patient follow-up, and provides real-time feedback on patient care performed in the emergency department. [source] | ||||||||||