(1/189) Public hospital resource allocations in El Salvador: accounting for the case mix of patients.

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.  (+info)

(2/189) The winter bed crisis--quantifying seasonal effects on hospital bed usage.

Winter bed crises are a common feature in NHS hospitals, and have given rise to great concern. We set out to determine the relative contribution of seasonal effects and other factors to bed occupancy in a large teaching hospital over one year. There were 190,804 occupied bed-days, which we analysed by specialty groupings. There was considerable variability in bed occupancy in each specialty. A significant winter peak occurred for general medicine and orthopaedics together with a significant increase on 'take-in' days. Virtually all specialties showed a significant variation in occupancy between weekdays. Geriatric Medicine had a high and fairly constant occupancy, with some seasonal effect. We conclude that seasonal trends in bed occupancy occur in 'front door' specialties and are predictable. In these specialties, admission policies also make a contribution to bed usage and are amenable to modification. There is no surge in occupancy in the immediate post-Christmas period, except that attributable to the seasonal trend. In the 'elective' specialties, bed occupancy fluctuates widely, with reduced occupancy at weekends and at Christmas. These differences are entirely amenable to modification. More effective bed management would make a very significant contribution to avoiding winter bed crises.  (+info)

(3/189) Dynamics of bed use in accommodating emergency admissions: stochastic simulation model.

OBJECTIVE: To examine the daily bed requirements arising from the flow of emergency admissions to an acute hospital, to identify the implications of fluctuating and unpredictable demands for emergency admission for the management of hospital bed capacity, and to quantify the daily risk of insufficient capacity for patients requiring immediate admission. DESIGN: Modelling of the dynamics of the hospital system, using a discrete-event stochastic simulation model, which reflects the relation between demand and available bed capacity. SETTING: Hypothetical acute hospital in England. SUBJECTS: Simulated emergency admissions of all types except mental disorder. MAIN OUTCOME MEASURES: The risk of having no bed available for any patient requiring immediate admission; the daily risk that there is no bed available for at least one patient requiring immediate admission; the mean bed occupancy rate. RESULTS: Risks are discernible when average bed occupancy rates exceed about 85%, and an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more. CONCLUSIONS: There are limits to the occupancy rates that can be achieved safely without considerable risk to patients and to the efficient delivery of emergency care. Spare bed capacity is therefore essential for the effective management of emergency admissions, and its cost should be borne by purchasers as an essential element of an acute hospital service.  (+info)

(4/189) Acute medical bed usage by nursing home residents.

An increasing number of elderly patients in nursing home care appears to be presenting to hospital for acute medical admission. A survey of acute hospital care was undertaken to establish accurately the number and character of such admissions. A total of 1300 acute medical beds was surveyed in Northern Ireland in June 1996 and January 1997 on a single day using a standardised proforma. Demographic details, diagnosis and length of admission were recorded. A total of 84 patients over the age of 65 (mean 79.5 years) admitted from nursing home care was identified in June 1996 and a total of 125 (mean 83.3 years) in January 1997. A total of 88 (70%) of admissions in 1997 were accompanied by a general practitioner's letter. The assessing doctor judged that 12 (9.6%) of admissions in 1997 could have had investigations and or treatment reasonably instituted in a nursing home. The proportion of acute medical beds occupied by nursing home residents was 6% in June 1996 rising to 10% in January 1997. The study accurately identifies the significant contribution of nursing home patients to acute medical admissions and the low proportion in whom admission was unnecessary. Closure of long stay hospital facilities should be accompanied by investment in community medical services and also reinvestment in acute hospital care for elderly people.  (+info)

(5/189) MediSign: using a web-based SignOut System to improve provider identification.

Continuity of care necessitates communication between the primary providers of inpatient and outpatient care. Communication requires identification of providers in addition to clinical information. We have constructed a web-based SignOut System to improve provider identification. The web-based SignOut System correctly identified the provider for 100% (34/34) of patients in 1997 and 93% (37/40) of patients in 1998. The hospital bed census correctly identified the attending provider for 50% (17/34) of patients in 1997 and 73% (29/40) in 1998. When analyzed by attending type (i.e., service and private,) the SignOut System correctly identified 86% of service providers in contrast to the hospital bed census that correctly identified 57% of service providers. Both the SignOut System (100%) and the hospital bed census (95%) had superior results in identifying private attendings. The web-based technology provides a familiar user interface and ubiquitous workstation access.  (+info)

(6/189) Measuring hospital efficiency: a comparison of two approaches.

OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process.  (+info)

(7/189) Measuring and modelling surgical bed usage.

Surgical departments treat two groups of inpatients--the simple and the complex--consequently a single average fails to describe the use being made of the occupied beds. Using decision support techniques, we show why indicators such as the average length, the average occupancy and the average admissions mislead. Furthermore, by analysing the fluctuating pattern of weekly admissions we show how weekends and the Christmas holiday periods impact on bed usage. Next, we demonstrate that flow process models can be used to describe how the in-patient workload concerns two groups of patients. On an average day, 71.4% of the beds contained patients who will have an average (exponential) stay of 4.8 days, and the other beds, 28.6%, contain patients who will have an average (exponential) stay of 22.8 days. The article concludes by demonstrating the short and long-term impact on daily admissions of a 10% change in four different parameters of the model. The data used come from a surgical department in Adelaide, as UK data sets report finished consultant episodes rather than completed in-patient spells.  (+info)

(8/189) The National Nursing Home Survey: 1995 summary.

OBJECTIVE: The 1995 National Nursing Home Survey (NNHS) was conducted to collect data on nursing homes and their current residents. This report presents detailed data on the characteristics of the nursing homes including ownership, certification, bed size, location, affiliation, and services provided. Data on current residents are presented by basic demographics, living arrangement prior to admission, functional status, and other health and personal characteristics of the residents. METHODS: The 1995 NNHS is a sample survey consisting of a two-stage design with a probability sample of 1,500 nursing facilities in the first stage and up to six current residents from each facility in the second stage. RESULTS: About 1.5 million residents were receiving care in an estimated 16,700 nursing homes in 1995. Nearly 1.8 million beds were available and facilities operated at about 87 percent of their capacity. Nearly 90 percent of the residents were 65 years and over. They were predominantly female and white with a large portion needing assistance in the activities of daily living (ADL's) and instrumental activities of daily living (IADL's).  (+info)