Impact of long-stay beds on the performance of a tertiary hospital in emergencies

Abstract

OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital.METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression.RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days.CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Palliative care team in a Brazilian tertiary emergency department

“…The Emergency Unit of the Ribeirão Preto Medical School Clinical Hospital, University of São Paulo (U.E.-HCFMRP/USP) is a hospital dedicated exclusively to the care of tertiary emergencies referenced within the Regional Health Department 13 of the State of São Paulo (RHD 13-SP) [4]. With 190 beds and an emergency department, the EU-RPMSCH/USP has improved its patient flow processes, adhering to the State Medical Regulation [5], implementing dehospitalization strategies for chronic dependent patients [6], prioritization of access to Intensive Care Units and the implementation of the Internal Regulation Center. However, the burden of chronic and end-stage patients is a problem that still requires improvement.…”

Modelo preditivo do risco de readmissão hospitalar no contexto brasileiro

“…De maneira semelhante, deve se considerar que a pontuação elevada no ICC está associada a um pior prognóstico do paciente, que permanecem na instituição por longo período de tempo, podem demandar cuidados mais avançados ou evoluir a óbito (PAZIN-FILHO et al, 2015).…”

Fatores prognósticos e estratégias de gerenciamento de fluxo para o manejo da sepse

“…O segundo marco importante foi a fixação de corpo docente dedicado ao estudo destas condições clínicas, que investiram em administração do sistema de saúde, capacitando pessoas, estruturando linhas de cuidado e captando recursos de diversas fontes para manter e aprimorar a estrutura (17). A estratégia de desospitalização para leitos de longa permanência ou de retaguarda pode ser considerado como o terceiro marco nesta importante trajetória (13).…”

“…Estes pequenos hospitais apresentam baixa taxa de ocupação, pois a maioria dos pacientes busca auxílio ou é transferido para municípios-polo onde há concentração de tecnologia. Embora este fato possa sugerir que a decisão correta seria o fechamento destas instituições, o ônus político impede que esta medida seja tomada na grande maioria dos casos.Somados, estes fatos foram a base para a solução de adequar estes pequenos hospitais para albergar pacientes que necessitem finalização do seu processo terapêutico quando não necessitam mais de alta tecnologia(2,105).Os dados iniciais do projeto já demonstravam que estes hospitais seriam capazes de desempenhar esta tarefa(13). A capacitação contínua destes hospitais se mostrou ponto fundamental para a perpetuação do processo como indicam os dados sobre evolução ao longo dos anos apresentados no presente estudo.…”