Alternatives to conventional hospitalization for improving lack of access to inpatient beds: a 12-year cross-sectional analysis

Corbella, Xavier; Ortiga, Berta; Juan, Antonio; N, Ortega; Gómez-Vaquero, Carmen; Capdevila, Cristina; Bardès, I.; Alonso, Gilberto; Ferre, C.; Soler, Loreto Maciá; Mañez, Rafael; Jaurrieta, Eduardo; Pujol, Ramón; Salazar, Albert

doi:10.5430/jha.v2n2p9

Cited by 9 publications

(4 citation statements)

References 61 publications

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“…Larger capacity of primary care to treat ACSCs results in a significant reduction of the hospitalisations of patients with these conditions 41. Daycare clinics and daycare centres, as well as socially appropriate and less expensive forms of medical care, are widely used in different countries as alternatives to hospital services 3 42 43…”

Section: Discussionmentioning

confidence: 99%

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings

Zhao

Doroshenko²,

Лехан

et al. 2019

BMJ Open

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ObjectivesThis article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine.Data and methodsThe original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.ResultWe observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals’ general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis.ConclusionThe proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.

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Section: Discussionmentioning

confidence: 99%

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings

Zhao

Doroshenko²,

Лехан

et al. 2019

BMJ Open

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“…This management can improve the quality of patient care, particularly postoperative recovery, while reducing length of stay [4]. Shortened hospital stay is basic to modern patient care and also reduces hospital-acquired infections and venous thromboembolism [5].…”

Section: Discussionmentioning

confidence: 99%

Short-Stay Surgery: Impact of Opening a New Unit in a Tertiary Urban Hospital

Salazar¹,

Bello²,

Muñoz³

et al. 2016

IJCM

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Objective: The number of procedures considered suitable for short-stay surgery has experienced a remarkable increase. The objective of the study was to determine whether a new short-stay surgical unit (SSSU) was an effective alternative to conventional Hospital Units (HU) for selected elective and urgent surgical conditions. Methods: A comparative analysis (Mann-Whitney test) was used to identify differences between patients admitted to HU (n = 2873) and those admitted to the SSSU (n = 544) during the following months (

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“…The causes of the massive use of the urban ED during winter are complex, but respiratory infections are definitely a major factor [22]- [27]. In previous studies, we reported how the implementation of particular interventions such as replacing residents with staff physicians or the opening of an EDSSU for those patients predicted to need a mean of a 3-day hospitalization resulted in shorter lengths of stays in the ED and might help to alleviate crisis from the ED overcrowding [1] [28]- [32]. Recently, we have published our experience with an EDSSU as an effective and safe alternative to standard inpatient hospitalization during winter for COPD exacerbation patients [8].…”

Section: Discussionmentioning

confidence: 99%

Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure

Salazar

Garcı́a-Eroles²,

Craywinckel³

et al. 2014

IJCM

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Study Objective: To determine whether a new emergency department short-stay unit (EDSSU) was an effective alternative to conventional hospital units (HU) for acute exacerbation of chronic heart failure patients. Methods: Design: A comparative analysis was used to identify differences among patients admitted to EDSSU (n = 1546) and those admitted to the internal medicine (n = 552) or cardiology wards (n = 336) during the period of the study (January 1, 2008 to December 31, 2012). Setting: The study was performed at Sant Pau Hospital, a 500-bed teaching tertiary care referral center in Barcelona, Spain. The ED attends about 144,000 emergency visits per year. Participants: We studied retrospectively the characteristics of patients hospitalized with an acute exacerbation of chronic heart failure between January 1, 2008 and December 31, 2012 (n = 2434). We chose charts of patients from the hospital discharge database and selected according to the 9th revision of the International Classification of Diseases Codes. We used the computerized database to obtain outcome data on all patients. Results: Statistically significant differences were found in terms of mean age (HU: 77.38 (14.44) years versus EDSSU: 82.43 (8.72) years; p < 0.001), mean length of stay (HU: 11.57 (10.42) days versus EDSSU: 4.75 (3.18) days; p < 0.001), mortality (HU: 14.0% versus EDSSU: 4.0%; p < 0.001), but not for urgent readmission rate of 30 days or less (HU: 18.30% versus EDSSU: 18.30%; p = 0.998). There were statistically significant differences regarding sex (HU women = 60.6%; EDDSU women = 67.7%; p < 0.001) and number of associated conditions (Charlson index HU = 1.25, EDDSU = 0.90; p < 0.001). Conclusion: The EDSSU proved to be an effective and safe measure in emergency care of patients with acute heart failure (AHF).

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Alternatives to conventional hospitalization for improving lack of access to inpatient beds: a 12-year cross-sectional analysis

Cited by 9 publications

References 61 publications

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings

Short-Stay Surgery: Impact of Opening a New Unit in a Tertiary Urban Hospital

Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure

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