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Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region.

https://arctichealth.org/en/permalink/ahliterature123167
Source
BMC Health Serv Res. 2012;12:172
Publication Type
Article
Date
2012
Author
Andrew P Costa
Jeffrey W Poss
Thomas Peirce
John P Hirdes
Author Affiliation
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. acosta@uwaterloo.ca
Source
BMC Health Serv Res. 2012;12:172
Date
2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Acute Disease - epidemiology - therapy
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data
Catchment Area (Health) - statistics & numerical data
Evidence-Based Medicine
Female
Health Services for the Aged - standards
Home Care Services - standards
Hospitalization - statistics & numerical data - trends
Humans
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data - trends
Long-Term Care - methods
Male
Middle Aged
Nursing Homes - standards
Ontario - epidemiology
Patient Discharge - standards - statistics & numerical data - trends
Retrospective Studies
Time Factors
Waiting Lists
Abstract
Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.
Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.
ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27?day mean deviation, 99% CI?=?±14.6), psychiatric diagnosis (13?day mean deviation, 99% CI?=?±6.2), abusive behaviours (12?day mean deviation, 99% CI?=?±10.7), and stroke (7?day mean deviation, 99% CI?=?±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.
A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
Notes
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PubMed ID
22726609 View in PubMed
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Admissions to a radiation oncology inpatient service.

https://arctichealth.org/en/permalink/ahliterature208233
Source
Cancer Prev Control. 1997 Jun;1(2):116-21
Publication Type
Article
Date
Jun-1997
Author
C R Hayter
W J Mackillop
Author Affiliation
Radiation Oncology Research Unit, Queen's University, Kingston General Hospital, Ont. chayter@octrf.on.ca
Source
Cancer Prev Control. 1997 Jun;1(2):116-21
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Aged
Bed Occupancy - statistics & numerical data
Breast Neoplasms - epidemiology - radiotherapy
Cardiovascular Diseases - epidemiology
Communicable Diseases - epidemiology
Comprehensive Health Care - statistics & numerical data
Databases as Topic
Endocrine System Diseases - epidemiology
Female
Genital Neoplasms, Female - epidemiology - radiotherapy
Hospital Information Systems
Hospital Units - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Lung Neoplasms - epidemiology - radiotherapy
Male
Nervous System Diseases - epidemiology
Ontario - epidemiology
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Radiation Oncology - statistics & numerical data
Survival Rate
Urogenital Neoplasms - epidemiology - radiotherapy
Abstract
Although the care of inpatients is an important aspect of radiation oncology practice in many countries, it has never been studied in detail. The goal of this study was to describe the admissions to a radiation oncology inpatient service over a 1-year period with respect to patient characteristics, primary malignancies, common nonmalignant diagnoses, use of radiotherapy and outcome of admission.
Using computerized hospital databases, we analysed the utilization of 11 radiation oncology beds in a 424-bed teaching hospital from March 31, 1991, to April 1, 1992.
There were 342 admissions of 277 patients. The median age was 66.5 years; the male:female ratio was 1:1. The commonest primary neoplastic diagnoses were lung (42%), gynecological (15%), genitourinary (14%) and breast (8%) cancers. Only 17% of the patients had cancer as the sole diagnosis; most patients had multiple medical diagnoses. Infections (22%), neurological (20%), cardiovascular (13%) and endocrine (9%) conditions were the commonest. Mean length of stay was 11.25 days. Most of the admissions (71%) resulted in discharge to the patient's home; few patients (15%) died. Only half of admissions involved radiotherapy, indicating that the focus of patient care was the medical treatment of cancer complications or other active medical problems.
These data show that radiation oncology inpatients have complicated medical problems, and they support the training of radiation oncologists in the comprehensive medical care of patients.
PubMed ID
9765733 View in PubMed
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All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

https://arctichealth.org/en/permalink/ahliterature129368
Source
Respir Med. 2012 Apr;106(4):549-56
Publication Type
Article
Date
Apr-2012
Author
Jesper Lykkegaard
Jens Søndergaard
Jakob Kragstrup
Jesper Rømhild Davidsen
Thomas Knudsen
Morten Andersen
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 1, DK-5000 Odense C, Denmark. jlykkegaard@health.sdu.dk
Source
Respir Med. 2012 Apr;106(4):549-56
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data - trends
Denmark - epidemiology
Female
Hospital Mortality - trends
Hospitalization - statistics & numerical data - trends
Humans
Incidence
Intensive Care Units - statistics & numerical data - trends
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - epidemiology
Sex Distribution
Treatment Outcome
Abstract
This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients.
Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed.
During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased.
Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study.
PubMed ID
22115929 View in PubMed
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[Capacity in Danish intensive care units. A national survey of capacity, cancellations and transfers of critically ill patients].

https://arctichealth.org/en/permalink/ahliterature165038
Source
Ugeskr Laeger. 2007 Feb 19;169(8):712-6
Publication Type
Article
Date
Feb-19-2007
Author
Anne Lippert
Kurt Espersen
Kristian Antonsen
Henning Joensen
Tina E Waldau
Kim Michael Larsen
Author Affiliation
a.lippert@dadlnet.dk
Source
Ugeskr Laeger. 2007 Feb 19;169(8):712-6
Date
Feb-19-2007
Language
Danish
Publication Type
Article
Keywords
Adult
Appointments and Schedules
Bed Occupancy - statistics & numerical data
Denmark
Hospital Bed Capacity - statistics & numerical data
Humans
Intensive Care Units - standards - statistics & numerical data
Patient Admission - statistics & numerical data
Patient Transfer - statistics & numerical data
Questionnaires
Risk factors
Surgical Procedures, Elective - standards - statistics & numerical data
Abstract
A shortage of intensive care beds and fully-booked intensive care units has a range of undesirable consequences for patients and personnel, eg. transfer to other intensive care units, cancellation of operations, tighter visitation criteria and an increase in the work-load. The problem is illustrated in a national survey.
The survey was undertaken in 3 parts and comprised all 50 adult intensive care units in Denmark. Part 1 was a questionnaire encompassing demographic data, the number of open intensive care beds and how often under or over capacity was experienced in the department. Parts 2 and 3 consisted of a daily registry of the capacity and occupancy rate in the intensive care departments for two weeks along with a contemporary registry of the number of admittances, transfers and cancellations of operations.
In Denmark only 2% of all somatic beds are intensive care beds. Under capacity, defined as a 100% occupancy rate, was experienced weekly or monthly in 80% of all intensive care units in Denmark. Occupancy rate was high, a medium of 78%, highest in level III intensive care units with an 88% occupancy rate. The numbers for transfers were equivalent to 800-1000 patient transfers per year. The number of cancelled operations was equivalent to 2000 per year.
This survey documents that there is a problem with the capacity in Danish intensive care units. Establishing more intensive care beds in selected departments, ensuring personnel for the beds already established and establishing intermediate care beds could relieve the shortage of beds.
Notes
Comment In: Ugeskr Laeger. 2007 May 7;169(19):1811; author reply 181117542086
PubMed ID
17313924 View in PubMed
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Chronic status patients in a university hospital: bed-day utilization and length of stay.

https://arctichealth.org/en/permalink/ahliterature225387
Source
CMAJ. 1991 Nov 15;145(10):1259-65
Publication Type
Article
Date
Nov-15-1991
Author
J. McClaran
R. Tover-Berglas
K C Glass
Author Affiliation
Division of Geriatric Medicine, Montreal General Hospital, PQ.
Source
CMAJ. 1991 Nov 15;145(10):1259-65
Date
Nov-15-1991
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data
Chronic Disease
Cohort Studies
Data Collection
Hospital Bed Capacity, 500 and over
Hospitals, University - utilization
Humans
Length of Stay - statistics & numerical data
Long-Term Care - utilization
Middle Aged
Prospective Studies
Quebec
Retrospective Studies
Abstract
To examine the lengths of stay of chronic status patients in an acute care hospital, to identify discharge stages that contribute to excessive stays, to estimate the length of stay at each discharge stage and to link hospital bed-day utilization by the discharge stage to the experience of the patient.
Two-year prospective cohort study. The number of hospital days retrospective to the date of the current admission were included in the analysis.
University hospital.
All 115 inpatients formally declared as achieving chronic status by July 31, 1987.
Lengths of stay (total days and days at acute and chronic status) for chronic status patients, including those still in hospital at the end of the study period. Each bed-day was assigned to a discharge stage that corresponded to the patient's status. The disposition of each patient by the end of the study period was reviewed.
The study population spent a total of 101 585 days in hospital. The total length of stay per patient was nearly four times that stated in the hospital's annual report, in which the figure was calculated only on the basis of discharge data. On average only 77.2 (8.7%) of the days were spent in acute care. The remaining days were at the chronic level: 24.1% were spent waiting for completion of an application to a long-term care facility, 25.3% for application approval and 41.9% for an available bed in the assigned long-term care institution. For 30 patients no initiation of the discharge process was ever undertaken. As the number of patients in each progressive discharge stage decreased, the wait per patient increased. By the end of the study period only 32 patients had been transferred to a public long-term care facility; 22 were still in hospital, and 35 had died waiting for placement.
Although considered to be a useful measure of hospital efficiency, length of stay determined from discharge data creates an iceberg effect when applied to chronic status patients in acute care hospitals. Lack of access to the assigned resource is the most important reason for a delay in discharge. Interventions, whether undertaken at the patient, hospital or provincial level, must to some degree address this issue. Further study is required to determine which risk factors will predict lags at each discharge stage. Since our discharge staging reflects not only the experience of the patient but also the utilization of hospital bed-days and access to provincial resources, it provides a common language for clinicians, hospital administrators and systems planners.
Notes
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PubMed ID
1933708 View in PubMed
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A clinical pathway for treating pneumonia in the nursing home: part II: the administrators' perspective and how it differs from nurses' views.

https://arctichealth.org/en/permalink/ahliterature168880
Source
J Am Med Dir Assoc. 2006 Jun;7(5):279-86
Publication Type
Article
Date
Jun-2006
Author
Soo Chan Carusone
Mark Loeb
Lynne Lohfeld
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Source
J Am Med Dir Assoc. 2006 Jun;7(5):279-86
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Bed Occupancy - statistics & numerical data
Clinical Competence - standards
Critical Pathways - standards
Cross Infection - diagnosis - therapy
Feasibility Studies
Geriatric Assessment
Health services needs and demand
Hospitalization - statistics & numerical data
Humans
Nurse Administrators - psychology
Nursing Assessment
Nursing Homes
Nursing Methodology Research
Nursing Staff - education - psychology
Ontario
Physician Executives - psychology
Pneumonia - diagnosis - therapy
Program Development
Qualitative Research
Quality of Health Care - standards
Questionnaires
Abstract
This paper examines the utility and sustainability of a clinical pathway for treating nursing home residents with pneumonia from the perspective of nursing administrators and medical directors in Ontario, Canada. The discussion includes a comparison of the perspectives of the administrators and the nursing staff (reported in part I of this article).
A qualitative case study design was used.
Data were collected from 6 nursing homes in Southern Ontario that were drawn from a larger randomized controlled trial of a clinical pathway to help identify, diagnose, and manage cases of nursing home-acquired pneumonia.
Six interviews were conducted with nursing administrators and 2 with medical directors (1 per facility). Key themes were identified in the interview data using the template style of analysis described by Miller and Crabtree.
Administrators were in favor of using a clinical pathway for identifying and treating pneumonia in nursing home residents. Participants thought that during the study residents with pneumonia received better and more timely care, and that nurses' clinical skills, knowledge, and confidence had improved. In comparison with views expressed by nurses and medical directors in the same facilities, nursing administrators tended to report less clinical training and staff support were required to successfully implement the pathway.
Even though nurses and administrators strongly support the use of a pneumonia clinical pathway in nursing homes, implementation plans should be tailored to individual facilities and be informed by the perspectives of both administrators and staff.
PubMed ID
16765863 View in PubMed
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A clinical pathway for treating pneumonia in the nursing home: part I: the nursing perspective.

https://arctichealth.org/en/permalink/ahliterature168881
Source
J Am Med Dir Assoc. 2006 Jun;7(5):271-8
Publication Type
Article
Date
Jun-2006
Author
Soo Chan Carusone
Mark Loeb
Lynne Lohfeld
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Source
J Am Med Dir Assoc. 2006 Jun;7(5):271-8
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Bed Occupancy - statistics & numerical data
Clinical Competence - standards
Critical Pathways - organization & administration
Cross Infection - diagnosis - therapy
Decision Trees
Education, Nursing, Continuing
Focus Groups
Geriatric Nursing - education - organization & administration
Health Facility Size - statistics & numerical data
Health services needs and demand
Hospitalization - statistics & numerical data
Humans
Nurse's Role
Nursing Homes
Nursing Methodology Research
Nursing Staff - education - psychology
Ontario
Pneumonia - diagnosis - therapy
Qualitative Research
Quality of Health Care - standards
Questionnaires
Self Efficacy
Abstract
This paper examines nursing staff's perspectives on the utility and sustainability of a clinical pathway for treating nursing home residents with pneumonia.
A qualitative (case study) design was used.
Data were collected from 6 nursing homes in Southern Ontario (5 from metro regions and 1 from a nonmetro region). Nursing homes were drawn from a larger randomized controlled trial of a clinical pathway for nursing home-acquired pneumonia conducted between 2001 and 2005. The clinical pathway was designed to assist in the identification, diagnosis, and management of pneumonia, including a decision tool for determining the appropriate location of treatment (hospital versus nursing home).
A total of 7 focus groups and 1 one-on-one interview were conducted between February 2003 and May 2004. Interview data were analyzed using the template style, described by Miller and Crabtree, to identify key themes.
Nurses strongly supported the idea of the clinical pathway and believed that providing pneumonia care in the nursing home was better for the resident. As a result of using the clinical pathway, nurses felt that pneumonia was being identified, diagnosed, and treated earlier, resulting in fewer hospitalizations. In addition to the benefits to resident care, the nurses felt that their skills and knowledge also improved. Nurses generally supported the implementation of the pathway although some concern was expressed about the additional responsibility and resources that would entail.
The implementation of a clinical pathway for treating pneumonia in nursing homes and quick access to a backup clinician are desired by nurses who also believe it will result in better care and fewer hospitalizations of residents.
PubMed ID
16765862 View in PubMed
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A comparison of infection control program resources, activities, and antibiotic resistant organism rates in Canadian acute care hospitals in 1999 and 2005: pre- and post-severe acute respiratory syndrome.

https://arctichealth.org/en/permalink/ahliterature154889
Source
Am J Infect Control. 2008 Dec;36(10):711-7
Publication Type
Article
Date
Dec-2008
Author
Dick E Zoutman
B Douglas Ford
Author Affiliation
Department of Pathology and Molecular Medicine, Queen's University and Infection Control Service, Kingston General Hospital, Kingston, Ontario, Canada. zoutmand@kgh.kari.net
Source
Am J Infect Control. 2008 Dec;36(10):711-7
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Bed Occupancy - statistics & numerical data
Canada - epidemiology
Clostridium difficile
Cross Infection - epidemiology
Data Collection
Enterococcus
Health Resources - organization & administration
Hospital Bed Capacity - statistics & numerical data
Hospitals - statistics & numerical data
Humans
Infection Control - methods - organization & administration
Infection Control Practitioners - organization & administration - statistics & numerical data
Logistic Models
Methicillin-Resistant Staphylococcus aureus
Population Surveillance
Severe Acute Respiratory Syndrome - epidemiology
Staphylococcal Infections - epidemiology
Vancomycin Resistance
Abstract
The Resources for Infection Control in Hospitals (RICH) project assessed infection control programs and rates of antibiotic-resistant organisms (AROs) in Canadian acute care hospitals in 1999. In the meantime, the severe acute respiratory syndrome (SARS) outbreak and the concern over pandemic influenza have stimulated considerable government and health care institutional efforts to improve infection control systems in Canada.
In 2006, a version of the RICH survey similar to the original RICH instrument was mailed to infection control programs in all Canadian acute care hospitals with 80 or more beds. We used chi(2), analysis of variance, and analysis of covariance analyses to test for differences between the 1999 and 2005 samples for infection control program components and ARO rates.
72.3% of Canadian acute care hospitals completed the RICH survey for 1999 and 60.1% for 2005. Hospital size was controlled for in analyses involving AROs and surveillance and control intensity levels. Methicillin-resistant Staphylococcus aureus (MRSA) rates increased from 1999 to 2005 (F = 9.4, P = .003). In 2005, the mean MRSA rate was 5.2 (standard deviation [SD], 6.1) per 1000 admissions, and, in 1999, it was 2.0 (SD, 2.9). Clostridium difficile-associated diarrhea rates trended up from 1999 to 2005 (F = 2.9, P = .09). In 2005, the mean Clostridium difficile-associated diarrhea rate was 4.7 (SD, 4.3), and, in 1999, it was 3.8 (SD, 4.3). The proportion of hospitals that reported having new nosocomial vancomycin-resistant Enterococcus (VRE) cases was greater in 2005 than in 1999 (chi(2) = 10.5, P = .001). In 1999, 34.5% (40/116) of hospitals reported having new nosocomial VRE cases, and, in 2005, 61.0% (64/105) reported new cases. Surveillance intensity index scores increased from a mean of 61.7 (SD, 18.5) in 1999 to 68.1 (SD, 15.4) in 2005 (F = 4.1, P = .04). Control intensity index scores trended upward slightly from a mean of 60.8 (SD, 14.6) in 1999 to 64.1 (SD, 12.2) in 2005 (F = 3.2, P = .07). Infection control professionals (ICP) full-time equivalents (FTEs) per 100 beds increased from a mean of 0.5 (SD, 0.2) in 1999 to 0.8 (SD, 0.3) in 2005 (F = 90.8, P
Notes
ReprintIn: Can J Infect Control. 2009 Summer;24(2):109-1519697536
PubMed ID
18834747 View in PubMed
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58 records – page 1 of 6.