Medical and social data on 980 consecutive admissions to the Medical Department, Aker Hospital, Oslo, were recorded prospectively with emphasis on patients' requirements and the Department's use of available resources. 73% of the admissions were acute, 4% were considered unnecessary. Half were because of chronic illness. Although 88% of the patients' requirements could have been met at a local hospital, 59% were treated in specialized units. 12% were admitted to the day unit at reduced cost for an average stay of three days. 41% of the patients were over 70 years of age, 37% lived alone and 14% needed rehabilitation. A main reason for admission was the patient's inability to take care of him/herself at home, in nearly all cases the main reason being acute illness or deterioration. Therefore many of the patients seemed to need care in an acute geriatric unit. At any one time the reason for 20-25% of the patients being in the department was delay in providing care at home or in a nursing home.
This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.
The changes in the demand for surgical inpatient care created by mammographic screening for breast cancer were analysed by comparing two counties, one with and one without a mass screening campaign. A comprehensive computerised register of inpatient care in the region was used. The results indicate that population based screening offered to women above 40 years and repeated every two to three years will increase the number of operations required for breast cancer and inpatient days by at least 150% during the initial screening round. During the second round the figures tend to return to previous levels. Of decisive importance for the demands on health service resources are the specificity of screening, the duration of the first screening round, and the age groups included.
A small proportion of the patients coming to emergency departments of general hospitals account for a substantial share of the department's resources by making repeated visits. Repeater behaviour is a complex product of many, sometimes concurrent factors. This study has focused on the medical and psycho-social factors. A group of patients with repeated visits to an emergency department of a middle-sized Stockholm hospital was studied in 1980. The repeater group had a heavier load of psycho-social problems than the source population. The repeater behaviour profile included: feeling of loneliness, living alone, contacts with social agency, disability pension, high sick absenteeism from work and alcoholism. The repeater group had numerous contacts with health-care providers outside the emergency department. Some of the repeaters needed and received help by a social hospital worker. Of those that received such help 80% significantly decreased their emergency department visiting rate.
Although the programs are of increasing popularity, little has been published on the effects of discharging maternity patients early from the hospital. In particular, there is almost no evidence to date to prove that these programs actually achieve two objectives for which they were designed; to reduce occupancy pressure on maternity beds and to lower hospital costs. Evaluation of the early stages of a relatively small and flexible maternity early discharge program in Alberta, Canada suggests that the program is effective in reducing length of stay in the hospital and hospital costs, but there is little evidence that it is actually used to reduce pressure on bed space in the maternity unit.