Academic literature on the topic 'Hospital utilization Length of stay Victoria'
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Journal articles on the topic "Hospital utilization Length of stay Victoria"
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Walsh, Thom, Tracy Onega, and Todd Mackenzie. "Variation in length of stay within and between hospitals." Journal of Hospital Administration 3, no. 4 (March 2, 2014): 53. http://dx.doi.org/10.5430/jha.v3n4p53.
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Background and objective: Variation in the delivery of health care services and the lack of association between greater utilization and higher quality care signal inefficient, low value care. The extent to which patient and hospital variables can explain variation in hospital length of stay is unclear. Methods: We examined hospital inpatient length of stay using data from 684 hospitals and 5.4 million discharges in the 2007 Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. We used a mixed effects model with a random effect for hospitals to quantify variation in length of stay due to differences within and between hospitals. Results: The interquartile range of hospital mean LOS was 3.4 days (3.3-6.7). Fifty-nine percent of the overall variation in length of stay remained unexplained after adjustment for discharge-level disease status, illness-severity, regional poverty, hospital-level contextual factors (e.g. proportion of patients from low-income ZIP-codes, proportion uninsured), and structural variables (e.g. teaching status, urban or rural location). Seventy-seven percent of the explainable variation was due to differences between hospitals. Conclusion: These findings indicate that wide variability in length of stay persists after adjustment for patient and hospital variables, signaling an opportunity for improved productivity and efficiency in the delivery of health care.
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Yu, Kaylee G., Jay J. Shen, Pearl C. Kim, Sun Jung Kim, Se Won Lee, David Byun, Ji Won Yoo, and Jinwook Hwang. "Trends of Hospital Palliative Care Utilization and Its Associated Factors Among Patients With Systemic Lupus Erythematosus in the United States From 2005 to 2014." American Journal of Hospice and Palliative Medicine® 37, no. 3 (December 3, 2019): 164–71. http://dx.doi.org/10.1177/1049909119891999.
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Objective: To investigate trends and associated factors of utilization of hospital palliative care among patients with systemic lupus erythematosus (SLE) and analyze its impact on length of hospital stay, hospital charges, and in-hospital mortality. Methods: Using the 2005-2014 National Inpatient Sample in the United States, the compound annual growth rate was used to investigate the temporal trend of utilization of hospital palliative care. Multivariate multilevel logistic regression analyses were performed to analyze the association with patient-related factors, hospital factors, length of stay, in-hospital mortality, and hospital charges. Results: The overall proportion of utilization of hospital palliative care for the patient with SLE was 0.6% over 10 years. It increased approximately 12-fold from 0.1% (2005) to 1.17% (2014). Hospital palliative care services were offered more frequently to older patients, patients with high severity illnesses, and in urban teaching hospitals or large size hospitals. Patients younger than 40 years, the lowest household income group, or Medicare beneficiaries less likely received palliative care during hospitalization. Hospital palliative care services were associated with increased length of stay (β = 1.407, P < .0001) and in-hospital mortality (odds ratio, 48.18; 95% confidence interval, 41.59-55.82), and reduced hospital charge (β = −0.075, P = .009). Conclusion: Hospital palliative care service for patients with SLE gradually increased during the past decade in US hospitals. However, this showed disparities in access and was associated with longer hospital length of stay and higher in-hospital mortality. Nevertheless, hospital palliative care services yielded a cost-saving effect.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
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A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Phillips, Leah A., Don C. Voaklander, Colleen Drul, and Karen D. Kelly. "The Epidemiology of Hospitalized Head Injury in British Columbia, Canada." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 36, no. 5 (September 2009): 605–11. http://dx.doi.org/10.1017/s0317167100008118.
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Objective:This descriptive study seeks to identify the incidence rates of head injuries in a large Canadian province, given incident cases for a ten year period. It describes cases in terms of age standardized rates, demographics, and health care utilization.Methods:The analyses were done using descriptive statistics. Incidence rates were calculated using the direct method. The indicators of hospital resource utilization were: mean length of hospital stay, number of intensive care unit (ICU) stays, and mean length of stay in an ICU.Results:In the ten year period, British Columbia saw 48,753 admissions due to an incident head injury. The most common head injury diagnosis was an “Intracranial” injury. The year with the highest total age standardized rate was 1991/92 (174.18/100 000). The mean length of hospital stay was 7.4 days. Ten percent had an ICU stay and the mean length of stay was 4.4 days (± 4.8). The diagnosis with the longest mean length of stay was a “Fractured Skull” while of the top five E-code categories; “Motor Vehicle Traffic” had the highest mean length of stay with 12.2 days.Conclusions:Our study provides a much needed analysis of the incidence of head injuries in British Columbia. These rates can be compared to other provinces using the 2001 Canadian population as the standardized population. Our results indicate that there are certain “at risk” groups that warrant attention, in particular, younger men with lower socioeconomic standing. Indicators of health care utilization presented in the study should generate policy discussions.
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Glazer, William M., and Hal Morgenstern. "The impact of utilization management on hospital length of stay and illness." Administration and Policy in Mental Health 21, no. 1 (September 1993): 41–49. http://dx.doi.org/10.1007/bf00706413.
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Deng, Aileen, and Atrayee Basu Mallick. "Healthcare utilization and costs associated with GI cancers in the United States." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 361. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.361.
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361 Background: In 2009, adults had 4.7 million cancer-related hospitalizations. Adult hospital stays with cancer identified as the principal diagnosis cost $20.1 billion and accounted for 6% of adult inpatient hospital costs. GI cancer-related healthcare utilization has not been well-defined. The aim of this study was to evaluate the trends in the incidence and costs of GI cancer-related hospital admissions in the U.S. Methods: We reviewed the National Inpatient Sample Database (NIS) from 1997-2014. All patients with principle discharge diagnoses of esophageal, stomach, colon, rectum and anus, liver and intrahepatic bile duct and pancreas cancer were analyzed. Temporal trends in the number of hospital admissions, length of stay, hospitalization cost and mortality rates were obtained by HCUPnet. Results: GI cancer-related hospital admissions decreased from 230,537 in 1997 to 221,220 in 2014. Although the number of hospital admissions decreased for esophageal (12,157 to 11,885), stomach (23,528 to 21,800), colon (110,939 to 90,135), rectum and anus cancer (43,807 to 40,160), it has increased for liver and intrahepatic bile duct (11,243 to 21,775, p < 0.001) and pancreas cancer (28,862 to 35,465, p < 0.001). While the mean length of stay decreased from 9.6 days in 1997 to 7.6 days in 2014, the mean hospital charges per patient (adjusted for inflation) increased 127% from $34,747 in 1997 to $78,742 in 2014. The highest increase in mean hospital charges per patient were in liver and intrahepatic bile duct ($27,128 to $74,619 (175%), p < 0.001), rectum and anus ($32,566 to $80,789 (148%), p < 0.001) and pancreas cancer ($33,562 to $75,981 (126%), p < 0.001). Conclusions: GI cancer-related hospital admissions decreased from 1997 to 2014. Despite decrease in the mean length of hospital stay, the costs of hospitalizations have increased substantially, especially in liver and intrahepatic bile duct, rectum and anus and pancreas cancer. Our study suggests that shorter length of stay alone has not reduced costs of hospitalizations in GI cancers. There remains a growing need to understand healthcare costs and to develop effective value-based interventions in GI cancer-related hospital admissions.
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Fateha, B. E. A. H. "Evaluation of the utilization management programme at Salmaniya Medical Complex, Bahrain." Eastern Mediterranean Health Journal 8, no. 4-5 (June 15, 2002): 556–65. http://dx.doi.org/10.26719/2002.8.4-5.556.
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In 1993, the Ministry of Health in Bahrain implemented a utilization management programme at the largest public hospital in the country, aimed at reducing patients’ mean length of stay from 8.3 days in 1993 to 6.0 days in 2000. Time series analysis, using linear trend modelling and the annual disparity reduction rate, were used to estimate performance towards achieving the targets. The study found that the length of stay declined consistently between 1984 and 2000, with a steeper decline in the period 1994-2000, which could be attributed to the utilization management programme. Overall, length of stay was reduced by 20.5% between the two periods, short of the target 27.8% proposed in 1993. Individual clinical departments showed mixed results, with better performance demonstrated by the Departments of Medicine and Surgery.
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Ore, Timothy. "Musculoskeletal malignant neoplasms hospitalisation in Victoria." Journal of Epidemiological Research 1, no. 1 (July 27, 2015): 33. http://dx.doi.org/10.5430/jer.v1n1p33.
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The paper describes factors associated with 2,605 hospital admissions for musculoskeletal malignant neoplasms (MMN) over oneyear. The rates per 10,000 population increased significantly (t=5.3, p<.01) with age, with men (4.5 per 10,000 population, 95% CI 4.1-5.0) at greater risk than women (3.3 per 10,000 population, 95% CI 2.8-3.7). The 30-day readmission rate was 19%, thethird highest of all admission categories. The average length of stay was significantly (t=4.5, p<.01) shorter in the metropolitanarea (8.2 days) than in rural communities (10.8 days). The age-standardised rates varied inversely (r=-0.28) with socioeconomicstatus. Communities with high MMN admission rates had high rates of heart failure admissions (r=0.35), alcohol consumption(r=0.34) and receiving Disability Support Pension (r=0.32). There was a significant (t=13.8, p<.001) monthly variability inMMN hospitalisation rates. As a leading cause of hospital readmission and disability, the condition requires closer analysis.
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Arantes, Aglai, Eduardo da Silva Carvalho, Eduardo A. S. Medeiros, Calil Kairalla Farhat, and Orlando Cesar Mantese. "Pediatric Risk of Mortality and Hospital Infection." Infection Control & Hospital Epidemiology 25, no. 9 (September 2004): 783–85. http://dx.doi.org/10.1086/502478.
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AbstractWe studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.
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Kelso, Michael, Rick A. Weideman, Daisha J. Cipher, and Linda A. Feagins. "Factors Associated With Length of Stay in Veterans With Inflammatory Bowel Disease Hospitalized for an Acute Flare." Inflammatory Bowel Diseases 24, no. 1 (December 19, 2017): 5–11. http://dx.doi.org/10.1093/ibd/izx020.
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Abstract Background Reducing hospital costs and risk of complications by shortening length of stay has become paramount. The aim of our study was to identify predictors and potentially modifiable factors that influence length of stay among veterans with inflammatory bowel disease admitted for an acute flare. Methods Retrospective review of patients admitted to the Dallas VA with an acute flare of their inflammatory bowel disease between 2000 and 2015. Patients with a length of stay of ≤4 days were compared with those whose length of stay >4 days. Results A total of 180 admissions involving 113 patients (59 with ulcerative colitis and 54 with Crohn’s disease) were identified meeting inclusion criteria. The mean length of stay was 5.3 ± 6.8 days, and the median length of stay was 3.0 days. On multiple logistic regression analysis, initiation of a biologic, having undergone 2 or more imaging modalities, and treatment with intravenous steroids were significant predictors of longer lengths of stay, even after controlling for age and comorbid diseases. Conclusions We identified several predictors for longer hospital length of stay, most related to disease severity but several of which may be modifiable to reduce hospital stays, including most importantly consideration of earlier prebiologic testing. Future studies are needed to evaluate the impact of interventions targeting modifiable predictors of length of stay on health care utilization and patient outcomes. 10.1093/ibd/izx020_video1 izx020.video1 5732756865001
Dissertations / Theses on the topic "Hospital utilization Length of stay Victoria"
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Heartfield, Marie. "Governing recovery : a discourse analysis of hospital stay length /." Connect to thesis, 2002. http://eprints.unimelb.edu.au/archive/00001712.
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Drager, Katrina A. "Inpatient psychiatric length of stay and readmission rates." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007dragerk.pdf.
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Khaskina, Yelena. "Using simulation to reduce length of stay in a hospital emergency department." Full text available online (restricted access), 1996. http://images.lib.monash.edu.au/ts/theses/Khaskina.pdf.
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Wiggins, Sandra. "Utilization management of acute care services : evaluation of the SWITCH index system." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/28355.
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In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use.
To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed.
An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management.
One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action.
Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Dilworth, Joyce Carroll. "The relationship of nutritional status to unreimbursable costs and length of hospital stay." CSUSB ScholarWorks, 1992. https://scholarworks.lib.csusb.edu/etd-project/721.
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Albano, Filipa Maria Marques. "Do hospitals react to random demand pressure by early discharges?" Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9534.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsThis project tries to assess whether hospitals react to random demand pressure by discharging patients earlier than expected. As a matter of fact, combining an unpredictable demand for medical services with limited and, to some extent, fixed medical resources, generates strong incentives to discharge patients earlier than expected when demand is high - increasing the risk of readmission and decreasing the benefit from treatment. This work was conducted as a way to determine whether those incentives actually affect discharging decisions. Analysis of Portuguese hospitals data shows that hospital utilization levels at the time of admission, prior to the admission and post admission do have a negative impact over the length of stay in hospital, although this impact is quantitatively irrelevant. More than that, larger utilization levels have a positive impact over the probability of being discharged at certain days of the week, indicating that an early discharges problem may exist.
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Dulka, Iryna M. 1953. "Interdisciplinary discharge planning rounds : impact on timing of social work intervention, length of stay and readmission." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69711.
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This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.
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Malkin, Jesse D. "The postpartum mandate estimated costs and benefits /." Santa Monica, CA : Rand, 1998. http://books.google.com/books?id=Uw_bAAAAMAAJ.
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Dwyer, Sean. "An audit of the time spent by patients in the post anesthetic care unit before and after the introduction of a discharge criteria scoring system at Tygerberg Academic Hospital." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86635.
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Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital.
AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.
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Pepler, Pieter Theo. "The identification and application of common principal components." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/96101.
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Thesis (PhD)--Stellenbosch University, 2014.ENGLISH ABSTRACT: When estimating the covariance matrices of two or more populations, the covariance matrices are often assumed to be either equal or completely unrelated. The common principal components (CPC) model provides an alternative which is situated between these two extreme assumptions: The assumption is made that the population covariance matrices share the same set of eigenvectors, but have di erent sets of eigenvalues. An important question in the application of the CPC model is to determine whether it is appropriate for the data under consideration. Flury (1988) proposed two methods, based on likelihood estimation, to address this question. However, the assumption of multivariate normality is untenable for many real data sets, making the application of these parametric methods questionable. A number of non-parametric methods, based on bootstrap replications of eigenvectors, is proposed to select an appropriate common eigenvector model for two population covariance matrices. Using simulation experiments, it is shown that the proposed selection methods outperform the existing parametric selection methods. If appropriate, the CPC model can provide covariance matrix estimators that are less biased than when assuming equality of the covariance matrices, and of which the elements have smaller standard errors than the elements of the ordinary unbiased covariance matrix estimators. A regularised covariance matrix estimator under the CPC model is proposed, and Monte Carlo simulation results show that it provides more accurate estimates of the population covariance matrices than the competing covariance matrix estimators. Covariance matrix estimation forms an integral part of many multivariate statistical methods. Applications of the CPC model in discriminant analysis, biplots and regression analysis are investigated. It is shown that, in cases where the CPC model is appropriate, CPC discriminant analysis provides signi cantly smaller misclassi cation error rates than both ordinary quadratic discriminant analysis and linear discriminant analysis. A framework for the comparison of di erent types of biplots for data with distinct groups is developed, and CPC biplots constructed from common eigenvectors are compared to other types of principal component biplots using this framework. A subset of data from the Vermont Oxford Network (VON), of infants admitted to participating neonatal intensive care units in South Africa and Namibia during 2009, is analysed using the CPC model. It is shown that the proposed non-parametric methodology o ers an improvement over the known parametric methods in the analysis of this data set which originated from a non-normally distributed multivariate population. CPC regression is compared to principal component regression and partial least squares regression in the tting of models to predict neonatal mortality and length of stay for infants in the VON data set. The tted regression models, using readily available day-of-admission data, can be used by medical sta and hospital administrators to counsel parents and improve the allocation of medical care resources. Predicted values from these models can also be used in benchmarking exercises to assess the performance of neonatal intensive care units in the Southern African context, as part of larger quality improvement programmes.
AFRIKAANSE OPSOMMING: Wanneer die kovariansiematrikse van twee of meer populasies beraam word, word dikwels aanvaar dat die kovariansiematrikse of gelyk, of heeltemal onverwant is. Die gemeenskaplike hoofkomponente (GHK) model verskaf 'n alternatief wat tussen hierdie twee ekstreme aannames gele e is: Die aanname word gemaak dat die populasie kovariansiematrikse dieselfde versameling eievektore deel, maar verskillende versamelings eiewaardes het. 'n Belangrike vraag in die toepassing van die GHK model is om te bepaal of dit geskik is vir die data wat beskou word. Flury (1988) het twee metodes, gebaseer op aanneemlikheidsberaming, voorgestel om hierdie vraag aan te spreek. Die aanname van meerveranderlike normaliteit is egter ongeldig vir baie werklike datastelle, wat die toepassing van hierdie metodes bevraagteken. 'n Aantal nie-parametriese metodes, gebaseer op skoenlus-herhalings van eievektore, word voorgestel om 'n geskikte gemeenskaplike eievektor model te kies vir twee populasie kovariansiematrikse. Met die gebruik van simulasie eksperimente word aangetoon dat die voorgestelde seleksiemetodes beter vaar as die bestaande parametriese seleksiemetodes. Indien toepaslik, kan die GHK model kovariansiematriks beramers verskaf wat minder sydig is as wanneer aanvaar word dat die kovariansiematrikse gelyk is, en waarvan die elemente kleiner standaardfoute het as die elemente van die gewone onsydige kovariansiematriks beramers. 'n Geregulariseerde kovariansiematriks beramer onder die GHK model word voorgestel, en Monte Carlo simulasie resultate toon dat dit meer akkurate beramings van die populasie kovariansiematrikse verskaf as ander mededingende kovariansiematriks beramers. Kovariansiematriks beraming vorm 'n integrale deel van baie meerveranderlike statistiese metodes. Toepassings van die GHK model in diskriminantanalise, bi-stippings en regressie-analise word ondersoek. Daar word aangetoon dat, in gevalle waar die GHK model toepaslik is, GHK diskriminantanalise betekenisvol kleiner misklassi kasie foutkoerse lewer as beide gewone kwadratiese diskriminantanalise en line^ere diskriminantanalise. 'n Raamwerk vir die vergelyking van verskillende tipes bi-stippings vir data met verskeie groepe word ontwikkel, en word gebruik om GHK bi-stippings gekonstrueer vanaf gemeenskaplike eievektore met ander tipe hoofkomponent bi-stippings te vergelyk. 'n Deelversameling van data vanaf die Vermont Oxford Network (VON), van babas opgeneem in deelnemende neonatale intensiewe sorg eenhede in Suid-Afrika en Namibi e gedurende 2009, word met behulp van die GHK model ontleed. Daar word getoon dat die voorgestelde nie-parametriese metodiek 'n verbetering op die bekende parametriese metodes bied in die ontleding van hierdie datastel wat afkomstig is uit 'n nie-normaal verdeelde meerveranderlike populasie. GHK regressie word vergelyk met hoofkomponent regressie en parsi ele kleinste kwadrate regressie in die passing van modelle om neonatale mortaliteit en lengte van verblyf te voorspel vir babas in die VON datastel. Die gepasde regressiemodelle, wat maklik bekombare dag-van-toelating data gebruik, kan deur mediese personeel en hospitaaladministrateurs gebruik word om ouers te adviseer en die toewysing van mediese sorg hulpbronne te verbeter. Voorspelde waardes vanaf hierdie modelle kan ook gebruik word in normwaarde oefeninge om die prestasie van neonatale intensiewe sorg eenhede in die Suider-Afrikaanse konteks, as deel van groter gehalteverbeteringprogramme, te evalueer.
Books on the topic "Hospital utilization Length of stay Victoria"
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Hall, Margaret Jean. Long-stay patients in short-stay hospitals. [Hyattsville, Md.] (6525 Belcrest Rd., Hyattsville 20782): [U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1993.
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Hall, Margaret Jean. Long-stay patients in short-stay hospitals. [Hyattsville, Md.] (6525 Belcrest Rd., Hyattsville 20782): [U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1993.
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Hall, Margaret Jean. Long-stay patients in short-stay hospitals. [Hyattsville, Md.] (6525 Belcrest Rd., Hyattsville 20782): [U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1993.
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Hall, Margaret Jean. Long-stay patients in short-stay hospitals. [Hyattsville, Md.] (6525 Belcrest Rd., Hyattsville 20782): [U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1993.
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Weidel, Carol. Wisconsin hospital discharge report, 1986: Case mix and length of stay efficiency. [Madison, WI] (P.O. Box 309, Madison 53701-0309): Dept. of Health and Social Services, Division of Health, Center for Health Statistics, 1987.
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Basu, Joy. An analysis of trends in average length of stay in Maryland hospitals, 1980-1987. Baltimore, Md: Maryland Health Resources Planning Commission, Division of Research and Information Systems, 1990.
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Epshṭain, Liʾon. Yeme ishpuz bilti mutsdaḳim be-vate ḥolim kelaliyim: Sikum seḳer she-neʻerakh bi-shene bate ḥolim bi-tsefon ha-arets. Yerushalayim: Mekhon Yerushalayim le-ḥeḳer Yiśraʾel, mi-yesodah shel Ḳeren Ts'arls H. Revson be-shituf ha-Merkaz ha-leʾumi li-veriʾut ha-tsibur, 1987.
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Farley, Dean E. Trends in hospital average lengths of stay, casemix, and discharge, 1980-85. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Center for Health Services Research and Health Care Technology Assessment, 1988.
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Epshṭain, Liʼon. Yeme ishpuz bilti mutsdaḳim be-vate ḥolim kelaliyim: Sikum seḳer she-neʻerakh bi-shene bate ḥolim bi-tsefon ha-arets. Yerushalayim: Mekhon Yerushalayim le-ḥeḳer Yiśraʼel, mi-yesodah shel Ḳeren Ts'arls H. Revson be-shituf ha-Merkaz ha-leʼumi li-veriʼut ha-tsibur, 1987.
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National Center for Health Services Research and Health Care Technology Assessment (U.S.) and Dartmouth Medical School, eds. Small area variations in hospitalized case mix for DRGs in Maine, Massachusetts and Iowa. [Rockville, Md.?]: National Center for Health Services Research and Health Care Technology Assessment, Public Health Service, U.S. Dept. of Health and Human Services, 1985.
Find full textBook chapters on the topic "Hospital utilization Length of stay Victoria"
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Saoud, Manel Saad, Abdelhak Boubetra, and Safa Attia. "A Simulation Knowledge Extraction-Based Decision Support System for the Healthcare Emergency Department." In Hospital Management and Emergency Medicine, 192–212. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-7998-2451-0.ch011.
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Nowadays, healthcare systems services have become a serious concern for many countries across the world. Due to its complexity and Variability the Emergency Department (ED) is considered the most critical unit of the hospital and the healthcare systems in general. Increasing the patient satisfaction, reducing as much as possible the patient's waiting time and the patient's length of stay, and optimizing the resources utilization are the overriding preoccupation for any ED manager. To support the performance enhancement in the ED, simulation studies have profusely been involved. In this paper the authors describe a decision support system based on the combination of a simulation and a temporal knowledge extraction model for the operation improvement of the emergency department in the public hospital Lakhdar Bouzidi in Bordj Bou Arreridj (Algeria). Their methodology points out how agent-based modeling simulation can benefit from data mining analysis methods to provide a powerful decision support system that can help managers to improve the functioning of the ED.
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Oueida, Soraia, Seifedine Kadry, and Sorin Ionescu. "Estimating Key Performance Indicators of a New Emergency Department Model." In Hospital Management and Emergency Medicine, 580–98. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-7998-2451-0.ch029.
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In this article, a real-life Emergency Department (ED) is studied and analyzed in order to propose areas for improvement in its operations and patient flow. EDs are in native very busy and complex systems where medical facility treatments are provided to arriving patients without any prior appointment. ED, a 24/7 open facility, interacts with the majority of other departments of the healthcare system. Due to this complexity and unplanned nature of patient surge, simulation modeling is proven to be very effective in order to study the necessary changes needed for better performance. As a consequence of these challenges, the patient LoS (Length of Stay) and the human-resource utilization rates are increased and thus leading to staff and customer dissatisfaction which need to be addressed for better performance. An emergency department of a hospital in Lebanon is chosen for simulation using Arena software where a model is designed to match the real system. This model is then verified, validated and enhanced by proposing some modifications in the resource allocation levels. These improvements are achieved by running different scenarios using Arena Process Analyzer and suggesting an optimal solution using Arena OptQuest tool without the need of interrupting the real system.
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Martin, Janet, and Davy Cheng. "Fast-track cardiac anaesthesia and early extubation." In State of the Art Surgical Coronary Revascularization, edited by John M. Murkin and Gregory Fischer, 174–80. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198758785.003.0032.
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‘Fast-track’ cardiac anaesthesia and recovery is the term given to a multicomponent intervention during cardiac surgery and postoperatively, with the ultimate goal of early extubation (within 1–6 hours) in order to reduce duration of mechanical ventilation, length of stay in the intensive care unit, and overall resource utilization. Key components of fast-track cardiac care include balanced anaesthesia (low-dose opioids together with inhaled or intravenous anaesthetics) and a time-directed extubation protocol. Fast-track cardiac care requires an interdisciplinary approach to anaesthesia during surgery, as well as a coordinated approach after surgery, in order to achieve early extubation and an overall streamlined approach to recovery and hospital discharge.
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Liu, Grace. "Using Case Costing Data and Case Mix for Funding and Benchmarking in Rehabilitation Hospitals." In Healthcare Administration, 1242–57. IGI Global, 2015. http://dx.doi.org/10.4018/978-1-4666-6339-8.ch068.
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The concern for Ontario hospitals in Canada is that the funding model has recently changed from global- to activity-based funding, which will affect hospitals' operational budget and cost management. Hospitals will be reimbursed based on a pre-set payment price for each patient type or case mix treated. Specifically, the purpose of this chapter is to describe how case costing data and case mix information are collected and used for funding. A framework is proposed for health administrators, policy makers, and researchers to understand the input variables for determining resource utilization and long stay trim point. A clinical decision-making tool is demonstrated to assist hospital administrators to define admission criteria and predict length of stay and volumes with clinical teams. The chapter highlights the importance of data quality and use of comparative data and concludes with 10 key success factors for better funding and benchmarking for rehabilitation hospitals.
Conference papers on the topic "Hospital utilization Length of stay Victoria"
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Boukhechba, Mehdi, Mingyue Tang, Brendan Bowman, Jamie Zoellner, and Emaad Abdel-Rahman. "A Smartwatch Based system for Monitoring Fluid Consumption of End Stage Kidney Patients." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002101.
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Background:End Stage Kidney disease (ESKD) patients must follow unique dietary restrictions. The most onerous of these is the need to restrict fluid intake. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations with diagnoses of heart failure and pulmonary edema, increased hospital length of stay, and increased total cost of care. Fluid intake control is a bedrock component of treatment for ESKD Patients, but continues to be a major challenge for patients, healthcare providers, and organizations. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations and increased total cost of care. The goal of this work is to investigate the feasibility of leveraging smartwatch technology to monitor fluid consumption of ESKD patients outside of the clinic. Adequate assessment of fluid intake of patients with ESKD on HD and offering timely feedback to patients and clinicians has the potential of curbing the extra fluid intake, hence reduce mortality and morbidity, and hopefully cut the costs of the need of frequent hospitalizations and/or extra dialysis treatments.Methods:We have designed a smartwatch app called Fluisense (available on Android play store,, https://play.google.com/store/apps/details?id=com.mob.fluisense) to help ESKD patients monitor their fluid intake. Fluisense helps patients record Fluid intake logs in an intuitive manner. Fluisense also collects sensor data such as mobility, acceleration, and heart rate to investigate biomarkers indicative of fluid overload. To the best of our knowledge, this is the first work leveraging smartwatches to monitor fluid accumulation of ESKD patients.N=15 ESKD patients were given an Android smartwatch with Fluisense pre-installed and were asked to log their fluid intake through the app by choosing from a list of predefined volumes each time they consume any liquid. The app computed and displayed the self-reported daily volume intake to help patients monitor their own fluid consumption. Patients received text messages twice a day (9am and 8pm) to remind them to use the watch. We also recorded patients’ weights before and after each of the thrice weekly dialysis sessions. The sum of self-reported interdialytic fluid intake was computed and compared against the interdialytic weight gain recorded in the clinic.Results: Patients recorded Fluids in 214 days out of 259 total days (i.e., 83% compliance rate). The average self-reported interdyalitic fluid consumption is 51 oz +/-64, and the average interdialytic weight gain is 2.67 kg +/- 1.56. We found a moderate but significant correlation between the self-reported fluid volumes and the interdialytic weight gain (r=0.363, P<0.001, r2=0.06). A deep learning method has also been designed to predict the interdialyctic weight gain from sensor data. Results validated through leave one subject out cross validation show an F1 score of 91 at predicting the level of weight change.Conclusion: Leveraging smartwatch-based sensing technology is a promising solution for fluid monitoring of ESKD patients. This can be related to the ease of utilization of this technology and the ecological validity of its measurements given they are collected close to when they happen, reducing recall biases.
Reports on the topic "Hospital utilization Length of stay Victoria"
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Konnyu, Kristin J., Louise M. Thoma, Monika Reddy Bhuma, Wagnan Cao, Gaelen P. Adam, Shivani Mehta, Roy K. Aaron, et al. Prehabilitation and Rehabilitation for Major Joint Replacement. Agency for Healthcare Research and Quality (AHRQ), November 2021. http://dx.doi.org/10.23970/ahrqepccer248.
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Objectives. This systematic review evaluates the rehabilitation interventions for patients who have undergone (or will undergo) total knee arthroplasty (TKA) or total hip arthroplasty (THA) for the treatment of osteoarthritis. We addressed four Key Questions (KQs): comparisons of (1) rehabilitation prior (“prehabilitation”) to TKA versus no prehabilitation, (2) comparative effectiveness of different rehabilitation programs after TKA, (3) prehabilitation prior to THA versus no prehabilitation, (4) comparative effectiveness of different rehabilitation programs after THA. Data sources and review methods. We searched Medline®, PsycINFO®, Embase®, the Cochrane Register of Clinical Trials, CINAHL®, Scopus®, and ClinicalTrials.gov from Jan 1, 2005, to May 3, 2021, to identify randomized controlled trials (RCTs) and adequately adjusted nonrandomized comparative studies (NRCSs). We evaluated clinical outcomes selected with input from a range of stakeholders. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. Meta-analysis was not feasible, and evidence was synthesized and reported descriptively. The PROSPERO protocol registration number is CRD42020199102. Results. We found 78 RCTs and 5 adjusted NRCSs. Risk of bias was moderate to high for most studies. • KQ 1: Compared with no prehabilitation, prehabilitation prior to TKA may increase strength and reduce length of hospital stay (low SoE) but may lead to comparable results in pain, range of motion (ROM), and activities of daily living (ADL) (low SoE). There was no evidence of an increased risk of harms due to prehabilitation (low SoE). • KQ 2: Various rehabilitation interventions after TKA may lead to comparable improvements in pain, ROM, and ADL (low SoE). Rehabilitation in the acute phase (initiated within 2 weeks of surgery) may lead to increased strength (low SoE) but result in similar strength when delivered in the post-acute phase (low SoE). No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA. Compared with various controls, post-acute rehabilitation may not increase the risk of harms (low SoE). • KQ 3: For all assessed outcomes, there is insufficient (or no) evidence addressing the comparison between prehabilitation and no prehabilitation prior to THA. • KQ 4: Various rehabilitation interventions after THA may lead to comparable improvements in pain, strength, ADL, and quality of life. There is some evidence of no increased risk of harms due to the intervention (low SoE). • There is insufficient evidence regarding which patients may benefit from (p)rehabilitation for all KQs and insufficient evidence regarding comparisons of different providers and different settings of (p)rehabilitation for all KQs. There is insufficient evidence on costs of (p)rehabilitation and no evidence on cost effectiveness for all KQs. Conclusion. Despite the large number of studies found, the evidence regarding various prehabilitation programs and comparisons of rehabilitation programs for TKA and THA is ultimately sparse. This is a result of the diversity of interventions studied and outcomes reported across studies. As a result, the evidence is largely insufficient or of low SoE. New high-quality research is needed, using standardized intervention terminology and core outcome sets, especially to allow network meta-analyses to explore the impact of intervention attributes on patient-reported, performance-based, and healthcare-utilization outcomes.