[Compulsory admissions].
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Commitment of Persons with Psychiatric Disorders↗
Biomedical subjects
Torhild Heggestad
Publications and source records attributed to Torhild Heggestad.
Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals.
OBJECTIVE: To test whether there is an association between hospital operating conditions such as average length of stays (LOS) and staffing ratio, and elderly patients' risk of readmission. DATA SOURCES: The main data source was a national patient database of admissions to all acute-care Norwegian hospitals during the year of 1996. STUDY DESIGN: It is a cross-sectional study, where Cox' regression analysis was used to test the factors acting on the probability of early unplanned readmission (within 30 days), and later occuring ones. The principal hospital variables included average hospital LOS and staffing ratio (discharges per man-years of personnel). Adjusting patient variables in the model included age, gender, and cost-weights of the Diagnosis Related Groups (DRGs). DATA EXTRACTION METHODS: The selected material included discharges from 59 hospitals, and 113,055 elderly patients (> or = 67 years). Multiple admissions to the same hospital were linked together chronologically, and additional hospital data were matched on. To maximize the association between the index stay and the defined outcome (unplanned readmission), no intervening planned admission was accepted. PRINCIPAL FINDINGS: Being admitted to a hospital with relatively short average LOS increased the patient's risk of early readmission significantly. In addition it was found that more intensive care (more staff) could have a compensatory effect. Furthermore, the predictive factors were shown to be time dependent, as hospital variables had much less impact on readmissions occurring late (within 90-180 days). CONCLUSIONS: The results give support to the assumption of a link between hospital operating conditions and patient outcome.
Acute Disease↗
Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.
OBJECTIVE: To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. MATERIAL AND METHODS: The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. RESULTS: The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. CONCLUSION: Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.
Air Ambulances↗