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PubMed1991

The single-hospital county: is its hospital at risk?

This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk.

Bed Occupancy↗

PubMed1990

The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

Black or African American↗

PubMedDate not supplied

Sigmoidoscopy service in a district general hospital: open-access versus hospital-referred.

In a retrospective analysis of open-access versus hospital-referred flexible sigmoidoscopies, the two groups are compared with reference to the demographic data, presenting symptoms, sigmoidoscopy findings and diagnostic yield. Overall, 1090 patients underwent sigmoidoscopy during 12 months, 544 in the open-access and 546 in the hospital-referred group. There was a preponderance of females in both groups, but patients in the hospital-referred group were older. Diarrhoea was the most common presenting symptom, followed by rectal bleeding. Significantly more patients presented with rectal bleeding with or without diarrhoea and abdominal pain in the open-access group, while there were more patients with iron deficiency in the hospital-referred group. The number of patients with colonic carcinoma was similar in the two groups, but significantly more early carcinomas were found in the open-access group. There were significantly more patients with haemorrhoids in the open-access group. The positivity rate was similar in the two groups (52% in the open-access vs 46% in the hospital-referred group). Of the 24% of patients 40 years or under, none had carcinomas. In this age range the positivity rate was no different in the two groups (32% in the open-access vs 23% in the hospital-referred group). The diagnostic yield of open-access flexible sigmoidoscopy is thus comparable to hospital-referred sigmoidoscopy, suggesting that it should be freely available to GPs.

Adult↗

PubMed1995

Differences in hospital casemix, and the relationship between casemix and hospital costs.

BACKGROUND: The aim of the study was to examine the relationship between hospital costs and casemix, and after adjustment for casemix differences, between cost and institutional size, number of specialties, occupancy and teaching status. METHODS: A retrospective analysis of all admissions to nine acute-care NHS hospitals in the Oxford region during the 1991-1992 financial year was undertaken. All episodes were assigned to a diagnosis-related group (DRG) and a cost weight assigned accordingly. Costs per finished consultant episode, before and after adjustment for casemix differences, were analysed at the hospital and specialty level. RESULTS: Casemix differences were significant, and accounted for approximately 77 per cent of the difference in costs between providers. Costs per casemix-adjusted episode were not significantly associated with differences in hospital size, scope, occupancy levels or teaching status, but sample size was insufficient to investigate these relationships adequately. Specialty costs were poorly correlated with specialty casemix. This was probably due to poor apportionment of specialty costs in hospital accounting returns. CONCLUSIONS: Casemix differences need to be taken into account when comparing providers for the purposes of contracting, as unadjusted unit costs may be misleading. Although the methods used may currently be applied to most NHS hospitals, widespread use would be greatly facilitated by the development of indigenous cost weights and better routine hospital data coding and collection.

Bed Occupancy↗

PubMed1997

[Hospital at home and conventional hospitalization. An economic evaluation].

BACKGROUND: To carry out an economic evaluation of hospital at home (HH) vs. conventional hospitalization (CH) from the hospital cost perspective. METHODS: A minimization cost analysis were performed in 2 groups of patients (HH: 148 patients, 1,776 days of care; CH: 148 patients, 1,113 days) with similar characteristics. We used cost per hospital episode (only for the comparable period in HH and HC) and cost per day as outcome measures. The costs of health care professionals, pharmacy, sanitary material, diagnostic and therapeutic tests and transport were directly estimated for each patient. Other costs were indirectly assigned from the hospital accountability information system. RESULTS: The average episode cost at home was 172,043 ptas. (about $1,300) less compared to the conventional hospitalization. Cost per diem for HH was 25,565 ptas. less than CH. Marginal costs were 14,987 and 2,913 ptas. minor in HH than CH, per episode and day respectively. When we consider HH staff as a differential cost (i.e. to establish a new hospital at home unit with new staff) marginal cost per episode was 2,276 pesetas higher than CH. CONCLUSIONS: HH is a cost-effective option when decisions take into account the average cost (establishment of a new unit vs. a new ward) or when the HH unit is created as a substitute service through the conversion of pre-existent resources. However, HH is a disadvantaged cost option when it is created as an additional resource.

Adolescent↗

PubMed1983

Cooperative groups and community hospitals. Measurement of impact in the community hospitals.

The Eastern Cooperative Oncology Group, composed of major cancer treatment centers, has an outreach program which involves community hospitals in ongoing cancer clinical trials. A prevalence survey was carried out in February 1981 among 104 community hospitals and 21 member institutions to determine the characteristics of patients being treated, their staffing, and reasons why patients were not on protocol studies. The survey sampled 25 (50) consecutive patients from community hospitals (member institutions). The purpose of the study was to assess the impact of a community cancer control program. The results of the study demonstrated that 16% of patients surveyed in the affiliated community hospitals were being treated on a research protocol. In addition, a further 35% had their treatment plan influenced by a protocol. Consequently protocols have impacted directly or indirectly on 51% of the patients. The corresponding figures in member institutions were 23% and 38% for a total of 61%. In studying protocol availability, it was found that 66% of all patients were ineligible for any protocol. Of patients eligible for a protocol but not registered on one, 52% were not registered because of physician preference for a specific treatment. The affiliates surveyed were shown to be on average half as large as member institutions in terms of number of beds and staff size. Also, staff/patient ratios are generally smaller in the community hospitals. The median age of patients was considerably lower than SEER incidence data. Also, elderly patients were slightly more prevalent in community hospitals than in member institutions. A clear relationship between disease stage and age in breast cancer patients was noted with the representation of early-stage disease much higher in young women.

Adult↗

PubMed1994

Physician-hospital integration in a community hospital: a case study.

Over the past 20 years, the hospital environment and physicians' relationships with hospitals have changed dramatically. Hough has presented a concise description of this relational evolution. He describes hospitals during the period 1900 to 1975 as physicians' workshops; 1976 to 1985, hospitals were physicians' competitors; 1986 to 1995, hospitals have been and will be physicians' suitors; and, from 1996 on, Hough sees hospitals as physicians' partners. At St. Joseph Health System, we have already taken strong moves toward the final scenario envisioned by Hough. In this article, the author describes the historical underpinnings and the methodologies of the system's planning and implementation processes for new arrangements with staff and community physicians.

Comprehensive Health Care↗

PubMed2003

Comparison of restorative dentistry referrals to a district general hospital and to a teaching hospital using a pilot Index of Restorative Dental Treatment Need.

The purpose of this study was to identify differences between referral patterns and the clinical conditions of patients referred to consultant-led Restorative Dentistry clinics in a district general hospital and a London dental teaching hospital. The Index of Restorative Dental Treatment Need was used to classify patients into those patients whose treatment was appropriate for any dental graduate in general practice, for an experienced dentist in general practice, and for a dentist with specialist training. Demographic and clinical details were recorded for one hundred patients at each hospital. The results of the study showed that the proposed treatment of 21% of the patients seen at the district general hospital and 16% of the patients seen at the teaching hospital was appropriate for specialist care. The results support the expansion of specialist restorative dentistry services in district general hospitals.

Adult↗

PubMed2004

[The neurology department of the Lankwitz Hospital. A contribution to the history of emigration, psychotherapy and the Berlin hospital].

At Lankwitz near Berlin the Jewish physicians James Fraenkel and Albert Oliven founded a private hospital in 1890. This hospital, which integrated seven departments, became one of the biggest private asylums in the Reich during the first decade of the 20th century. Parts of the hospital served the military during WWI. As most of the physicians at Lankwitz were Jewish, the year 1933 meant an immense moral and scientific decline, since these physicians were forced to leave and later threatened. We know of one physician killed in a concentration camp. Hardly any research about this hospital had been published until the 1990's. This contribution is the first portraying one department--that of neurology. From the early years of the hospital, therapists involved with psycho-dynamic psychiatry and psychoanalysis were attracted to it. Lankwitz was a major experience for a number of later famous psychiatrists and psychoanalysts. This continued to be the case during the years of the Weimar Republic, after the hospital had been leased [verpachtet] to the insurance companies [gesetzliche Krankenkassen] of Greater Berlin. Revealing more about the history of Berlin's private clinics, this article also contributes to the city's history of neurology, psychiatry and psychotherapy. For the example of Lankwitz, the myth of a 'marginalized psychoanalysis', rejected by the contemorary medicine, cannot be corroborated. On the contrary, the Lankwitz physicians portrayed here seemed to have combined and integrated clinical work with psychoanalytic theory and practice. Germany's turn towards National Socialism however meant an immediate end for the Lankwitz clinic and the mode of therapy described.

Berlin↗

PubMed1997

Fast, flexible, and fluid: the continuing success of the Charlotte-Mecklenburg Hospital Authority in an era of public hospital crisis.

The changing face of health care delivery continues to challenge public hospitals, and many of these hospitals are in danger of closing. Increasing numbers of uninsured patients, coupled with state and federal cuts in Medicaid spending, threaten to worsen the situation. These facilities' survival may well depend upon their ability to create integrated delivery systems (IDSs). However, public hospitals are likely to face significant barriers in forming and participating in IDSs. This article present some of the barriers facing public hospitals as they attempt to form an IDS. Additionally, the authors present a brief case study of a public hospital whose successful efforts to form an IDS began before the IDS concept became popular. In forming an IDS this public hospital has strengthened its commitment to research, education, and the delivery of quality public health care.

Community Networks↗

PubMed1998

[What do people expect from their hospital? Results of a visitor survey at open house in a general hospital].

Both increasing competition between hospitals and growing demands for quality by patients and health insurances require a good knowledge of patients' needs and expectations. For this reason the hospital management organized a survey during Open Day in the hospital. The visitors were asked to find facts about their expectations concerning a potential stay in a hospital. The results of this survey show the importance of hospital staff's communication skills. Moreover, the results indicate that structural changes in a hospital must be aimed at patient's needs and requirements. Only in this manner can the expectations of potential patients be met to ensure high patient satisfaction.

Adult↗

PubMed1995

Parental presence at induction of anaesthesia: a survey of N.S.W. hospitals and tertiary paediatric hospitals in Australia.

We undertook a survey of N.S.W. hospitals and tertiary paediatric hospitals in other States to determine their practice in relation to parental presence at induction of anaesthesia of children. There were 135 responses to 174 questionnaires. Twenty-one indicated that no children were anaesthetized at their institution and one was inadequately filled out. One hundred and thirteen questionnaires were assessed. Only 44% of departments had an official policy on parental attendance. A quarter of all hospitals described their facilities as entirely suitable, and a half compromised to allow parents to be present. The remaining quarter described their facilities as unsuitable. Overall, two-thirds of hospitals never or only sometimes had parents present at induction, and this applied equally to day stay patients and inpatients. Tertiary hospitals were more likely to have parents present, however they were more likely to have suitable facilities. The most common reason cited for parental attendance was parental expectation of being present, closely followed by the individual anaesthetist's philosophy. The most common reason for parents not attending was the individual anaesthetist's philosophy, followed by inadequate staffing.

Adult↗

PubMed1990

Hospital readmissions, otolaryngology, and the diagnosis related group hospital payment system.

An analysis of otolaryngologic patients requiring readmission was conducted at our institution during a 4-year period to determine the number of readmissions per patient and the time between discharge and hospital readmission. Readmitted otolaryngologic patients were found to have had greater hospital resource utilization, financial risk under diagnosis-related group payment, and mortality, compared with those patients not readmitted to our facility. For patients readmitted to otolaryngologic services (21.2% of total otolaryngologic patients), 20.4% of the readmissions occurred within 30 days of hospital discharge. Of these, 39.3% required one hospital readmission, 16.3% required two readmissions, and 46.4% of the patients called for three or more hospital admissions. Clinical factors were identified that resulted in a greater incidence of otolaryngologic readmission. Otolaryngologic patients readmitted to other clinical services were also studied. This analysis loads to the conclusion that inequities exist within the diagnosis related group hospital payment system vis-à-vis otolaryngologic readmissions. The results of these data also demonstrate leverage points in which we will be able to focus outpatient services for otolaryngologic patients requiring readmission and potentially decrease inpatient hospital expenditures in the days ahead.

Academic Medical Centers↗

PubMed2004

A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research.

OBJECTIVE: As the use of "day hospitals" increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e.g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care. METHOD: Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001--2002. RESULTS: Response rates varied from 52 to 91 %. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital's statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries. CONCLUSION: Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.

Adolescent↗

PubMed1989

Hospital costs and resource characteristics for cardiothoracic surgical hospital deaths.

No major changes in the federal Medicare diagnostic-related group (DRG) prospective hospital payment system have been implemented by the United States Congress. We analyzed hospital resource consumption for 1,567 cardiothoracic surgical patients by outcome (ie, survivors versus nonsurvivors). The 76 patients who died had a much greater intensity of hospital resource utilization and represented a substantial financial risk under DRG pricing schemes compared with the 1,491 survivors. Only patients who died within 1 week of admission to the hospital generated a financial surplus under DRGs. A long hospital stay for nonsurvivors produced a substantial deficit (patients with a stay greater than 60 days generated a $154,433 loss per patient). The cardiothoracic patients admitted on an emergency basis who died tended to have a shorter length of stay and represented a lower financial risk under DRGs compared with patients admitted on a nonemergency basis who died. Among nonsurvivors, patients referred for cardiothoracic surgical procedures from other clinical services had lower resource utilization and financial risk under DRGs compared with nonreferrals. These data suggest significant inequities in the current DRG prospective payment system vis-à-vis cardiothoracic surgical patients who die. Variables predictive of greater hospital resource utilization by outcome included a longer hospital stay, nonemergency admission, and admission directly to the cardiothoracic surgical service. Methods to improve the equity of DRG payment vis-à-vis cardiothoracic surgical nonsurvivors should be implemented in the future.

Adolescent↗

PubMed1993

Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation.

During a 9-year period 1472 cardiopulmonary resuscitations were analysed. Five-hundred seventy-two were in-hospital and 898 out-of-hospital resuscitations. Of the out-of-hospital resuscitations 495 (55.1%) patients were less than 70 years and 403 (44.9%) older than 70 years. Survival in the former group was 71 (14.3%) in the elderly group 44 (10.9%) (P < 0.1). In the in-hospital population 245 (43%) were below 70 years and 327 patients above 70 years (57%). Seventy patients (28.2%) in the former group and 46 (14.1%) in the latter group survived (P < 0.01). The statistical analysis of the out-of-hospital resuscitations indicates no significant difference in the survival rate of patients younger than 70 years compared to those above 70 years. The survival rate however for patients above 70 years in the in-hospital group was significantly worse, probably attributed to multimorbidity of the older in-hospital patients. The results in our study indicate that old age is not a determinant of prognosis or outcome after CPR.

Age Factors↗

PubMed2006

The establishment of a statewide surveillance program for hospital-acquired infections in large Victorian public hospitals: a report from the VICNISS Coordinating Centre.

BACKGROUND: A 1998 survey of acute Victorian public hospitals (VPH) revealed that surveillance of hospital-acquired infections (HAI) was underdeveloped, definitions and methodology varied considerably, and results disseminated inconsistently. The survey identified the need for an effective surveillance system for HAI. OBJECTIVE: To develop and support a standardized surveillance program for HAIs in large acute VPH and to provide risk-adjusted, procedure-specific, HAI rates. METHODS: In 2002, the independent Victorian Nosocomial Infection Surveillance System (VICNISS) Coordinating Centre (VCC) was established to develop and support the standardized surveillance program. A multidisciplinary team was recruited. A communication strategy, surveillance manual, user groups, and Web site were developed. Formal education sessions were provided to participating infection control nurse consultants (ICCs). Surveillance activities were based on the US Centers for Diseases Control and Prevention's National Nosocomial Infection Surveillance System (NNIS) surgical site infection and intensive care unit (ICU) components. NNIS methods were modified to suit local needs. Data collection was paper based or through existing hospital software. An advisory committee of key stakeholders met every second month. RESULTS: The surveillance program was rolled out over 12 months to all 28 large adult VPH. Data on over 20,000 surgical procedures performed at participating sites between November 11, 2002, and December 31, 2004, were submitted. Thirteen hospitals contributed to the ICU surveillance activities. Following aggregation and analysis by the VCC, hospital- and state-level results were posted on the Web page for hospitals to review. CONCLUSION: A standardized approach for surveillance of HAI was established in a short time frame in over 28 VPH. VICNISS is a tool that will continue to provide participating hospitals with a basis for continuous quality improvement.

Benchmarking↗

PubMed2004

Pre-hospital and hospital traumatic deaths in the former homeland of Transkei, South Africa.

This retrospective descriptive study on 274 medicolegal cases was to determine the issues related to pre-hospital and hospital deaths in injured patients and to determine whether any of the deaths were preventable in the area. Interviews of the family members were conducted individually before carrying out autopsies. Time of survival after trauma, place of death, and the cause of death were recorded along with the demographic information -- age, sex, occupation, and personal habits. Umtata General Hospital in the Eastern Cape Province is the referral hospital for a surrounding population of about 400,000. Seventy four percent (74%) of the victims had been declared, 'presumably dead' at the scene by the community or police, and taken to mortuary without any death certification by a physician. The rest (26%) were taken to hospital where later they succumbed to trauma. Out of these only 4% underwent surgery. The majority (68%) of the victims were young ( < 40 years). The causes of deaths were: motor vehicle accidents (MVA) 32%, gunshot 24%, stab injury 17%, blunt trauma 9% and miscellaneous (fall from height, burns, etc.) 17%. Head and chest injuries were the commonest 50%. Only 17% survived from days to weeks. About 75% subjects died within 6 h of the trauma. There is a very high pre-hospital (74%) mortality of trauma patients in the Transkei region. The fact that members of the community or police and not a medical practitioner confirmed deaths raises the ethical issue of right to life. Some may actually be alive when they are considered dead. As it appears that 12% of pre-hospital deaths are preventable, employing more medical personnel in the rural areas along with an effective ambulance service would seem to be required.

Accidents, Traffic↗