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PubMed2005

[Hospitalizations for varicella in the Hospital Infantil La Fe, Valencia,Spain, 2001-2004].

INTRODUCTION: Varicella is a common, highly contagious disease. It is usually benign but has potentially serious complications. PATIENTS AND METHODS: To assess the clinical characteristics and the associated cost of varicella hospitalization, we reviewed the medical records of children hospitalized for varicella between 2001 and 2004. Children with coincidental varicella hospitalized for a different reason were excluded. RESULTS: Of 1177 children with varicella attended at the emergency room, 101 (8.6 %) were hospitalized. The median age was 3.2 years (21 days to 18.9 years). Twenty-eight children had underlying disease. Thirty-seven children had no complications and the reason for admission was: a) risk of severe varicella (21 immunocompromised children, three neonates), and b) high fever or observation (13 cases). The 64 remaining children were admitted for 66 complications of varicella. The most common complications were skin/soft tissue infections (33 patients) and the leading cause was Streptococcus pyogenes (n = 13) and Staphylococcus aureus (n = 10) isolated in blood or the site of infection. Other complications were pneumonia (13 children), neurological (febrile seizures in nine, meningoencephalitis in two, acute disseminated encephalomyelitis in one, cerebellitis in one), hematological (neutropenia in one, Henoch-Schönlein purpura in one and thrombopenic purpura in three) and osteoarticular (synovitis in one and septic arthritis in one). One patient died of multiorgan failure. During the study period, the rate of emergency room visits due to varicella doubled and the number of admissions for complications tripled. The mean length of hospital stay was 6.8 days (range: 1-28 days) and the total associated cost was 397,314.14 Euro, excluding symptomatic treatment. CONCLUSIONS: The high morbidity associated with varicella and its complications, as well as the high social costs of this disease, support the implementation of routine varicella vaccination. This could reduce the total number of cases, their severity, direct costs, generated by medical care, and indirect costs, generated by the disease and hospitalization.

Adolescent↗

PubMed1986

The determinants of small-area variation in hospital utilization. The evidence from hospital discharge abstracts.

Small-area differences in hospital use were examined using hospital discharge abstract data for the populations of seven small service areas in Iowa that exhibited substantial variation in admission rates during 1980. The results indicate a marked difference in the age composition of the patient populations with older patients being more common among residents of high-use areas, higher age- and sex-adjusted discharge rates per 1000 in the high-use areas across many diagnostic categories, frequently higher average lengths of stay in high-use areas, a lack of conformity between discharge patterns for selected surgical procedures and diagnoses, and more readmissions to the same hospital during a 12-month period for residents of high-use areas. This data set comprises one part of a study of small-area differences that also employed household surveys, physician surveys, and other existing data sets. The findings illustrate the potential and limitations of hospital discharge abstracts as a data base for evaluating hospital discharge abstracts as a data base for evaluating hospital utilization differentials.

Catchment Area, Health↗

PubMed1995

Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale.

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.

Attitude of Health Personnel↗

PubMed2002

Issues in the governance of Canadian hospitals, Part II: Hospital planning.

A hospital's board is directly accountable to the corporation of the hospital. Together they are accountable to the patients and communities served by the hospital, to the provincial government that funds the hospital on behalf of these patients and communities, and to the staff of the hospital. Thus, the board of trustees has a critical role in defining the purposes, principles and objectives of hospitals.

Canada↗

PubMed2006

Hospital library foreign language labs: the experiences of two hospital libraries.

Increasingly, hospital-based physicians, residents, and medical students are welcoming into their care foreign-born patients, who do not speak English. Most hospitals today have an Interpretive Services Department, but many of the physicians, residents, and medical students want to become more proficient in the most frequently spoken foreign languages in their respective locales. To help recruit and retain a diverse workforce, some hospitals sponsor English programs for staff. The Treadwell Library at Massachusetts General Hospital in Boston, Massachusetts, and the Grady Branch Library at Grady Memorial Hospital in Atlanta, Georgia, have developed a special collection and hospital library-based language laboratories in order to meet this need.

Communication Barriers↗

PubMedDate not supplied

[Hospital humanization: professional satisfaction in a pediatric hospital].

It was aimed at evaluating the professionals' satisfaction of a municipal pediatric hospital of Fortaleza with relationship to the humanization of the attendance in the hospital, as National Program of Humanization of the Hospital Assistance extolled by ministry of Health. The descriptive study had as sample 38 professionals. The data collection was carried out by a questionnaire, being the data presented in tables. Interaction was detected between the administration of the hospital and the professionals by internal discussions to evaluate the service. They consider the work environment is confortable for their work practice, therefore some improvement was indicated. The support for the professionals was suggested as an improvement point. The professionals suggested trainings, improvement of the atmosphere of the hospital and quality of the attendance. It is expected that this study supplies subsidies for the planning of actions favorable for the humanization of hospital assistance.

Adult↗

PubMed1988

Hospital charges for people with AIDS in Washington State: utilization of a statewide hospital discharge data base.

We analyzed Washington State inpatient hospital utilization for 165 AIDS (acquired immunodeficiency syndrome) cases with 344 hospitalizations from July 1984 through December 1985. We found that mean charges per hospitalization were $9,166 and mean length of stay was 13.3 days. In addition, evaluation of two diagnosis-related groups (DRGs 079 and 398) commonly used for AIDS hospitalizations showed that AIDS hospitalizations were substantially more expensive than non-AIDS hospitalizations within the same diagnosis-related group. AIDS-specific diagnosis-related groups may be necessary to achieve a balance between inpatient charges and reimbursements.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Serum uric acid levels as a predictor of in-hospital death in patients hospitalized for decompensated heart failure.

OBJECTIVES: The aim of this study was to determine the value of serum uric acid levels in predicting in-hospital mortality of chronic heart failure patients hospitalized for decompensation in spite of appropriate medical therapy. METHODS AND RESULTS: This study was conducted in patients who were admitted to our clinic between January 2003 and April 2004 due to decompensated heart failure. Only patients who had a functional capacity of class IV and who already received loop diuretic and ACE inhibitor therapy before their admission were included. Patients with recurrent admissions during this period were excluded. Eighty-five patients fulfilled these criteria: group I consisted of 25 patients who died during hospitalization whereas group II consisted of 60 patients who were discharged alive after treatment. Age, sex, left ventricular ejection fraction derived from 2-D echocardiography, serum sodium (Na), gamma-glutamyl transpeptidase (GGT), creatinine, uric acid levels, white blood cell counts and drugs used on admission were the selected parameters as predictors of in-hospital mortality in these patients. When stepwise logistic regression analysis was used, female sex and serum uric acid levels at admission appear to be the only predictors of death during that hospitalization independent of other variables. CONCLUSIONS: Serum uric acid levels may be used as a predictor of death in hospitalized heart failure patients with class IV symptoms.

Aged↗

PubMed2004

Do the leading children's hospitals have quality web sites? A description of children's hospital web sites.

BACKGROUND: Although leading children's hospitals are recognized as preeminent in the provision of health care to children, the quality of their Web sites has not been described. OBJECTIVE: To describe technical characteristics of the Web sites of leading children's hospitals. METHODS: This is a cross-sectional descriptive infodemiology study. Two reviewers independently reviewed and analyzed the Web sites of 26 nationally prominent children's hospitals in June 2003, using objective criteria based on accessibility (based on age and language), attribution, completeness, credibility, currency, disclosure, readability, and other technical elements. RESULTS: One-third of Web sites included content for children and adolescents. Twenty-four (92%) of the Web sites had health and disease-specific information. One-third contained only English, while two-thirds included other languages. All 26 Web sites included a disclaimer, although none had a requirement to read the disclaimer before accessing health and disease specific information. Twenty-four (92%) had search options. Although most (85%) listed a copyright date, only 10% listed the date last updated. CONCLUSIONS: This is the first study to examine the Web sites of leading children's hospitals. Although the Web sites were designed for children's hospitals, only a few sites included content for children and adolescents. Primary care physicians who refer patients to these sites should be aware that many have limited content for children, and should assess them for other limitations, such as inconsistent documentation of disclaimers or failure to show the date of the last Web site update. These Web sites are a potentially useful source of patient information. However, as the public increasingly looks to the Internet for health information, children's hospitals need to keep up with increasingly high standards and demands of health-care consumers.

Adolescent↗

PubMed2006

To hospitalize or not to hospitalize? That is the question: an analysis of decision making in the nursing home.

The authors examined the processes and factors that influence physicians' decision-making processes as regarding hospitalization of nursing home residents. In a large nonprofit nursing home, 6 full-time male physicians and 1 female nurse practitioner completed questionnaires that described the medical decision-making process for 52 nursing home residents for whom hospitalization was considered. The questionnaire covered the following topics: medical event description, the decision-making process, considerations in making treatment decisions, and the role of advance directives. Hospitalized residents had fewer treatments considered and fewer treatments chosen than those who were not hospitalized. Residents with fractures were the most commonly hospitalized residents, whereas residents in frailer conditions, with breathing problems, and for whom the physician considered quality of life to be most important were less likely to be hospitalized. The results of this study clarify the complexity of factors affecting the decision-making process and suggest a methodology that may assist in discerning those factors in the future.

Aged↗

PubMed2004

Outcomes and in-hospital treatment of out-of-hospital cardiac arrest patients resuscitated from ventricular fibrillation by early defibrillation.

OBJECTIVE: To describe and evaluate the in-hospital treatment of ventricular arrhythmias and underlying structural heart disease in patients who survive ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) in a region with a high survival rate after hospital discharge. PATIENTS AND METHODS: The study included all patients presenting in Olmsted County, Minnesota, who had experienced OHCA between November 1990 and December 2000 and who underwent defibrillation of VF by an emergency medical service system. RESULTS: Of 200 patients who experienced VF arrest, 138 (69%) survived to hospital admission (7 died in the emergency department before admission), and 79 (40%) were discharged. Of patients who were discharged, 37 (47%) had a reversible cause of the arrest (perimyocardial infarction) and received treatment of the primary process. The other 42 patients who were discharged had ischemic coronary heart disease (CHD) (n=25), nonischemic CHD (n=10), or idiopathic VF (n=7). Four of the patients with CHD but no left ventricular dysfunction were treated with coronary artery bypass grafting or percutaneous coronary intervention alone. A total of 52 patients (66%) were candidates for electrophysiologic testing. Of these patients, 48 (92%) underwent electrophysiologic testing; of these patients, 10 received amiodarone alone, and 35 received an implantable cardioverter-defibrillator (ICD) (of whom 3 also received amiodarone). Patients who did not receive ICD therapy typically presented before 1998 with CHD and underwent coronary artery bypass grafting or percutaneous coronary intervention only. Of 79 patients who were discharged, 14 (18%) with an ICD have received subsequent shocks. Nineteen (24%) of 79 patients have died, 5 of a primary cardiac etiology (including 2 with repeated OHCA). CONCLUSIONS: The VF OHCA survival rate is high in the setting of rapid defibrillation, with 40% of patients being discharged from the hospital. By the end of the 10-year study, more patients were receiving antiarrhythmic therapy, in particular ICD implantation, after hospital admission. Overall, the long-term survival in patients with VF OHCA is favorable.

Aged↗

PubMed1990

A decision support model and analysis for hospital administrators when choosing future strategies of their hospitals.

How to allocate a hospital's finite resources to health care is an extremely important problem for hospital management. This paper shows what kind of business strategies a given hospital should consider, and present a model to support such decision making. From the model, a hospital can decide how much to emphasize different tasks in order to set a given direction for the future. We used nonlinear discriminant functions to derive a decision support model, based on findings from 831 hospital directors. This model provides a probabilistic basis for deciding how much a given hospital should emphasize any of a number of different strategies.

Decision Support Systems, Management↗

PubMed1993

Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs.

Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.

Aged↗

PubMed1996

Hospitals--East meets West--reflections on international hospital co-operation.

On the European scene, particularly in the Member States of the European Union, the social system and the healthcare system as essential part of it are under demographic and economic pression and in full change. Hospitals being important partners in the healthcare network are rethinking their role and re-orienting their mission. Co-operation is a key issue both within the hospital with its multiple interprofessional relationships around the patients and outside the hospital with the variety of partners of the local healthcare network, with the general public and with the competent authorities. Change and co-operation are the keywords in the HOPE operation which the HCEC started in synergy with WHO Europe within a year after the Wall in Berlin was broken down in November 1989. Whatever the importance of East-West Co-operation between hospitals may be, it can not separate the paneuropean hospitals from the rest of the world. Hospitals and their national and international associations could play an exemplary role in the real active management of the changes at world level and in the prevention of poverty and violence.

Europe↗

PubMed1999

[Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 4. Actual status of the management of tuberculosis patients in a university hospital without isolation wards for infectious diseases].

We retrospectively evaluated clinical findings and the actual status of management of 69 tuberculosis patients admitted to the Fujita Health University Hospital, a hospital without isolation wards for infectious diseases, between 1991 and 1994. Forty-nine patients were smear-positive and 22 patients were smear-negative and culture-positive. Twenty-five cases (36.2%) were classified as type II (cavitary) and 29 cases (42.0%) as type III (non-cavitary) according to the GAKKAI classification of findings on chest X-ray films for pulmonary tuberculosis. Physicians in charge did not diagnose twenty-four patients (34.8%) as tuberculosis on admission. Physicians in charge tended not to suspect smear-negative patients of tuberculosis. Most of the patients with cavities on their chest X-ray films were strongly suspected of tuberculosis on admission, but in some of them, tuberculosis was not considered at all. Smear-positive patients with strongly suspected tuberculosis were diagnosed with the disease within three hospital days, while it took about three weeks in patients who were not considered as tuberculosis on admission to be diagnosed as tuberculosis. In the case of smear-negative patients, it took about one month and two months respectively to diagnose the case as tuberculosis. About half (51.1%) of the smear-positive patients were admitted and treated in single-bed rooms while 44.7% were attended in multiple-bed rooms for 11 days before they were transferred to single-bed rooms. When acid-fast bacilli were detected, 57.4% of the smear-positive patients were transferred to hospitals with isolation wards for infectious diseases, while the remaining smear-positive patients were treated in single-bed rooms at the university hospital. About one-third (31.7%) of the smear-negative patients had already left the hospital when specimens were found to be culture positive for tubercle bacilli. In conclusion, it is utmost important for physicians to suspect to tuberculosis for the early diagnosis of the disease.

Adult↗

PubMed1999

[Predictive factors of hospital admission in ambulatory surgery at a regional hospital].

BACKGROUND: Hospital admission following ambulatory surgery is a valid measure of morbidity and a quality indicator. To improve the efficiency of an ambulatory surgery unit it is essential to study the factors associated with unexpected hospital admission. Our goal was to analyze the association of age, ASA, type of surgical and anesthetic procedures, surgical duration, pain, vomiting and surgical and anesthetic complications with unexpected hospital admission. PATIENTS AND METHODS: Retrospective case-control study. The cases were all patients who underwent ambulatory surgery in the Viladecans Hospital (Barcelona, Spain) from October 1990 till May 1996 (n = 6,071), cases (n1 = 93), controls (n0 = 552). Logistic regression models with a predictive variable and multiple logistic regression were obtained. OR and 95% CI were calculated. RESULTS: Age was not significant for admission. ASA greater than status 1 (OR: 3.4 [1.4-9]); p = 0.01), the procto-perineo-sacrococcygeal procedures have significant risk (OR: 35 [4-304]; p < 0.00001), and other types of surgery were not significant. General, spinal anaesthesia and non-spinal locoregional ones with sedation were not significant (p > 0.2), but spinal anesthesia with deep sedation carried a significant risk (OR: 20 [3-122]; p < 0.00001). Surgical duration higher than 40 min (OR: 22 [5-94]; p < 0.00001), pain (OR: 12 [3-55]; p < 0.00001) and vomiting (OR: 8.5 [1.2-59]; p = 0.03) were significant factors in predicting hospital admission. CONCLUSIONS: The factors related with unexpected hospital admission following ambulatory surgery were: surgical and anesthetic complications, pain, procto-perineal and sacrococcigeal procedures, spinal anesthesia with profound sedation and a surgical duration time higher than 40 min.

Adolescent↗

PubMed1982

The effects of hospital rate-setting programs on volumes of hospital services: a preliminary analysis.

This article describes a preliminary study of the effects of State rate-setting programs on volumes of hospital services, specifically admission rates, occupancy levels, and average lengths of stay. A volume response to rate-setting may be anticipated as a result of program effects on hospital costs or charges as well as on hospitals' behavioral incentives. We analyzed data for samples of hospitals and counties in States with and without rate-setting programs for the 9-year period 1969 to 1978. The results suggested that rate regulation has brought about, in some States, an increase in hospital occupancy by increasing patients' lengths of stay. Few programs have had a measurable effect on the admission rate. Programs that regulate per diem rates seem to produce more consistent and predictable volume effects than those controlling charges. The findings were generally consistent with prior hypotheses and partially account for earlier findings regarding the effects of rate-setting programs on hospital costs.

Bed Occupancy↗

PubMed1999

Hospital admission policy for tuberculosis in pulmonary centres in Italy: a national survey. AIPO Tuberculosis Study Group. Italian Association of Hospital Pulmonologists.

SETTING: A national survey including 203 pulmonary centres (PCs) (144 hospital PCs with beds dedicated to TB patients and 59 out-patient PCs) managing tuberculosis cases in Italy during 1995. OBJECTIVES: To evaluate: 1) hospitalisation practices (criteria for admission/discharge; duration of hospitalisation) as primary end-points; and 2) as secondary end-points the availability of beds, the preventive measures adopted to reduce the spread of infection, the sources of referral for hospitalisation and the procedures adopted to follow up TB patients after discharge. DESIGN: A 26-point questionnaire mailed to 203 PCs. RESULTS: Of 167 PCs that responded to the questionnaire (82.3%), 159 questionnaires were considered valid for the analysis (110 from hospitals PCs and 49 from out-patient PCs). The criteria adopted by PCs to admit TB patients were: all TB cases 47%, only smear-positive pulmonary TB 14%, TB cases with clinical problems 39%. Hospital PCs hospitalised significantly more cases of smear-negative, extra-pulmonary TB. On average 71.6% of all cases were hospitalised (88.2% by hospital and 28% by out-patient PCs). The median hospital stay was 34 days for sputum smear-positive, 20 for sputum smear-negative and 21.5 for extra-pulmonary TB cases. Sputum conversion was considered the mandatory criterion to allow discharge from 61% of hospital PCs. CONCLUSION: A switch from the present policy (majority of cases hospitalised for a long period) to an outpatient oriented policy needs the co-ordinated educational effort of scientific societies and health authorities.

Health Care Surveys↗