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Evaluación de la adecuación de las estancias en un hospital de tercer nivel
Pérez-Rubio,A.; Santos,S.; Luquero,F. J.; Tamames,S.; Cantón,B.; Castrodeza,J.J.;
Anales del Sistema Sanitario de Navarra , 2007, DOI: 10.4321/S1137-66272007000100003
Abstract: background: the appropriateness evaluation protocol (aep) has proved to be a useful tool for reviewing the utilisation of hospital resources. the aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the hospital clínico universitario de valladolid (hcuv). material and methods: a retrospective, analytical, observational, cohort study. the period of study was one year (2004). a sample of 1,630 admissions was gathered. case definition, variables of interest and the model of data gathering were carried out in accordance with the aep. the principal variables were analysed by means of a basal analysis and the possible relations between them. results: fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to delays in the development of study or treatment. conclusions: the utilisation of methods of identification of inappropriate use such as aep show applications both in planning and in hospital management, by making it possible to identify hospital problems causing delays, principally problems of an organisational type, making it possible to develop interventions aimed at reducing inappropriate use.
Adecuación de los ingresos y estancias en un Servicio de Medicina Interna de un hospital de segundo nivel utilizando la versión concurrente del AEP (Appropriateness Evaluation Protocol)
Rodríguez-Vera,F. J.; Marín Fernández,Y.; Sánchez,A.; Borrachero,C.; Pujol de la Llave,E.;
Anales de Medicina Interna , 2003, DOI: 10.4321/S0212-71992003000600005
Abstract: aims: to study the inappropriateness of the admissions and stays in an internal medicine department using the concurrent versión of the aep (appropriateness evaluation protocol). method: aplication of the concurrent versión of the aep to all the patients internated in an internal medicine department. results: 59 patients and 485 stays fulfilled the inclusión criteria. a 15.3% of the admissions and a 33% of the stays did not acomplish the criteria of appropriateness of the aep. the most frequent cause of innappropriate admisión was to avoid the delay of the ambulatory studies. the most common cause of innappropriate stay was the wait for results of complementary tests and consultancy between different specialities. conclusions: using the concurrent versión of the aep allows to obtain information about the overuse of the hospitalization resources in an easy and rapid way. the results obtained in our study are similar to other made in spain using the retrospective versión of the aep.
Factores asociados a las estancias anormalmente prolongadas en las hospitalizaciones por insuficiencia cardiaca en Espa a Associated factors with unusually long stays in heart failure hospitalizations in Spain  [cached]
J.M. García Torrecillas,E. Moreno,I. Sánchez-Montesinos,M.C. Lea
Anales del Sistema Sanitario de Navarra , 2011,
Abstract: Fundamento. La insuficiencia cardiaca es un proceso de alta prevalencia que origina repetidos ingresos hospitalarios con sobrecarga asistencial e incremento del gasto sanitario. Los objetivos de este trabajo son describir y caracterizar los casos con estancias prolongadas por este síndrome, detectando posibles factores asociados a la misma. Método. Estudio de cohorte histórica de todos los episodios de personas mayores de 45 a os, ingresados por insuficiencia cardiaca en el Sistema Sanitario Público Espa ol en el período 1997-2007. Fuente: 808.229 episodios clasificados como Grupos Relacionados de Diagnóstico 127 y 544, según el Conjunto Mínimo Básico de Datos del Instituto de Información Sanitaria. Se evaluaron variables sociodemográficas (edad, género, comunidad autónoma), clínicas (comorbilidades, complicaciones, tipo de ingreso y alta) y de gestión (estancia, tipo de hospital, reingresos). Se definió estancia anormalmente prolongada aquella que superó el percentil 90 (14 y 16 días, respectivamente), construyéndose un modelo de regresión logística para valorar sus posibles factores asociados. Resultados. Presentaron estancias anormalmente prolongadas el 11,4%, mostrando inferior edad media y mayor número de diagnósticos y procedimientos, reingresos y mortalidad que el grupo sin estancias prolongadas. Padecer anemia, insuficiencia renal, TEP o ictus así como el reingreso y el ingreso programado se asociaron a mayor probabilidad de estancia anormalmente prolongada. Conclusión. Es posible definir un perfil de comorbilidad y sociodemográfico que valore la probabilidad de tener un ingreso prolongado, si bien dadas las características de las bases de datos administrativas la capacidad discriminativa del modelo es discreta. Background. Heart failure is a process of high prevalence that causes repeated hospital admissions with increased health care costs. The aim of this article is to describe and characterize the cases with long stays due to this syndrome, identifying associated factors wherever possible. Method. An historical cohort of all the episodes of people over 45 years with a diagnosis of heart failure admitted in the Spanish Public Health System in the period 1997-2007. Source: 808,229 episodes classified as Diagnosis Related Groups 127 and 544 according to the Minimum Basic Data provided by the Institute for Health Information. We assessed sociodemographic variables (age, gender, region), clinical variables (comorbidities, complications, type of admission and discharge) and management variables (length of stay, type of hospital readmissions). An a
Factors associated with the appropriate use of preoperatory hospital stays: historical cohort study
Sonia Tamames, Alberto Perez Rubio, Javier Castrodeza Sanz, Maria Belen Canton Alvarez, Francisco J Luquero, Sara Santos Sanz, Placido Lopez Encinar, Maria Paz de la Torre Pardo, Juan Manuel Gil Gonzalez
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-187
Abstract: Historical cohort study. The histories of 440 hospitalised patients who underwent at least one surgical procedure were analysed. Data collection was carried out by doctors not involved in the services studied, following the Appropriateness Evaluation Protocol. A bivariate and multivariate analysis of the factors associated with the appropriateness of preoperatory stays was carried out.The mean number of days of preoperatory stay was 5.5 (SD 5.11), of which a mean number of 2.5 days were considered to be inappropriate (SD 4.11). The overall rate of inappropriateness was 45.2% (CI 95% 43.3–47.1). The multivariate analysis showed a positive association of the inappropriateness of the preoperatory stay with weekend days, programmed admission, hospital stays longer than 7 days, medical records incorrectly or incompletely documented and the age groups of 45–65 and the >65 with respect to the <45 age group. Sex and an incorrect or incomplete nursing register did not show such an association.The inappropriate use of hospital stay during preoperatory care affects almost half the period and there are some risk determinants that could act as indicators at admission. In addition, the efficiency of care provision was found to vary greatly from the point of view of its appropriateness.Increased healthcare expenditure in developed countries is influenced by several complex factors, among which can be numbered the population's own expectations concerning their health and their demographic structure [1]. The ability to guarantee the sustainability of Europe's healthcare systems, without detriment to accessibility or efficiency, is an ever growing preoccupation. Some of the proposed strategies for keeping down expenditure on healthcare include the provision of services at an 'as simple as possible assistance level', thus optimising the use of available resources [2]. In this sense, a review of the appropriate use of hospital care is especially relevant, as it allows inappropriate sta
Clasificación de las causas que determinan estadía inadecuada útil para la gestión hospitalaria Usefulness of the classification of causes of inappropriate lengths of stay for the hospital management
María Eugenia Elorza,Nadia Vanina Ripari,Franco Cruciani,Nebel Silvana Moscoso
Revista Cubana de Salud Pública , 2012,
Abstract: Introducción: la búsqueda de eficiencia en la gestión hospitalaria motiva el empleo de indicadores de gestión que detecten y evalúen la presencia de estancias hospitalarias inadecuadas. Objetivo: dise ar una clasificación de las causas que determinan una estadía hospitalaria inadecuada adaptada al contexto del sistema de salud argentino. Métodos: se revisaron 25 artículos publicados entre los a os 1990 y 2009 en revistas argentinas y de otras nacionalidades, en idioma inglés y espa ol. Para la exploración se incluyeron buscadores genéricos de Internet y las bases de datos bibliográficos: Medline, Cochrane y Lilacs. Las palabras clave empleadas fueron: inappropriateness, inappropriate hospital days, the appropriateness evaluation protocol, factors associated with inappropriate hospitalization days, uso inadecuado de la hospitalización, lenght of stay. Sintesis de los datos: es necesario distinguir entre ingresos y estadías inadecuadas. Las causas de estas últimas, según la clasificación dise ada, pueden deberse a la responsabilidad de: 1. La planificación y gestión hospitalaria. 2. El médico. 3. La familia del paciente. 4. El sistema de salud. Conclusiones: el dise o de esta clasificación es una herramienta útil para la implementación de indicadores de gestión hospitalaria que involucren los días de estadía. Introduction: the search for the hospital management efficiency encourages the use of management indicators that detect and assess inappropriate lengths of hospital stay. Objective: to design a classification of the causes that determine inappropriate lengths of hospital stay, adjusted for the Argentinean health system setting. Methods: twenty five articles, both in English and Spanish, published from 1990 to 2009 in Argentinean journals and in those of other nations, were reviewed. For this search, the generic Internet's searchers and the main databases such as Medline, Cochrane, Lilacs, and others were consulted. The key words were inappropriateness, inappropriate hospital stays, the appropriateness evaluation protocol, factors associated with inappropriate hospitalization days, uso inadecuado de la hospitalización, length of stay. Results: it is necessary to differentiate incomes from inappropriate lengths of stay. The designed classification included the following causes: 1. Difficulties in hospital planning and management, 2. The physician's responsibility, 3.The responsibility of the patient's family, 4. The responsibility of the health care system. Conclusions: the design of this classification is a useful tool to implement hospital management
Indicators of healthcare results: analysis of adverse events during hospital stays
Nascimento, Camila Cristina Pires;Toffoletto, Maria Cecília;Gon?alves, Leilane Andrade;Freitas, Walkíria das Gra?as;Padilha, Katia Grillo;
Revista Latino-Americana de Enfermagem , 2008, DOI: 10.1590/S0104-11692008000400015
Abstract: this quantitative, retrospective study aimed to characterize adverse events (ae) in intensive care units (icu), semi-intensive care units (scu) and inpatient units (iu), regarding nature, type, day of the week and nursing professionals / patient ratio at the moment of occurrence; as well as to identify nursing interventions after the event and ae rates. the study was performed at a private hospital in the city of s?o paulo, brazil. two hundred twenty-nine ae were notified. the predominant events were related to nasogastric tubes (ngt) (57.6%), followed by patient fall (16.6%) and medication errors (14.8%). the nursing professionals /patient ratio at the moment of the event was 1:2 for the icu, 1:3 for the scu and 1:4 for the iu. a similar distribution was observed for the other days of the week. the nursing interventions were: repositioning the ngt (83.2%) and communication of the occurrence to the physician in case of medication errors (47.6%) and falls (55.2%). the highest ae rate was related to ngt.
Reducing Hospital Stays through Subacute and Complex Care Programs  [PDF]
Ronald Lagoe, Louise Pernisi, Shelly Littau
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.510090
Abstract: The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This study described the efforts of the acute hospitals in Syracuse, New York to address the needs of these Complex Care patients. The hospitals developed a series of Subacute Programs, each of which addressed a single care need, which might have helped restrain the growth of adult medicine stays during a five-month period. The study demonstrated that reductions in adult medicine stays were associated with the introduction of Complex Care Programs that addressed multiple care needs, in 2015. The association between the implementation of the Complex Care Programs and length of stay reduction for adult medicine was present at the combined and individual hospital levels. The study suggested that the amount of Program Development Funds invested in these programs saved 2000 adult medicine days or $1,600,000 compared with total expenses of $292,000 during a five-month period. The experiences of the Syracuse hospitals suggested that small programs with simple structures could have a positive impact on health care efficiency at the community level.
Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)  [PDF]
Constant Assi, Marie Jeanne Lohouès-Kouacou, Emile Allah-Kouadio, Christian Jomo Njossu, Anassi Jean-Baptiste Okon, Stanislas Doffou, Siaka Koné, Ganda Soumaré, Amadou Koné, Amadou Ouattara, Dramane Soro, Mamadou Diakité, Beno?t-Mathieu Camara
Open Journal of Gastroenterology (OJGas) , 2012, DOI: 10.4236/ojgas.2012.24039
Abstract: Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice; 2) To assess appropriateness colonoscopy using EPAGE criteria; 3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%; 27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years; p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.
Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de Asturias
Velasco Díaz,Luis; García Ríos,Susana; Oterino de la Fuente,David; Suárez García,Francisco; Diego Roza,Susana; Fernández Alonso,Reyes;
Revista Espa?ola de Salud Pública , 2005, DOI: 10.1590/S1135-57272005000500004
Abstract: background: unnecessary admissions of acute cases have major impacts on hospital efficiency and organization. this study is aimed to identify percentage of unnecessary admissions from a hospital emergency department and the reasons why, as well as to quantify the unnecessary hospital days of care generated by these admissions. methods: it has been analyzed the appropriateness of 622 admissions made in 2002, selected at random, all of the hospital stays generated by the inappropriate admissions and a representative sample of the appropriate admissions of a second-level hospital in asturias. the review tool was the appropriateness evaluation protocol. a descriptive analysis, a bivariate analysis and a multivariate logic regression analysis were made. results: a total of 63 admissions (10.1%) were judged inappropriate. the main cause of inappropriateness were admissions for performing diagnostic tests and/or treatments, which could be carried out on an outpatient basis. these unnecessary admissions generated 78.2% of unnecessary stays, and the appropriate admissions generated 24.8% of unnecessary stays. referrals to hospital emergency rooms from physicians outside of the hospital proper heightened the risk of unnecessary admissions (or:4.50, 95% ci: 1.59-12.76), daytime admissions (or: 13.97, 95% ci: 1.86-104.76) or evening admissions (or: 7.70, 95% ci: 1.01-58.72), admissions to cardiology wards (or: 3.93, 95% ci: 1.22-12.70) and neurology wards (or: 5.86, 95% ci: 1.88-18.30), the experience of prior admissions having lowered the risk of unnecessary admission (or: 0.34, 95% ci: 0.18-0.65). conclusions: unnecessary admissions generate three times more inappropriate stays than the necessary admissions. hospital organization-related problems are the main cause of inappropriate admissions.
Appropriateness and Diagnostic Yield of Referrals for Oesophagogastroduodenoscopy at the Korle Bu Teaching Hospital
K Tachi, KN Nkrumah
West African Journal of Medicine , 2011,
Abstract: Background: Increasing endoscopy workload in open-access services necessitates adoption of appropriateness criteria to check abuse and improve yield. Objective: To assess the appropriateness of referrals for oesophagogastroduodenoscopy (OGD) and its relationship to yield at Korle-Bu Teaching Hospital (KBTH), Accra. Methods: Referrals, signs, and symptoms of 375 consecutive patients for diagnostic oesophagogastroduodenoscopy were evaluated over four months. Indications were categorized as appropriate or inappropriate using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and endoscopic findings (yield) categorized as positive or negative. The relationship between these was analyzed and the diagnostic accuracy of the guidelines determined. Results: There were 209 (55.7%) females, and 316 (84.3%) open-access procedures. Mean age was 46 ± 17 years. Dyspepsia, 272 (72.5%) and epigastric tenderness, 192 (41.4 %) were the commonest symptom and sign respectively. Only 133 (35.5%) reported alarm symptoms. Appropriate referrals constituted 221(58.9%). Inappropriate referral rate was similar for endoscopists and non-endoscopists. Positive yield was 62.7%. Male sex, age > 45 years, haematemesis, persistent vomiting, gastroenterologists’ referrals and epigastric tenderness were the best predictors of positive yield. Gastritis, 121 (32.3%), duodenal ulcer, 48 (12.5%) and oesophagitis, 36 (9.6%) were the leading endoscopy diagnoses. Carcinomas were reported only after 45years and 18 (81.8%) of the cases had alarm symptoms. Conclusions: Inappropriate referral for OGD rate is high in Accra. Yield is improved by adherence to the ASGE guidelines but its accuracy as a screening tool for OGD at Korle Bu Teaching Hospital is too low to recommend it for adoption.
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