Impact of long-stay beds on the performance of a tertiary hospital in emergencies
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista de Saúde Pública |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102015000100266 |
Resumo: | ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. |
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Impact of long-stay beds on the performance of a tertiary hospital in emergenciesBed OccupancyHospital Bed CapacityLength of StayLong-Term CareTertiary HealthcareEmergency Medical ServicesCharlson Comorbidity IndexABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. Faculdade de Saúde Pública da Universidade de São Paulo2015-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102015000100266Revista de Saúde Pública v.49 2015reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USP10.1590/S0034-8910.2015049006078info:eu-repo/semantics/openAccessPazin-Filho,AntonioAlmeida,Edna deCirilo,Leni PeresLourençato,Frederica MontanariBaptista,Lisandra MariaPintyá,José PauloCapeli,Ronaldo DiasSilva,Sonia Maria Pirani Felix daWolf,Claudia MariaDinardi,Marcelo MarcosScarpelini,SandroDamasceno,Maria Cecíliaeng2016-01-22T00:00:00Zoai:scielo:S0034-89102015000100266Revistahttp://www.scielo.br/scielo.php?script=sci_serial&pid=0034-8910&lng=pt&nrm=isoONGhttps://old.scielo.br/oai/scielo-oai.phprevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2016-01-22T00:00Revista de Saúde Pública - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
title |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
spellingShingle |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies Pazin-Filho,Antonio Bed Occupancy Hospital Bed Capacity Length of Stay Long-Term Care Tertiary Healthcare Emergency Medical Services Charlson Comorbidity Index |
title_short |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
title_full |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
title_fullStr |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
title_full_unstemmed |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
title_sort |
Impact of long-stay beds on the performance of a tertiary hospital in emergencies |
author |
Pazin-Filho,Antonio |
author_facet |
Pazin-Filho,Antonio Almeida,Edna de Cirilo,Leni Peres Lourençato,Frederica Montanari Baptista,Lisandra Maria Pintyá,José Paulo Capeli,Ronaldo Dias Silva,Sonia Maria Pirani Felix da Wolf,Claudia Maria Dinardi,Marcelo Marcos Scarpelini,Sandro Damasceno,Maria Cecília |
author_role |
author |
author2 |
Almeida,Edna de Cirilo,Leni Peres Lourençato,Frederica Montanari Baptista,Lisandra Maria Pintyá,José Paulo Capeli,Ronaldo Dias Silva,Sonia Maria Pirani Felix da Wolf,Claudia Maria Dinardi,Marcelo Marcos Scarpelini,Sandro Damasceno,Maria Cecília |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Pazin-Filho,Antonio Almeida,Edna de Cirilo,Leni Peres Lourençato,Frederica Montanari Baptista,Lisandra Maria Pintyá,José Paulo Capeli,Ronaldo Dias Silva,Sonia Maria Pirani Felix da Wolf,Claudia Maria Dinardi,Marcelo Marcos Scarpelini,Sandro Damasceno,Maria Cecília |
dc.subject.por.fl_str_mv |
Bed Occupancy Hospital Bed Capacity Length of Stay Long-Term Care Tertiary Healthcare Emergency Medical Services Charlson Comorbidity Index |
topic |
Bed Occupancy Hospital Bed Capacity Length of Stay Long-Term Care Tertiary Healthcare Emergency Medical Services Charlson Comorbidity Index |
description |
ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102015000100266 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102015000100266 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0034-8910.2015049006078 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Faculdade de Saúde Pública da Universidade de São Paulo |
publisher.none.fl_str_mv |
Faculdade de Saúde Pública da Universidade de São Paulo |
dc.source.none.fl_str_mv |
Revista de Saúde Pública v.49 2015 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Revista de Saúde Pública |
collection |
Revista de Saúde Pública |
repository.name.fl_str_mv |
Revista de Saúde Pública - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
revsp@org.usp.br||revsp1@usp.br |
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1748936503241736192 |