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Article
Publication date: 5 September 2018

Silvia Bruzzi, Paolo Landa, Elena Tànfani and Angela Testi

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and…

Abstract

Purpose

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process.

Design/methodology/approach

The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice.

Findings

The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.

Research limitations/implications

The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings.

Practical implications

The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required.

Originality/value

This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

Details

Management Decision, vol. 56 no. 10
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 1 March 2016

Susan Camilleri and Kathleen Colville

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for…

Abstract

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for patients who receive post-acute care in facilities over which hospitals have little influence to monitor care. Using resource dependence and transaction cost economics to describe the theoretical advantages of hospital ownership of post-acute care facilities (PACs), we empirically test whether hospitals that own PACs experience reduced readmissions. Our findings indicate partial support for the predicted relationship between PAC ownership and readmission rates. We found that hospital ownership of a skilled-nursing facility (SNF) was related to a lower readmissions rate for some patients, while ownership of other types of PACs did not result in significant findings. Our results offer support for the theoretical advantages of ownership, however, the savings realized by ownership may not merit the ownership investment.

Details

International Journal of Organization Theory & Behavior, vol. 19 no. 2
Type: Research Article
ISSN: 1093-4537

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Article
Publication date: 17 June 2011

Jonathan Webster

This paper seeks to demonstrate the role of person‐centred assessment in improving the standard of care for people with dementia in acute hospitals.

Abstract

Purpose

This paper seeks to demonstrate the role of person‐centred assessment in improving the standard of care for people with dementia in acute hospitals.

Design/methodology/approach

The paper offers a review of recent research and literature on person centred care highlighting its role in acute hospital settings. Case studies are also used by way of illustration.

Findings

Acute hospitals are inherently complex environments which pose particular challenges for the care and management of people with dementia. Evidence drawn from the literature and recent research suggests that person‐centred assessment has the capacity to enhance the quality of care for people with dementia and improve outcomes. Patients who are understood, listened to, and responded to tend to display lower levels of challenging behaviour, are calmer, more receptive to accepting treatment and have higher levels of well being. Although experienced nurses working in acute wards often have in‐depth knowledge of older peoples' health‐related needs, a reliance on inflexible “assessment frameworks” can distract them from focusing on the individual. The routinised nature of many ward environments, shift patterns, high staff turnover and weak clinical leadership also act as barriers. Person‐centred assessment can be employed to identify the needs of people with dementia based upon their life history and patterns of daily living; it can also underpin the design and delivery of person‐centred care and treatment throughout their hospital stay.

Originality/value

The capacity of person‐centred care to improve care suggests that it needs to be embedded in gerontological nursing practice in acute hospital settings as a clinical and managerial priority.

Details

Quality in Ageing and Older Adults, vol. 12 no. 2
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 12 August 2014

Yang Tian, James Thompson and David Buck

The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls…

Abstract

Purpose

The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period.

Design/methodology/approach

The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients’ care costs – for those patients admitted to an acute hospital due to their fall – in the 12 months before and after their fall.

Findings

On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly.

Originality/value

This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs.

Details

Journal of Integrated Care, vol. 22 no. 4
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 July 2014

Nikunj Agarwal and M.P. Sebastian

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized…

Abstract

Purpose

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

Design/methodology/approach

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

Findings

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

Practical implications

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Originality/value

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

Details

Clinical Governance: An International Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 28 October 2014

Jared Frank and Muhiuddin Haider

The purpose of this study is to conduct a comparative analysis of the Medicare patients discharged to a long-term (acute) care hospitals (LTCH), skilled nursing facility…

Abstract

Purpose

The purpose of this study is to conduct a comparative analysis of the Medicare patients discharged to a long-term (acute) care hospitals (LTCH), skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) following an acute inpatient hospitalization under Medicare-severity diagnosis-related group (MS-DRG) 207. The likelihood of discharge by provider type was also examined to determine criteria informing patient discharge to a LTCH, SNF or IRF for treatment.

Design/methodology/approach

Retrospective cohort study, based on secondary data analysis, utilizing Medicare Provider Analysis and Review (MedPAR) File data collected by Centers for Medicare & Medicaid Services for fiscal year 2011, October 1, 2010, through September 30, 2011.

Findings

Numerous analyses were conducted upon those patients discharged to a LTCH, SNF or IRF following an acute inpatient hospitalization under MS-DRG 207. Concerning those patients discharged to LTCHs, patients were not significantly older, did not have the highest length of stay and had comparable diagnoses and diagnosis counts to those discharged to SNFs or IRFs. However, costs were significantly higher among discharges to LTCHs. Multinomial logistic regression analyses also indicated numerous associations between certain variables and discharge location.

Originality/value

With the aging of the US population and increasing costs of rendering services, both the Medicare population and Medicare expenditures, already at their highest levels in the history of the program, are projected to rise going forward (The Boards of Trustees, 2012). As such, recent research has focused on Part A hospitals/facilities and the variations in costs submitted and payments received for treatment/services provided. This study aims to address whether patients discharged to LTCHs, which receive higher payment(s) as a result of serving a higher proportion of medically complex beneficiaries, are more medically complex than those discharged to SNFs/IRFs.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 4
Type: Research Article
ISSN: 1750-6123

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Article
Publication date: 1 March 2000

Gerald Wistow

A changing boundary between hospital and home‐care services over two decades has taken place enabling people to live in their own homes wherever possible, enabling “choice…

Abstract

A changing boundary between hospital and home‐care services over two decades has taken place enabling people to live in their own homes wherever possible, enabling “choice of independence”. Against this background, five principal issues are raised regarding how hospital services have been reshaped over that time and how the pattern of service developments outside the hospital has altered over the same period.

Details

Journal of Management in Medicine, vol. 14 no. 1
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 19 July 2011

Jeffrey P. Harrison and Emily D. Ferguson

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency…

Abstract

Purpose

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Design/methodology/approach

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

Findings

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

Research limitations/implications

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

Practical implications

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

Originality/value

This article has important information on US emergency service availability in the hospital industry.

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 February 2005

Korina Katsaliaki, Sally Brailsford, David Browning and Peter Knight

Purpose – Aims to describe a project carried out within Hampshire Social Services investigating potential care pathways for older people after discharge from hospital and…

Abstract

Purpose – Aims to describe a project carried out within Hampshire Social Services investigating potential care pathways for older people after discharge from hospital and to show the potential of the simulation methodology in such situations. Design/methodology/approach – A discrete‐event simulation was used to determine the system capacities and to estimate the likely associated reimbursement costs. Findings – A prototype simulation model was developed showing the potential value of this approach. Research limitations/implications – Restrictions in data access shifted the focus from quantitative service mapping to a more descriptive approach. Practical implications – Currently, many older patients experience delayed discharge from acute beds because of capacity limitations in Social Services’ traditional post‐acute care services. At the same time, new regulations require Local Authorities to reimburse NHS Acute Trusts if hospital discharge is delayed solely due to inadequate provision of social care assessments and services. In order to overcome the so‐called “bed‐blocking” problem, a new range of services termed “Intermediate Care” has been introduced to offer alternative options for older patients. These services are examined in terms of capacity and appropriateness. Originality/value – This paper fulfils an identified need to record and evaluate the new post‐acute packages introduced by the Social Services and NHS and proposes simulation as one of the most suitable methodologies for such objectives.

Details

Journal of Health Organization and Management, vol. 19 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 13 February 2017

Dick E. Zoutman and B. Douglas Ford

The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care

Abstract

Purpose

The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety.

Design/methodology/approach

An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives.

Findings

The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety.

Practical implications

There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI.

Originality/value

QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

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