130: An Alternate Care Environment to Decrease Inpatient Length-of-Stay
Notice bibliographique
Résumé
In an increasingly challenging fiscal climate, there is pressure to reduce inpatient length-of-stay. Current research suggests that unnecessarily-prolonged paediatric admissions are common, and that for many diseases, day-hospital management provides efficient care that is well-liked by patients and families. Many current paediatric inpatients may not require overnight nursing, and remain as inpatients to facilitate rapid services. To develop and evaluate an Alternate Care Environment (“ACE Space”) that transitions inpatients to a day-hospital setting where they receive rapidly-arranged follow-up, investigations, interventions, and specialty consultations, while reducing inpatient length-of-stay. At our single tertiary-care facility in Spring 2014, all paediatric medicine inpatients were audited for potential to be managed in a day-hospital setting. Families identified by ward staff were interviewed to determine their interest in day-hospital care. Physicians and nurses were interviewed to determine patient inclusion criteria. A Rapid Improvement Event finalized the ACE's design. An ongoing pilot was launched in August 2014. In the ACE, patients receive inpatient-level access to hospital services. Outcome measures (ACE visit number, satisfaction, estimated savings of inpatient days, average inpatient length-of-stay), process measures (referral source, diagnosis, hours per visit, investigations, interventions, and specialty consultations), and balancing measures (ACE patients requiring inpatient admission, nursing resource utilization) are being tracked. Pre-pilot audits identified on average four patients per day (7.8% of total patients) as potentially manageable in a day-hospital setting. Sixteen of 26 “ACE-eligible” families (61.5%) said they would prefer going home at night. In its first 3.5 months, the ACE had 146 patient visits (39.6/ month), saving an estimated 139 inpatient bed days (38.2/month). There was a heterogeneous mix of diagnoses. Fifty-three of 55 families (96.4%) rated their overall experience as “very good” or “excellent”. Thirty-two patients received laboratory investigations, and 35 received diagnostic imaging (e.g. MRI). There were 18 IV or subcutaneous medication administrations, six central line procedures, 16 other procedures (e.g. urinary catheterization), 63 subspecialty consultations, and 21 allied health consultations. Four (2.7%) patients required inpatient admission from the ACE. These data demonstrate that some paediatric inpatients do not require overnight nursing, and can be safely managed in a day-hospital setting. The ACE provides a safe inpatient alternative for a heterogeneous mix of diagnoses and patient needs, and services that are not available or expedient in a clinic setting. Future work will analyze the ACE's effect on inpatient length-of-stay and cost.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».