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PubMed1999

Review of Emergency Department thrombolytic therapy and changes in inpatient mortality of acute myocardial infarction on the NSW Central Coast 1986 to 1994-96.

AIMS: To examine changes in inpatient mortality of acute myocardial infarction (AMI) from 1986 to 1994-96 and to review the Emergency Department (ED) use of thrombolytic therapy (TT) for AMI on the NSW Central Coast. METHOD: A retrospective review of medical records of patients presenting to the EDs of Gosford and Wyong Hospitals with a discharge diagnosis of AMI (ICD9 code 410.x) from 1 January 1986 to 31 December 1986 and 1 January 1994 to 31 December 1996. Data were collected on patients' age, sex, duration of symptoms on arrival at the ED, ECG changes and presence of positive ECG criteria for thrombolysis, agent used, contraindications to TT, and inpatient mortality. The main measure of outcome was inpatient mortality. RESULTS: There were 423 admissions for AMI in 1986 and 1,220 admissions in 1994-96. The overall inpatient mortality has declined from 18.9% in 1986 to 9% in 1994-96 (p<0.0001). The mean age of patients has increased from 67.5 years to 68.1 years (p=0.35). The proportion of patients over age 75 years has increased significantly from 24.6% to 30.3% (p<0.0001). Presentation times from onset of symptoms have not changed significantly from a median time of two hours in 1986 to 2.5 hours in 1994 to 1996 (p=0.52). The overall proportion of patients with ECG criteria for TT was 53.2% in 1994-96. TT was administered to 42.9% of patients with a mean door to needle time of 67 minutes (median 45 minutes). The Australasian College for Emergency Medicine benchmark door to needle time of 60 minutes was achieved in 71.3% of patients. Streptokinase was the predominant agent given in 78%, while recombinant tissue plasminogen activator accounted for 15.7% of patients. Patients not receiving TT due to negative ECG criteria showed a decline in mortality from 18.6% to 6.7% (p<0.0001). Patients who underwent mechanical revascularisation (by bypass graft or angioplasty) increased from 8.7% to 17.4% (p<0.0001). Inpatient mortality has declined for all age groups, for both sexes, and for all sites of AMI. CONCLUSION: There have been significant declines in inpatient mortality of patients with AMI on the Central Coast. TT has had a significant impact on this decline but has an eligibility rate of less than half. Significant declines in mortality have also been seen in patients ineligible for thrombolysis. These patients have benefited from other therapies introduced or more widely used in the last decade. The results achieved on the Central Coast compare favourably with published reviews in Australia and overseas despite the lack of facilities for coronary angiography, coronary angioplasty and cardiothoracic surgery.

Aged↗
PubMed1999

A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage.

OBJECTIVE: To compare the use of outpatient and inpatient procedures in the investigation of abnormal uterine bleeding. DESIGN: A randomised controlled trial. SETTING: Two university teaching hospitals. PARTICIPANTS: Four hundred women with abnormal uterine bleeding (postmenopausal bleeding, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular periods) above the age of 35 years, between June 1993 and January 1995. MAIN OUTCOME MEASURES: 1. Incidence of detection of abnormal pathology by vaginal ultrasound, outpatient hysteroscopy and endometrial biopsy compared with inpatient hysteroscopy and curettage; 2. Number of 'lesions' (e.g. fibroids, polyps, endometrial hyperplasia or malignancy) found by hysteroscopy that would have been missed by the combination of endometrial sampling and ultrasound; 3. Comparison of the quality of tissue obtained for histology by outpatient endometrial sampling and inpatient curettage; and 4. An evaluation of patient acceptability of outpatient and inpatient procedures. RESULTS: 1. A combination of transvaginal sonography, Pipelle endometrial biopsy and outpatient hysteroscopy has similar efficacy to inpatient hysteroscopy and curettage for the investigation of abnormal uterine bleeding; 2. Hysteroscopy will detect some fibroids and polyps missed by a combination of transvaginal ultrasound and Pipelle endometrial sampling; 3. The quality of histological samples obtained by outpatient Pipelle were comparable to those obtained by formal inpatient curettage; and 4. Outpatient procedures were well tolerated, with good patient acceptability. CONCLUSION: Transvaginal sonography and endometrial biopsy can safely be used as the initial investigations in the management of abnormal uterine bleeding. Hysteroscopy can be used as a second line investigation. Outpatient hysteroscopy with local anaesthesia is well tolerated although general anesthesia may occasionally be necessary.

Adult↗
PubMed1975

Sex chromatin anomaly among Chinese psychiatric inpatients compared to schoolchildren.

In a study of sex chromatin abnormality among Chinese psychiatric inpatients, buccal smears were examined from a total of 1,253 psychiatric inpatients (639 males and 614 females). One male psychiatric inpatient (1.6/1000) was chromatin positive (plus ve); two female psychiatric inpatients (3.3/1000) were found to have two sex chromatin bodies (less than e). The lower rate for male inpatients in comparison to Chinese schoolboys (i.3/1000) is thought to reflect a higher rate of mental subnormality in the primary schoolchildren. This is considered attributable to the special nature of the school system and psychiatric patient facilities in Taiwan. The higher rate for female inpatients in comparison with the schoolgirls (0.5/1000) tends to indicate a predisposition to mental disorder in favor of psychosis associated with double sex chromatin abnormality in the female.

Asian People↗
PubMed1991

Relation between use of health check ups starting in middle age and demand for inpatient care by elderly people in Japan.

OBJECTIVE: To find out whether there is any correlation between the use of general health check ups (provided for by the Health Services for the Elderly Act 1982) by insured Japanese residents aged 40 or older and demand by the elderly for inpatient care. DESIGN: A questionnaire was posted in 1988 to municipal offices of Japanese cities. All questionnaires were returned with data for 1983 and 1986. SETTING: All 509 Japanese cities with a population of 30,000-199,999. SUBJECTS: All people aged 40 or older who hold a resident card and are not offered health examinations at work are eligible for general health check ups. The questionnaire also inquired about use of inpatient care by elderly residents (aged 70 or older) who were covered by national health insurance. MAIN OUTCOME MEASURES: Correlation coefficients between the rates of use of general health check ups and mean annual bed days for the elderly. Comparison of relative changes by analysis of correlation between improvement indices in mean bed days and mean inpatient fee. RESULTS: In cities with relatively high rates of use of health check ups both the mean annual bed days and the mean inpatient fee for the elderly tended to be low. Correlation coefficients between the logarithmic rates of use of check ups and mean bed days by sizes of cities and number of beds were all negative values. There tended to be more correlation between improvement indices for rate of use of check ups and both mean bed days and mean inpatient fee with higher rates of use in 1983, and the correlation was significant for rates of 60% or more. CONCLUSIONS: Strong health service programmes that start in middle age decrease the demand for inpatient care of the elderly. It was estimated that in a single year from 1985 to 1986, when there was an increase in the rate of use of check ups from 25.5% to 27.6%, the reduction in the number of bed days for the total of 8.5 million elderly insured people was 2.21 million bed days.

Age Factors↗
PubMed1997

Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.

OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to day hospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or day hospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for day hospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall day hospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that day hospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of day hospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but day hospital treatment leads to less burden on carers in the long term.

Adolescent↗
PubMed1998

Use of ECT for the inpatient treatment of recurrent major depression.

OBJECTIVE: The authors' goals were to determine the frequency and distribution of ECT for general hospital inpatients with recurrent major depression and to estimate the effects of prompt ECT on the length and cost of inpatient care. METHOD: Data from the 1993 Healthcare Cost and Utilization Project were analyzed to determine the rate of ECT use for adult inpatients with a principal discharge diagnosis of major depression, recurrent. Associations between prompt initial use of ECT (in the first 5 hospital days) and length and cost of inpatient care were examined before and after control for sociodemographic, diagnostic, and hospital organizational characteristics. RESULTS: An estimated 9.4% of general hospital adult inpatients with a principal diagnosis of recurrent major depression received ECT in the survey year. A majority (59.2%) of these received their initial ECT session within the first 5 days after hospital admission. In univariate analyses, the likelihood of receiving ECT was greater for older patients, whites, privately insured individuals, and patients who lived in more affluent areas. Patients who received ECT tended to have relatively long and costly admissions. After control for several demographic, diagnostic, and hospital organizational characteristics, prompt ECT (as compared with delayed ECT or none) was associated with significantly shorter and less costly inpatient care. CONCLUSIONS: The longer stays and higher treatment costs associated with ECT may be a consequence of patient selection. When patient selection is taken into account, prompt administration of ECT is associated with shorter and less costly hospital stays. Nonetheless, economically disadvantaged patients are relatively unlikely to receive this treatment.

Adolescent↗
PubMed2003

Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997-2000.

OBJECTIVE: The study examined trends in use of inpatient and outpatient mental health services, including pharmacotherapy, among privately insured children and adolescents from 1997 to 2000. METHOD: Data from a national database of more than 1.7 million privately insured individuals were used in an analysis of inpatient, outpatient, and pharmacy claims of users of mental health care age 17 years and younger (approximately 20,000 patients per year). Annual utilization rates and adjusted costs for services and dispensed psychotropic medications were calculated. Results from 1997 and 2000 were compared across diagnostic and age categories. RESULTS: The proportion of youths with an inpatient psychiatric admission decreased by 23.7% from 1997 to 2000, and annual inpatient and outpatient costs decreased by 1,216 US dollars (18.4%) and 157 US dollars (14.4%), respectively. Decreases were driven by a reduction in inpatient days (20.0%) and by a combination of a reduction in outpatient visits (11.3%) and declining payments per outpatient visit (6.1%). Payment trends across diagnoses varied considerably, with the largest reductions seen in treatment of depression, hyperactivity, adjustment disorders, and anxiety disorders. Over the same period, the proportion of youths receiving medication increased by 4.9%, and mean annual medication-related costs per outpatient increased by 41 US dollars (12.1%). CONCLUSIONS: Reductions in inpatient and outpatient mental health service intensity and reimbursements documented in previous research continued through the late 1990s. Declines were accompanied by concurrent increases in the use of and costs associated with psychotropic medications, particularly for youths with mood and anxiety disorders. These results document a shift toward medication-based outpatient treatment modalities.

Adolescent↗
PubMed2003

A comparison of the performance of for-profit and nonprofit U.S. psychiatric inpatient care providers since 1980.

OBJECTIVE: The authors synthesized evidence from a systematic review of the literature reporting substantiated performance differences between private for-profit and private nonprofit psychiatric inpatient care providers in the United States since 1980. They also compared reported differences in performance between nonprofit and for-profit inpatient psychiatric care providers with reported differences between nonprofit and for-profit providers of other types of health care. METHODS: Studies were located by means of computerized bibliographic searches and follow-up searches of studies cited in the articles located in the computerized search. The analysis included peer-reviewed studies that compared the performance of for-profit and nonprofit health service providers, including inpatient psychiatric services, in the areas of access, quality, cost-efficiency, and amount of charity care on the basis of quantitative data collected after 1980. The studies were classified in one of three categories according to the study conclusion: for-profit superiority, nonprofit superiority, or no difference or mixed results. RESULTS: Almost all studies (with one exception) found that the nonprofit psychiatric providers performed as well as or better than their for-profit counterparts. The proportion of studies reporting performance superiority of nonprofit versus for-profit psychiatric inpatient providers was greater than the proportion of studies reporting the same conclusion for providers of all other types of health care taken together. CONCLUSIONS: On the basis of data collected since 1980, nonprofit psychiatric inpatient care providers in the United States had superior performance on access, quality, cost-efficiency, and amount of charity care, compared with for-profit providers. Caution is warranted in pursuing public policies that permit or encourage the replacement of nonprofit psychiatric inpatient care providers with for-profit providers of these services.

Cost-Benefit Analysis↗
PubMed2006

Representation of asylum seekers and refugees among psychiatric inpatients in London.

OBJECTIVE: Refugees are at high risk of mental disorders but often complain about a lack of access to appropriate care. The purpose of this study was to assess the representation of refugees among psychiatric inpatients, given that it has been suggested that they use a disproportionate level of care compared with nonrefugees. METHODS: A census of all psychiatric inpatient units in London was used to determine the numbers of inpatients, the numbers of refugees, and measures of need, such as compulsory detention, duration of admission, need for interpreters, and whether inpatient status was appropriate. RESULTS: Of 2,955 psychiatric inpatients, 134 (4.5 percent) were refugees. Refugees' admission rates were similar to or lower than those of nonrefugees. Refugees were more likely to be inappropriately placed, to require interpreters, and to have more complex needs. CONCLUSION: The results of this study suggest that refugees are not overusing London's psychiatric inpatient units but have complex needs that challenge existing service providers.

Adolescent↗
PubMed1998

Diagnosis and management of substance use disorders among inpatients with schizophrenia.

OBJECTIVE: The study examined the extent of clinical recognition of comorbid substance use disorders and the clinical management of these disorders among inpatients hospitalized for an acute exacerbation of schizophrenia. METHODS: Medical records of 42 inpatients who met research diagnostic criteria for both schizophrenia and a current substance use disorder were reviewed for information about admission evaluation, inpatient management, discharge diagnosis, and disposition. RESULTS: Alcohol use disorders were the most frequent co-occurring substance-related diagnoses, found for 86 percent of the dually diagnosed inpatients. Twenty-four patients (57 percent) did not receive a diagnosis of a substance-related disorder at admission, and 19 (45 percent) did not receive a substance-related diagnosis at discharge. Referral to inpatient or outpatient substance abuse treatment was documented for a minority of subjects. CONCLUSION: The results suggest that improvements are needed in the process of clinical care for inpatients with schizophrenia who have co-occurring substance-related disorders. They highlight a need for education of health care providers and continuous quality improvement in this area.

Adult↗
PubMed1998

Comparative outcomes and costs of inpatient care and supportive housing for substance-dependent veterans.

OBJECTIVE: This study examined the differential effectiveness and costs of three weeks of treatment for patients with moderately severe substance dependence assigned to inpatient treatment or to a supportive housing setting. Supportive housing is temporary housing that allows a patient to participate in an intensive hospital-based treatment program. Type and intensity of treatment were generally equivalent for the two groups. METHODS: Patients were consecutive voluntary admissions to the substance abuse treatment program of a large metropolitan Veterans Affairs medical center. Patients with serious medical conditions or highly unstable psychiatric disorders were excluded. Patients in supportive housing attended the inpatient program on weekdays from 7:30 a.m. to 5 p.m. They were assessed at baseline and at two-month follow-up. RESULTS: Baseline analyses of clinical, personality, and demographic characteristics revealed no substantive differences between the 62 patients assigned to inpatient treatment and the 36 assigned to supportive housing. The degree of treatment involvement and dropout rates did not differ between groups. Of the 55 inpatients completing treatment, 29 were known to be abstinent at follow-up, and of the 35 supportive housing patients completing treatment, 22 were abstinent. The proportion was similar for both groups, about 70 percent. The cost of a successful treatment for the inpatient group was $9,524. For the supportive housing group, it was $4,291. CONCLUSIONS: Given the absence of differential treatment effects between inpatient and supportive housing settings, the use of supportive housing alternatives appears to provide an opportunity for substantial cost savings for VA patients with substance dependence disorders.

Adult↗
PubMedDate not supplied

Relationship between type of health insurance and time to inpatient rehabilitation placement for surgical subspecialty patients.

A significant proportion of patients on a neurosurgical service require inpatient rehabilitation placement after discharge. The relationship between the type of health insurance of the patient at the time of admission and the time to placement of patients has not previously been addressed. We prospectively studied all patients on the adult neurosurgical service at our hospital to determine whether the type of health insurance carried by patients is related to the time necessary to arrange acceptance into inpatient rehabilitation facilities. Ninety-one patients (51 men, 40 women; mean age, 56 years) admitted to the neurosurgery service during a 6-month period required inpatient rehabilitation placement after discharge. The time in days between the request for placement into a rehabilitation facility and the acceptance of the patient was examined. The mean time for placement of patients with and without health insurance at the time of admission was 0.8 days and 2.1 days, respectively (overall mean, 1.1 days) (P < .002). No statistically significant associations were found between age, sex, or race of the patient and the time to placement. In addition, there was no difference in the time to placement between those patients admitted as a result of trauma and those patients admitted for reasons other than trauma. These results indicate that among patients on a neurosurgical service, patients with private health insurance are accepted into inpatient rehabilitation approximately 1 day sooner than patients without private health insurance. Patients without private health insurance are delayed in their transfer to inpatient rehabilitation facilities and more aggressive inpatient rehabilitation. How this finding translates into an increase in cost of care or a decrease in patient outcomes is unknown.

Adolescent↗
PubMed2003

Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis.

STUDY OBJECTIVE: To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults. DESIGN: Prospective, observational study with historical inpatient cases as controls. SETTING: Ambulatory thrombosis clinic of a tertiary care teaching center in Canada. PATIENTS: Forty-nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001. INTERVENTION: The 49 inpatients received unfractionated heparin, and the 51 outpatients received low-molecular-weight heparin (LMWH). MEASUREMENTS AND MAIN RESULTS: A cost-minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was 248 Canadian dollars (95% confidence interval 216-280 Canadian dollars) and was significantly different from the mean cost/inpatient case of 2826 Canadian dollars (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%. CONCLUSION: Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.

Ambulatory Care↗
PubMed2006

Prevalence and severity of intimate partner violence and associations with family functioning and alcohol abuse in psychiatric inpatients with suicidal intent.

BACKGROUND: Many medical settings have conducted screenings for domestic violence, but no study has assessed the prevalence and frequency of intimate partner violence (IPV) within the acute psychiatric inpatient population. METHOD: This descriptive, cross-sectional study was conducted in adult inpatient acute care units at a psychiatric hospital. Participants completed questionnaire-based assessments of recent and lifetime history of IPV, family functioning, and alcohol use. Recruited patients were aged between 18 and 65 years, were English-fluent and literate, had suicidal ideation, and had been living with an intimate partner for at least the past 6 months. Acutely psychotic patients and patients who were too agitated to complete the questionnaires were excluded. 110 patients completed the assessments. Interpersonal violence was assessed using the Revised Conflict Tactics Scale (CTS2), family functioning was measured using the Family Assessment Device, and alcohol use was assessed with the Alcohol Use Disorders Identification Test. Data were gathered from August 2004 through February 2005. RESULTS: Over 90% of suicidal inpatients reported IPV perpetration and victimization in their relationships in the past year, with the overwhelming majority reporting severe IPV. Male and female patients did not differ significantly on any CTS2 violence perpetration or victimization subscale (all p values >.05). Poor family functioning predicted physical violence victimization in both male and female suicidal inpatients, even after controlling for alcohol use and demographic characteristics. CONCLUSION: Psychiatric inpatients with suicidal ideation or intent would benefit from screening for IPV. Information about IPV and treatment options should be made available to psychiatric inpatients with suicidal intent. Attention to the family functioning of these patients is recommended.

Acute Disease↗
PubMed1991

The changing face of adolescent inpatient psychiatric treatment.

Widespread changes in the criteria and resources for psychiatric inpatient treatment of adolescents present enormous challenges and demand serious and far-reaching adaptive efforts. Among these efforts may be a redesigning of the inpatient treatment milieu to accommodate different patient populations for whom different models of treatment and therapeutic strategies are necessary. This paper describes the redesigning and successful integration of an adolescent inpatient unit at a private psychiatric hospital to include separate treatment tracks for three different patient populations. An intensive/reconstructive treatment track provides the long-term inpatient treatment of youth with treatment-refractory personality disorders who have the clinical justification and resources for therapy that aspires to effect structural personality change. An acute crisis intervention track provides short-term inpatient treatment with an adaptation-oriented and highly focused approach to patients who have had limited previous treatment, are confined to short lengths of stay by financial constraints, or for whom regression should be discouraged. Finally, a psychosocial skills treatment group conducts longer term inpatient treatment for neurobiologically impaired patients. Psychotic, severely developmentally disturbed, profoundly abused patients, and those with extremely primitive personalities characterized by an abundance of deficits cannot tolerate the emotional and interpersonal intensity of a reconstructive treatment approach, but can benefit from a supportive, developmental, ego-building strategy.

Adolescent↗
PubMed1999

Impact and inequity of inpatient waiting times for advanced cardiovascular services in community hospitals across the greater Toronto area.

OBJECTIVE: To assess waiting times for inpatients requiring urgent transfer for advanced cardiovascular procedures from community hospitals; the magnitude of adverse events while waiting; and possible inequity among community hospitals in access to these services. SETTING: Seven representative community hospitals in the Greater Toronto Area (GTA). DESIGN: Prospective data collection over 12 months (May 1997 to April 1998). PATIENTS: One thousand, two hundred and three inpatients who waited a total of 7261 hospital days for advanced cardiovascular procedures. MAIN RESULTS: The average (+/- SD) inpatient waiting time, in days, for catheterization was 5.7+/-1.3, angioplasty 5.8+/-2.1, bypass surgery 7.0+/-2.1 and pacemakers 4.2+/-1.6. During this time there were 14 deaths (1.2%) and 12 (1.0%) morbid events in-hospital. Extrapolation of these data to all 21 community hospitals in the GTA suggests that annually 21,783 bed days are used by inpatients awaiting transfer for advanced cardiovascular procedures, during which time 42 fatal and 36 morbid events can be expected to occur. Of the seven hospitals, one had a catheterization laboratory (group 1), two had no laboratory but had catheterizing cardiologists (group 2), and four had no laboratory and no catheterizing cardiologists (group 3). None of these hospitals had on-site revascularization facilities. The average number of days spent waiting for catheterization in group 1 (3.1+/-0.4) was significantly less than that in group 2 (5. 4+/-1.3, P<0.001) and group 3 (6.5+/-1.3, P<0.0001). The catheterization wait in group 2 was significantly less than that in group 3 (P<0.02). There were no significant differences among the three groups in the number of days spent waiting for angioplasty or bypass surgery. CONCLUSION: Waiting times for inpatients requiring advanced cardiovascular procedures in GTA community hospitals are long, and are associated with substantial morbidity and mortality. These waiting times also promote inefficient bed use and increased health care costs. Furthermore, these data suggest that access to inpatient coronary angiography in the GTA is inequitable and appears to depend more on the presence of on-site catheterization laboratories or catheterizing cardiologists than on illness severity.

Cardiovascular Diseases↗
PubMed2001

[Risk of hemorrhage after outpatient versus inpatient tonsillectomy].

INTRODUCTION: This study evaluates the risk of post-tonsillectomy haemorrhage in outpatient surgery compared to conventional inpatient management. MATERIAL AND METHODS: We reviewed 528 tonsillectomies performed at the ENT Department, Rigshospitalet, University of Copenhagen, in the period 1.6.1997 to 31.5.1998. The 264 outpatient tonsillectomies were compared with 264 inpatient procedures. The number of post-operative haemorrhages and the time interval from operation to post-operative bleeding were registered, along with the need for re-operation. Outpatients were discharged 8 hours after surgery, inpatients after 24 hours. RESULTS: Forty-five (8.5%) of 528 tonsillectomies had post-operative haemorrhage complications, 15 (2.8%) patients needed a re-operation. Twenty-five (55%) cases of reactionary haemorrhage occurred < 8 hours after surgery and nine needed a re-operation. Two of three cases of post-operative haemorrhage 8-24 hours after primary surgery were re-operated, whereas four of 17 patients with haemorrhage > 24 hours post-operatively needed another surgery. There were no differences between inpatient and outpatient management. Eighty-nine per cent of all early (0-24 h) post-operative haemorrhages occurred < 8 hours post-operatively. In the time period from 8-24 hours post-operatively there were only three cases of reactionary haemorrhage. The risk of post-operative haemorrhage after discharge was 4.2% and 3.4% after outpatient and inpatient management respectively, a difference of only 0.8%. This makes outpatient tonsillectomy an acceptable alternative to inpatient management.

Adolescent↗
PubMed2003

[Antimicrobial resistance of Staphylococcus aureus isolates from inpatients of departments of internal medicine, surgery, and pediatrics and intensive care unit].

OBJECTIVE: To investigate the antimicrobial resistance of Staphylococcus aureus isolates obtained from inpatients of departments of internal medicine, surgery, and pediatrics and intensive care unit (ICU), and study on the differences of resistant rates among the clinical isolates. METHODS: The strains of Staphylococcus aureus were cultured and their antimicrobial resistance was assayed by disc diffusion test (K-B method) and the data was analyzed by WHO NET 5 software. chi(2) test was made to identify the significance of difference. RESULTS: 2 625 strains of Staphylococcus aureus were obtained from the clinical departments of 60 hospitals all over China, among which 1 669 strains (63.3%) were obtained from the inpatients of departments of internal medicine, surgery, and pediatrics and ICU from 1 January to 31 December 2001. Most of the strains were isolated from sputum (34.3%, 572/1 669), secretion (13.2%, 221/1 669), pus (11.7%, 195/1 669), blood (10.2%, 171/1 669), and wound (5.6%, 94/1 669). The resistant rates of Staphylococcus aureus isolates from the inpatients in department pediatrics of to oxacillin, gentamicin, clindamycin, ciprofloxacin, levofloxacin, and chloramphenicol were 23.3%, 16.1%, 29.3%, 11.2%, 4.0% and 14.4% respectively, all significantly lower than those of the isolates from the inpatients of the departments of internal medicine and surgery, and ICU (all P < 0.001). The resistant rates of Staphylococcus aureus isolates from the inpatients of departments of internal medicine and surgery to oxacillin, gentamicin, clindamycin, ciprofloxacin, and levofloxacin were significantly lower than those of isolates from the patients of ICU (all P < 0.001). CONCLUSION: A high isolation rate of multi-drug resistant Staphylococcus aureus among the inpatients of departments of internal medicine, surgery, and pediatrics and ICU. It is important to select appropriate antimicrobial agents based on the origin of bacterial strains and avoid blindness before the results of drug sensitivity are obtained.

Anti-Bacterial Agents↗