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Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales

BACKGROUND: Patient outcomes in specialist burns units have been used as a metric of care needs and quality. Besides patient factors there are service factors that might influence Length of Stay (LOS) and mortality, e.g. pressure on beds. Although the bed needs of UK hospitals have dropped significa...

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Autores principales: Stylianou, Neophytos, Carr, Matthew, Kontopantelis, Evangelos, Buchan, Iain, Dunn, Ken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389493/
https://www.ncbi.nlm.nih.gov/pubmed/25888757
http://dx.doi.org/10.1186/s12913-015-0813-4
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author Stylianou, Neophytos
Carr, Matthew
Kontopantelis, Evangelos
Buchan, Iain
Dunn, Ken
author_facet Stylianou, Neophytos
Carr, Matthew
Kontopantelis, Evangelos
Buchan, Iain
Dunn, Ken
author_sort Stylianou, Neophytos
collection PubMed
description BACKGROUND: Patient outcomes in specialist burns units have been used as a metric of care needs and quality. Besides patient factors there are service factors that might influence Length of Stay (LOS) and mortality, e.g. pressure on beds. Although the bed needs of UK hospitals have dropped significantly over the past three decades, with changes in policies and practices, recent reports suggest that hospitals have 90% bed occupancy for 48 weeks of the year. In the UK, the specialist burn injury service is organised so that patients are assessed on arrival at hospital, and those needing admission are found a nearby bed in a suitable unit through the National Burn Bed Bureau. The aim of this study was to investigate the effect on outcomes of service pressures due to shortages of beds. METHODS: We took an extract of the anonymised patient data from the specialised burn injury database, iBID, and created a new database based on matching that data with bed availability data provided by the national Burn Bed Bureau. Cox proportional hazard modelling was used for analysis to investigate if there is an impact of bed occupancy (a proxy measure of workload) on LOS. RESULTS: Cox proportional hazard modelling indicated that half of the services in England and Wales are less likely to discharge a patient if the bed availability is high. Two of the services have abnormally high bed availability and LOS, therefore a model without these two services indicates a general reluctance to discharge patients when beds are available. CONCLUSIONS: It is possible that the effect we observed is a result of gaming as service providers are paid by the number of admissions. In addition, providers many not all give the same level of accuracy of bed availability information to the NBBB: some may under report availability, for example at times of high pressure on staff. Furthermore, burn services may not empty beds to avoid being filled up by work from other specialties, thus making them unable to admit a burn when referred.
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spelling pubmed-43894932015-04-09 Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales Stylianou, Neophytos Carr, Matthew Kontopantelis, Evangelos Buchan, Iain Dunn, Ken BMC Health Serv Res Research Article BACKGROUND: Patient outcomes in specialist burns units have been used as a metric of care needs and quality. Besides patient factors there are service factors that might influence Length of Stay (LOS) and mortality, e.g. pressure on beds. Although the bed needs of UK hospitals have dropped significantly over the past three decades, with changes in policies and practices, recent reports suggest that hospitals have 90% bed occupancy for 48 weeks of the year. In the UK, the specialist burn injury service is organised so that patients are assessed on arrival at hospital, and those needing admission are found a nearby bed in a suitable unit through the National Burn Bed Bureau. The aim of this study was to investigate the effect on outcomes of service pressures due to shortages of beds. METHODS: We took an extract of the anonymised patient data from the specialised burn injury database, iBID, and created a new database based on matching that data with bed availability data provided by the national Burn Bed Bureau. Cox proportional hazard modelling was used for analysis to investigate if there is an impact of bed occupancy (a proxy measure of workload) on LOS. RESULTS: Cox proportional hazard modelling indicated that half of the services in England and Wales are less likely to discharge a patient if the bed availability is high. Two of the services have abnormally high bed availability and LOS, therefore a model without these two services indicates a general reluctance to discharge patients when beds are available. CONCLUSIONS: It is possible that the effect we observed is a result of gaming as service providers are paid by the number of admissions. In addition, providers many not all give the same level of accuracy of bed availability information to the NBBB: some may under report availability, for example at times of high pressure on staff. Furthermore, burn services may not empty beds to avoid being filled up by work from other specialties, thus making them unable to admit a burn when referred. BioMed Central 2015-04-02 /pmc/articles/PMC4389493/ /pubmed/25888757 http://dx.doi.org/10.1186/s12913-015-0813-4 Text en © Stylianou et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Stylianou, Neophytos
Carr, Matthew
Kontopantelis, Evangelos
Buchan, Iain
Dunn, Ken
Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title_full Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title_fullStr Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title_full_unstemmed Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title_short Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales
title_sort patient outcomes vs. service workload: an analysis of outcomes in the burn service of england and wales
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389493/
https://www.ncbi.nlm.nih.gov/pubmed/25888757
http://dx.doi.org/10.1186/s12913-015-0813-4
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