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Booking patients for hospital admissions: evaluation of a pilot programme for day cases.

ABSTRACT: NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.24 pilot sites in England with relatively short waiting times and some experience of booking appointments.Proportion of patients with booked or "to come in" date during and after pilot programme, proportion not attending for admission, and proportion waiting > or = 6 months. Comparison of pilot sites with non-pilot sites.National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of 9.9m pounds sterling to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology.Proportion of patients with booked or "to come in" date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting > or = 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or "to come in" date than non-pilot sites at end of each period.Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors.

SUBMITTER: McLeod H

PROVIDER: S-EPMC261817 | biostudies-literature | 2003 Nov

REPOSITORIES: biostudies-literature

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Booking patients for hospital admissions: evaluation of a pilot programme for day cases.

McLeod Hugh H Ham Chris C Kipping Ruth R

BMJ (Clinical research ed.) 20031101 7424

<h4>Problem</h4>NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.<h4>Design</h4>18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.<h4>Background and setting</h4>24 pilot sites in England with relatively short waiting times and some experience of booking appointments.<h4>Key measures for improvement</h4>Proportion of patients with booked or "to c ...[more]

PMID: 14615342

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Project description:PROBLEM: Zimbabwe has one of the highest rates of HIV seroprevalence in the world. In 2001 only 4% of women and children in need of services for prevention of mother to child transmission of HIV were receiving them. DESIGN: Pilot implementation of the first programme for prevention of mother to child transmission of HIV in rural Zimbabwe. SETTING: 120 bed district hospital in Buhera district (285,000 inhabitants), Manicaland, Zimbabwe. KEY MEASURES FOR IMPROVEMENT: Programme uptake indicators monitored for 18 months; impact of policy evaluated by assessing up-scaling of programme. STRATEGIES FOR CHANGE: Voluntary counselling and testing services for HIV were provided in the hospital antenatal clinic. Women identified as HIV positive and informed of their serostatus and their newborn were offered a single dose antiretroviral treatment of nevirapine; mother-child pairs were followed up through routine health services. Nursing staff and social workers were trained, and community mobilisation was conducted. EFFECTS OF CHANGE: No services for prevention of mother to child transmission of HIV were available at baseline. Within 18 months, 2298 pregnant women had received pretest counselling, and the acceptance of HIV testing reached 93.0%. Of all 2137 women who had an HIV test, 1588 (74.3%) returned to collect their result; 326 of the 437 HIV positive women diagnosed had post-test counselling, and 104 (24%) mother-child pairs received nevirapine prophylaxis. LESSONS LEARNT: Minimum staffing, an enhanced training programme, and involvement of district health authorities are needed for the implementation and successful integration of services for prevention of mother to child transmission of HIV. Voluntary counselling and testing services are important entry points for HIV prevention and care and for referral to community networks and medical HIV care services. A district approach is critical to extend programmes for prevention of mother to child transmission of HIV in rural settings. The lessons learnt from this pilot programme have contributed to the design of the national expansion strategy for prevention of mother to child transmission of HIV in Zimbabwe.

Project description:BackgroundA small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs.MethodsCommunity and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach.ResultsNineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3%) had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient.ConclusionsA pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated.Trial registrationClinicaltrials.gov Identifier: NCT01292096.

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Booking patients for hospital admissions: evaluation of a pilot programme for day cases.

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Booking patients for hospital admissions: evaluation of a pilot programme for day cases.

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