Efficiency of acute public hospitals in the region of Murcia, Spain.

Aim: To evaluate the level of efficiency of public acute hospitals situated in the region of Murcia (Spain). Materials & methods: Data from nine acute general hospitals of Murcia's Health Service (SMS by its Spanish acronym) were analyzed over the 2012-2014 period. The data were extracted from the In-patient Health Establishment Statistics of the Ministry of Health, Social Services and Equality, from the National Health Service (SNS) portal and the SMS portal. To this end, the data envelopment analysis (DEA)-window method was used, since this extension of the basic DEA model allows to compare the efficiency of a small number of units over different years and analyze changes in efficiency over time. In addition, the model was complemented by smooth bootstrapping and a superefficiency analysis to improve the quality of the data interpretation. Four inputs were used (number of beds, number of operating rooms, personnel costs and operating costs), two undesirable outputs (average stay and rate of return) and three desirable outputs (weighted discharges, emergencies and surgical interventions). Results: The average level of inefficiency was 1.58% over the study period, with a good evolution between 2012 (3.53%) and 2014 (0.20%). This improvement was also reflected in the number of efficient hospitals that rose from two in 2012 to eight in 2014. Moreover, the slack levels detected were small. Conclusion: The management of the public hospitals analyzed was favorable, both regarding average level of efficiency and the number of hospitals qualified as efficient. However, the analysis revealed several ways to increase efficiency by reducing specific inputs and nondesirable outputs (mainly operating and personnel costs as well as average length of stay) while increasing desirable outputs (mostly the number of surgical interventions). To finish, specific policy measures are suggested to improve the performance of these hospitals.

[Chest pain in clinical practice: impact of routine troponin determination on clinical manifestations and care]. / El dolor torácico en la práctica clínica hospitalaria: repercusión clínica y asistencial del uso rutinario de troponinas.

UNLABELLED: INTRODUCTION AND OBJECTIVES. To study the significance of chest pain in the clinical practice of a Spanish hospital and to evaluate the impact of routine troponin determination. METHODS: In our institution, routine serial measurements of troponins I and T were made in the evaluation of chest pain in 2000. We compared the results obtained in 1999 for all patients who visited the emergency room for chest pain and the patients who were hospitalized. We recorded the diagnosis at discharge, duration of the hospital stay, and associated costs. RESULTS: In 2000, 1,820 patients with chest pain visited the emergency department, which was equivalent to 1.9% of visits and 7.5 cases per 1,000 people and year: 43% of these patients were hospitalized for suspected acute coronary syndrome as compared to 49% in 1999 (-12%; p > 0.001). Among the patients admitted, 28% were discharged with a diagnosis of non-ischemic chest pain. Troponin determinations were associated with a lower probability of admission due to unstable angina (11.5 vs 16.0%; -28%; p < 0.001) and non-ischemic chest pain (12.1 vs 14.5%; -16%; p < 0.05), and an increase in diagnoses of non-Q wave acute myocardial infarction (3.4% vs 1.8%; +89%; p < 0.01). Non-ST elevation acute coronary syndrome ACS required 3,751 days of hospitalization and 1,003,420 euros of cost, and troponin determinations were associated with a reduction in hospital stays of 832 days (-18.2%) and 185,100 euros (-15.6%). CONCLUSION: Chest pain had a high incidence, 7.5, and generates high costs in hospital admissions. The routine use of serial troponin determinations was associated with a reduction in hospital admissions due to unstable angina and non-ischemic chest pain, and costs.

El dolor torácico en la práctica clínica hospitalaria: repercusión clínica y asistencial del uso rutinario de troponinas / Chest pain in clinical practice: impact of routine troponin determination on clinical manifestations and care

Introducción y objetivos. Estudiar la importancia del dolor torácico como motivo de consulta urgente e ingreso hospitalario, así como la repercusión del uso rutinario de troponinas sobre su manejo clínico y los costes asociados. Métodos. Durante el año 2000 nuestro protocolo de evaluación del dolor torácico incluyó la determinación seriada de troponinas I y T. Estudiamos en el año 2000, respecto a 1999, todas las consultas por dolor torácico en urgencias, los ingresos, su diagnóstico final, estancia y cuantificación económica. Los pacientes fueron agrupados en IAM con y sin onda Q, angina inestable y dolor torácico no isquémico. Resultados. En el año 2000, el dolor torácico motivó 1.820 consultas (1,9 per cent) y 7,5 casos por 1.000 habitantes y año. Un 43 per cent de los pacientes con dolor torácico fue ingresado por sospecha de síndrome coronario agudo, frente al 49 per cent en 1999 (-12 per cent; p < 0,001). Un 29 per cent de hospitalizaciones se debió a dolor torácico de origen no isquémico en el momento del alta. El uso de troponinas se asoció con una menor probabilidad de ingreso por angina inestable (11,5 frente a 16,0 per cent; -28 per cent; p < 0,001) y dolor torácico no isquémico (12,1 frente a 14,5 per cent; -16 per cent; p < 0,05), y mayor por IAM sin onda Q (3,4 frente a 1,8 per cent; +89 per cent; p < 0,01). La sospecha de síndrome coronario agudo sin ascenso del segmento ST ocasionó 3.751 días de estancia y 1.003.420 euros de coste, con una reducción, asociada al uso de troponinas, de 832 días (-18,2 per cent) y 185.100 euros (-15,6 per cent).Conclusión. El dolor torácico ocasiona una elevada demanda asistencial, con un alto consumo de recursos hospitalarios. La incorporación de troponinas se asoció a una reducción significativa de las hospitalizaciones por angina inestable y dolor torácico de origen no isquémico, así como de los costes ocasionados (AU)