[The use of resources. Unnecessary stays in pediatric surgical services]. / Utilización de recursos. Estancias innecesarias en un servicio de cirugía infantil.

BACKGROUND: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard. OBJECTIVE: The main aim of this work is to determine the percentage of inadequate stays in a pediatric surgery service and to identify the causes that provoke them. METHOD: It was a concurrent study in pediatric patients entered, at least 24 hours, by different disease for surgery, observation or study. Revising trained applied the pediatric version of the Appropriateness Evaluation Protocol on the medical records of these patients. It has been measured if the stay was appropriated or not, and the cause. RESULTS: The studied patients (279) caused a total of 1,001 stays of those which 373 (37.3%) were deemed to be unnecessary. The diseases with greater number of inappropriate stays were cryptorchidia (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissues surgery (43.1%). A 68.2% of the unnecessary stays were responsibility of the hospital-service-surgeon, a 22.6% to the associated environment-familiar, and a 9.2% to the lack of alternative resources to the hospital. CONCLUSIONS: A meaningful proportion by day of hospital stay would be avoided. The unnecessary stays search facilitates the weak points identification on those which to develop improvement actions.

[Activity and costs of diagnosis-related groups (DRG) of neurological services at the Virgen de las Nieves Hospital of Granada]. / Actividad y costes por GRD del Servicio de Neurología del Hospital Universitario Virgen de las Nieves de Granada.

INTRODUCTION: The influence on health costs of variations in the clinical practice of doctors makes it necessary for them to be involved in the administration of resources so as to increase the efficacy, effectiveness and efficiency of clinical units. OBJECTIVES: To analyze the activity of the Neurology Department of the Virgen de las Nieves Hospital of Granada and to determine its costs per GRD. PATIENTS AND METHODS: Activity during 1996 was compared with that of the previous year and with a standard using measurements of cases, efficiency in administration of beds, quality of data and quality of care. The GRD costs of the service were found. RESULTS: Ninety percent of the discharges were grouped in 20 GRD, and GRD 014 and 015 represented 44% of the productivity. Complexity of the cases was 5% more than in 1995, similar to that of Rule IV [20]. Extreme cases led to a third of all admissions. Mortality was less than expected (3.13%). Hospital stays made up 82% of the total cost. The cost of one stay in hospital was 463.686 pesetas. CONCLUSIONS: It is essential to improve the structure and procedures related to hospital care of patients with cerebral vacular pathology. Those with uncomplicated conditions should be attended as outpatients or in smaller hospitals. The GRD costs obtained are not comparable to those of other authors. Hospital activity should be measured homogeneously and use should be made of analytical accounting systems with common operators and standardized applications so as to obtain reliable, comparable data.