Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System.

Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.

A stochastic programming approach to perform hospital capacity assessments.

This article introduces a bespoke risk averse stochastic programming approach for performing a strategic level assessment of hospital capacity (QAHC). We include stochastic treatment durations and length of stay in the analysis for the first time. To the best of our knowledge this is a new capability, not yet provided in the literature. Our stochastic programming approach identifies the maximum caseload that can be treated over a specified duration of time subject to a specified risk threshold in relation to temporary exceedances of capacity. Sample averaging techniques are applied to handle probabilistic constraints, but due to the size and complexity of the resultant mixed integer programming model, a novel two-stage hierarchical solution approach is needed. Our two-stage hierarchical solution approach is novel as it combines the application of a meta-heuristic with a binary search. It is also computationally fast. A case study of a large public hospital has been considered and extensive numerical tests have been undertaken to highlight the nuances and intricacies of the analysis. We conclude that the proposed approach is effective and can provide extra clarity and insights around hospital outputs. It provides a way to better calibrate hospitals and other health care infrastructure to future demands and challenges, like those created by the COVID pandemic.

Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion.

The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.

Gestión de camas hospitalarias durantela pandemia en Navarra con el apoyo demétodos matemáticos de predicción / Management of hospital beds during the pandemic in Navarra with the support of mathematical prediction methods

Durante la pandemia por coronavirus, en Navarra se utilizaron modelos matemáticos depredicción para estimar las camas necesarias, convencionales y de críticos, para atender alos pacientes COVID-19. Las seis ondas pandémicas presentaron distinta incidencia en la población, ocasionandovariabilidad en los ingresos hospitalarios y en la ocupación hospitalaria. La respuesta a laenfermedad de los pacientes no fue constante en cada onda, por lo que, para la predicción decada una, se utilizaron los datos correspondientes de esa onda.El método de predicción constó de dos partes: una describió la entrada de pacientes alhospital y la otra su estancia dentro del mismo. El modelo requirió de la alimentación a tiempo real de los datos actualizados. Los resultados delos modelos de predicción fueron posteriormente volcados al sistema de información corporativotipo Business Intelligence. Esta información fue utilizada para planificar el recurso cama y lasnecesidades de profesionales asociadas a la atención de estos pacientes en el ámbito hospitalario.En la cuarta onda se realizó un análisis para cuantificar el grado de acierto de los modelospredictivos. Los modelos predijeron adecuadamente el pico, la meseta y el cambio detendencia, pero sobreestimaron los recursos necesarios para la atención de los pacientes enla parte descendente de la curva. El principal punto fuerte de la sistemática utilizada para la construcción de modelospredictivos fue proporcionar modelos en tiempo real con datos recogidos con precisión porlos sistemas de información que consiguieron un grado de acierto aceptable permitiendo unautilización inmediata.(AU)

Hospital COVID-19 preparedness: Are (were) we ready?

BACKGROUND: Terrorist attacks and natural disasters such as Hurricanes Katrina and Harvey have increased focus on disaster preparedness planning. Despite the attention on planning, many studies have found that hospitals in the United States are underprepared to manage extended disasters appropriately and the surge in patient volume it might bring. AIM: This study aims to profile and examine the availability of hospital capacity specifically related to COVID-19 patients, such as emergency department (ED) beds, intensive care unit (ICU) beds, temporary space setup, and ventilators. METHOD: A cross-sectional retrospective study design was used to examine secondary data from the 2020 American Hospital Association (AHA) Annual Survey. A series of multivariate logistic analyses were conducted to investigate the strength of association between changes in ED beds, ICU beds, staffed beds, and temporary spaces setup, and the 3,655 hospitals' characteristics. RESULTS: Our results highlight that the odds of a change in ED beds are 44 percent lower for government hospitals and 54 percent for for-profit hospitals than not-for-profit hospitals. The odds of ED bed change for nonteaching hospitals were 34 percent lower compared to teaching hospitals. Small and medium hospitals have significantly lower odds (75 and 51 percent, respectively) than large hospitals. For ICU bed change, staffed bed change, and temporary spaces setup, the conclusions were consistently significant regarding the impact of hospital ownership, teaching status, and hospital size. However, temporary spaces setup differs by hospital location. The odds of change is significantly lower (OR = 0.71) in urban hospitals compared with rural hospitals, while for ED beds, the odds of change is considerably higher (OR = 1.57) in urban hospitals compared to rural hospitals. CONCLUSION: There is a need for policymakers to consider not only resource limitations that were created from supply line disruptions during the COVID-19 pandemic but also a more global assessment of the adequacy of funding and support for insurance coverage, hospital finance, and how hospitals meet the needs of the populations they serve.

One System, Multiple Hospitals: A Unified Paediatric Healthcare System Response to the COVID-19 Pandemic.

To address severe adult in-patient capacity pressures during the COVID-19 pandemic, 15 community hospitals were mandated to close their in-patient paediatric units (167 beds) and transfer paediatric in-patients to a single paediatric tertiary hospital. The tertiary hospital increased bed capacity through a surge plan activation, while community hospitals redeployed resources to fill the gaps in adult care. Also, 530 patients were transferred solely to increase adult bed capacity during the closure. Several factors enabled the system to function collaboratively. Closures increased the potential adult in-patient capacity by 6,740 bed days and demonstrated an unprecedented system-wide approach to the provision of integrated paediatric care across the region.

Research on outpatient capacity planning combining lean thinking and integer linear programming.

BACKGROUND: The size and cost of outpatient capacity directly affect the operational efficiency of a whole hospital. Many scholars have faced the study of outpatient capacity planning from an operations management perspective. OBJECTIVE: The outpatient service is refined, and the quantity allocation problem of each type of outpatient service is modeled as an integer linear programming problem. Thus, doctors' work efficiency can be improved, patients' waiting time can be effectively reduced, and patients can be provided with more satisfactory medical services. METHODS: Outpatient service is divided into examination and diagnosis service according to lean thinking. CPLEX is used to solve the integer linear programming problem of outpatient service allocation, and the maximum working time is minimized by constraint solution. RESULTS: A variety of values are taken for the relevant parameters of the outpatient service, using CPLEX to obtain the minimum and maximum working time corresponding to each situation. Compared with no refinement stratification, the work efficiency of senior doctors has increased by an average of 25%. In comparison, the patient flow of associate senior doctors has increased by an average of 50%. CONCLUSION: In this paper, the method of outpatient capacity planning improves the work efficiency of senior doctors and provides outpatient services for more patients in need; At the same time, it indirectly reduces the waiting time of patients receiving outpatient services from senior doctors. And the patient flow of the associate senior doctors is improved, which helps to improve doctors' technical level and solve the problem of shortage of medical resources.

Hospitalización a domicilio para pacientes quirúrgicos ante una pandemia por SARS-CoV-2: nuestra experiencia / Hospitalization at home for surgical patients in the face of a SARS-CoV-2 pandemic: our experience

Introducción: La hospitalización a domicilio para pacientes quirúrgicos (HaDQ) es una al-ternativa a la hospitalización convencional para pacientes quirúrgicos estables clínicamente, que precisen procedimientos de enfermería complejos por intensidad, frecuencia o carac-terísticas, y control por especialista quirúrgico en el domicilio.Método: Estudio transversal, descriptivo y retrospectivo de la actividad de la HADQ de nuestro hospital durante los primeros seis me-ses del 2020, para analizar la repercusión de la pandemia por SARS-CoV-2 en la unidad. Se distinguen tres periodos: prepandemia (enero-febreo), confinamiento (marzo-abril), poscon-finamiento (mayo-junio). Se diferencian dos grupos: A (HaD convencional) y B (despistaje preoperatorio COVID19). Se recogieron diver-sas variables: mes, tipo, estancia (HaD y hospi-tal), procedimientos, reingresos, domicilio, tipo visitas, COVID+. Se realizó un análisis estadís-tico descriptivo cuantitativo y cualitativo de los resultados obtenidosResultados: Ingresaron 345 pacientes, 225 en el grupo A (fase Pre (34%), fase C (40%), y fase Pos (25%)), y 120 en el B (fase C (75%), fase Pos (25%)). El confinamiento (fase C) fue el pe-ríodo más activo de la HADQ, tanto por número de ingresos (53%), como por la complejidad del grupo A que requería más procedimientos (71%) y más visitas domiciliarias (52%). Tam-bién aumentaron los pacientes de zona de no cobertura (42%), que implicaron visitas médicas y de enfermería en Hospital de Día (HD) (21%), y aumento de consultas telefónicas médicas (36%). En la fase Pos disminuyeron un 37% los ingresos del grupo A.Conclusiones: La HaDQ se reorganizó por la pandemia para atender a más pacientes quirúr-gicos, siendo un recurso asistencial esencial, especialmente durante el confinamiento. (AU)

Introduction: The HaDQ is an alternative to conventional hospitalization for clinically stable surgical patients who require complex nursing procedures due to intensity, frequency or char-acteristics, and control by a surgical specialist at home.Method: Cross-sectional, descriptive and ret-rospective study of the HADQ activity of our hospital during the first six months of 2020, to analyze the impact of the SARSCov2 pandemic in the unit. Three periods are distinguished: pre-pandemic (Jan-Feb), lockdown (Mar-Apr), post-lockdown (May-Jun). Two groups are differen-tiated: A (conventional HaD) and B (COVID19 preoperative screening). Various variables were collected: month, type, stay (HaD and hospi-tal), procedures, readmissions, address, type of visits, covid+. A quantitative and qualitative descriptive statistical analysis of the results ob-tained was carried out.Results: 345 patients were admitted, 225 in group A (phase Pre (34%), Phase C (40%), and phase Post (25%)), and 120 in group B (Phase C (75%), phase Post (25%)). %)). The confinement (phase C) was the most active period of the HADQ, both due to the number of admissions (53%), and the complexity of group A, which re-quired more procedures (71%) and more home visits (52%). There was also an increase in pa-tients from the non-coverage area (42%), which involved medical and nursing visits at the Day Hospital (HD) (21%), and an increase in medi-cal telephone consultations (36%). In the phase Post, the income of group A decreased by 37%.Conclusions: The HaDQ was reorganized due to the pandemic to care for more surgical pa-tients, being an essential care resource, espe-cially during confinement. (AU)

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya.

BACKGROUND: In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program. METHODS: A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web-based survey. RESULTS: A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1-5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192-570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT. CONCLUSIONS: In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals.

Contribuições do núcleo interno de regulação para a segurança do paciente / Contributions of the regulatory inner core to patient safety / Aportes del núcleo interno normativo para la seguridad del paciente

Objetivo: identificar as contribuições do Núcleo Interno de Regulação para a segurança do paciente. Método: pesquisa qualitativa desenvolvida entre agosto a outubro de 2020. Foram realizadas entrevistas audiogravadas junto a 13 profissionais que atuavam nas enfermarias, no pronto-socorro, na gestão da qualidade e no Núcleo Interno de Regulação. Os dados foram analisados com o auxílio do software IraMuteq® e as etapas propostas por Creswell. Resultados: os achados revelaram que o Núcleo Interno de Regulação contribui para a segurança do paciente, entornando as metas instituídas: comunicação efetiva; identificação do paciente; redução do risco de infecções associadas aos cuidados em saúde - a pandemia de COVID-19 foi apresentada como um importante dado; segurança para cirurgia, uma vez que agiliza o acesso ao hospital para procedimento cirúrgico; e diminuição de filas de espera. Ainda, contribui para prevenir complicações decorrentes de quedas, pois o paciente pode ser alocado com agilidade num leito seguro. Por fim, o enfermeiro, no seu papel de liderança do serviço e como elo para a gerência do cuidado seguro, também se mostrou importante. Conclusão: embora algumas fragilidades tenham sido detectadas, a contribuição do Núcleo Interno de Regulação se sobressai por fortalecer as metas da segurança do paciente. Em razão disso, reafirma-se a importância de fluxos regulatórios na perspectiva de gestão de leitos hospitalares, assim como os preceitos da segurança do paciente almejada pelos gestores. Não obstante, o enfermeiro atua como elo entre esses dois cenários.(AU)

Objective: to identify the contributions of the Internal Regulation Core to patient safety. Method: qualitative research carried out between August and October 2020. Audio-recorded interviews were carried out with 13 professionals who worked in the wards, in the emergency room, in quality management and in the Internal Regulation Center. Data were analyzed using the IraMuteq® software and the steps proposed by Creswell. Results: the findings revealed that the Internal Regulation Nucleus contributes to patient safety, bypassing the established goals: effective communication; patient identification; reduction in the risk of infections associated with health care - the COVID-19 pandemic was presented as an important fact; safety for surgery, as it speeds up access to the hospital for a surgical procedure; and reduction of queues. It also helps to prevent complications resulting from falls, as the patient can be quickly allocated to a safe bed. Finally, the nurse, in his role as a leader in the service and as a link in the management of safe care, also proved to be important. Conclusion: although some weaknesses were detected, the contribution of the Internal Regulation Center stands out for strengthening patient safety goals. As a result, the importance of regulatory flows from the perspective of hospital bed management is reaffirmed, as well as the precepts of patient safety desired by managers. Nevertheless, the nurse acts as a link between these two scenarios.(AU)

Objetivo: identificar los aportes del Núcleo Interno Normativo para la seguridad del paciente. Método: investigación cualitativa desarrollada de agosto a octubre de 2020. Se realizaron entrevistas audiograbadas a 13 profesionales que trabajaban en las salas, en el servicio de urgencias, en la Gestión de Calidad y en el Núcleo Interno Normativo. Los datos fueron analizados con la ayuda del software IraMuteq® y los pasos propuestos por Creswell. Resultados: los hallazgos revelaron que el Núcleo Interno Normativo contribuye a la seguridad del paciente, desbordando los objetivos establecidos: comunicación eficaz; identificación del paciente; reducción del riesgo de infecciones asociadas a la asistencia sanitaria - la pandemia COVID-19 se presentó como un dato importante; en la seguridad para la cirugía, ya que agiliza el acceso al hospital para procedimientos quirúrgicos y, en la reducción de las colas de espera. También contribuye a la prevención de complicaciones derivadas de caídas, ya que el paciente puede ser ubicado rápidamente en una cama segura. Y, finalmente, el enfermero, en su papel de líder en el servicio, como enlace en la gestión del cuidado seguro, también resultó ser un resultado importante. Conclusión: aunque se detectaron algunas debilidades, se destaca la contribución del Núcleo Interno Normativo en el fortalecimiento de las metas de seguridad del paciente. Como resultado, reafirma la importancia de los flujos normativos desde la perspectiva de la gestión de camas hospitalarias, así como los preceptos de seguridad del paciente deseados por los gestores. Sin embargo, la enfermera actúa como enlace entre estos dos escenarios.(AU)

New bed configurations and discharge timing policies: A hospital-wide simulation.

OBJECTIVE: Optimising patient flow is becoming an increasingly critical issue as patient demand fluctuates in healthcare systems with finite capacity. Simulation provides a powerful tool to fine-tune policies and investigate their impact before any costly intervention. METHODS: A hospital-wide discrete event simulation is developed to model incoming flow from ED and elective units in a busy metropolitan hospital. The impacts of two different policies are investigated using this simulation model: (i) varying inpatient bed configurations and a load sharing strategy among a cluster of wards within a medical department and (ii) early discharge strategies on inpatient bed access. Several clinically relevant bed configurations and early discharge scenarios are defined and their impact on key performance metrics are quantified. RESULTS: Sharing beds between wards reduced the average and total ED length of stay (LOS) by 21% compared to having patients queue for individual wards. The current baseline performance level could be maintained by using fewer beds when the load sharing approach was imposed. Earlier discharge of inpatients resulted in reducing average patient ED LOS by approximately 16% and average patient waiting time by 75%. Specific time-based discharge targets led to greater improvements in flow compared to blanket approaches of discharging all patients 1 or 2 hours earlier. CONCLUSIONS: ED access performance for admitted patients can be improved by modifying downstream capacity or inpatient discharge times. The simulation model was able to quantify the potential impacts of such policies on patient flow and to provide insights for future strategic planning.

El despegue de la sanidad leonesa en la segunda mitad de los años sesenta del siglo XX. La construcción de los grandes hospitales privados / The acknowledgement of health service of León in the second half of the sixties of the twentieth century. The building of the large and private hospitals

En una época de precariedad sanitaria e inexistencia de camas hospitalarias, la capital de la provincia leonesa, siguiendo la estela de lo que ocurría en el resto del país, asistió, en la segunda mitad de los años sesenta del siglo XX, a la construcción de cinco hospitales, uno de titularidad pública y cuatro de titularidad privada, a los que dedicaremos este artículo. Objetivo principal: Evaluar la importancia de la década de los sesenta del siglo XX en el desarrollo sanitario de la capital de la provincia española de León. Metodología: Se ha realizado un estudio histórico descriptivo de las instalaciones sanitarias al inicio y al final de la década. Resultados principales: Se dotó de más de 900 camas sanitarias de titularidad privada y 280 de titularidad pública, además de un hospital antituberculoso y todo ello en el corto periodo de diez años. En solo cinco años, la oferta de camas privadas prácticamente se triplicó. Conclusión principal: La sanidad leonesa dio un salto cuantitativo y cualitativo para ofrecer a los ciudadanos instalaciones hospitalarias de titularidad privada que complementarían, en su caso, a la Seguridad Social y competirían con ella en la oferta de especialidades médicas y tecnología (AU)

In the second half of the sixties of the twentieth century during the period of health precariousness and lack of hospital beds, the capital of the province of León, which kept up with the other cities of Spain, put up five hospitals, on the one hand, a hospital of public ownership, and the other, four hospitals of private ownership, which will be looked into this article. Main target: Analysing the importance of the sixties of the twentieth century during the health development of the capital of the Spanish province of León. Methodology: We have made a developing a historical-descriptive study of the sanitary facilities at the beginning and end of this decade. Main results: 900 hospital beds of private ownership and 280 of public ownership, besides an antitubercular hospital were put up in so short a period of ten years. In five years, the amount of private beds almost tripled. Main conclusion: The health service of León made a quantitative and qualitative leap, which provides the citizens hospital facilities of private ownership. This will be complementary with social security and will compare with her in the amount of medical specialities and technology (AU)

Time-dependent risk of COVID-19 death with overwhelmed health-care capacity in Japan, 2020-2022.

BACKGROUND: It has been descriptively argued that the case fatality risk (CFR) of coronavirus disease (COVID-19) is elevated when medical services are overwhelmed. The relationship between CFR and pressure on health-care services should thus be epidemiologically explored to account for potential epidemiological biases. The purpose of the present study was to estimate the age-dependent CFR in Tokyo and Osaka over time, investigating the impact of caseload demand on the risk of death. METHODS: We estimated the time-dependent CFR, accounting for time delay from diagnosis to death. To this end, we first determined the time distribution from diagnosis to death, allowing variations in the delay over time. We then assessed the age-dependent CFR in Tokyo and Osaka. In Osaka, the risk of intensive care unit (ICU) admission was also estimated. RESULTS: The CFR was highest among individuals aged 80 years and older and during the first epidemic wave from February to June 2020, estimated as 25.4% (95% confidence interval [CI] 21.1 to 29.6) and 27.9% (95% CI 20.6 to 36.1) in Tokyo and Osaka, respectively. During the fourth wave of infection (caused by the Alpha variant) in Osaka the CFR among the 70s and ≥ 80s age groups was, respectively, 2.3 and 1.5 times greater than in Tokyo. Conversely, despite the surge in hospitalizations, the risk of ICU admission among those aged 80 and older in Osaka decreased. Such time-dependent variation in the CFR was not seen among younger patients < 70 years old. With the Omicron variant, the CFR among the 80s and older in Tokyo and Osaka was 3.2% (95% CI 3.0 to 3.5) and 2.9% (95% CI 2.7 to 3.1), respectively. CONCLUSION: We found that without substantial control, the CFR can increase when a surge in cases occurs with an identifiable elevation in risk-especially among older people. Because active treatment options including admission to ICU cannot be offered to the elderly with an overwhelmed medical service, the CFR value can potentially double compared with that in other areas of health care under less pressure.

Extending floating catchment area methods to estimate future hospital bed capacity requirements.

A new hospital in north-west Sydney, Australia is to start construction in the year 2023. However, the number of emergency department beds/treatment spaces (EDBs) that it will contain is yet to be determined, as this region is expected to have relatively high population growth from year 2021 to year 2036. In this paper, floating catchment area (FCA) methods were employed to estimate the required number of EDBs for this new hospital. Metrics including spatial accessibility index and spatial equity were calculated based on the predicted populations for 2021 and 2036 using government sourced data. Specifically, potential spatial accessibility and horizontal spatial equity were employed for this paper. Mathematical optimisation was used to determine the most efficient distribution of EDBs throughout different hospitals in this region in 2036. The best allocation of capacity across the study area that simultaneously improved average spatial accessibility and improved spatial equity relative to the metrics of 2021 was found. Traditional methods of healthcare planning seldom consider the spatial location of populations or the travel cost to hospitals. This paper presents a novel method to how capacity of future services are determined due to population growth. These results can be compared to traditional methods to access the validity of the methods outlined in this paper.

Development of a model for predicting hospital beds shortage and optimal policies using system dynamics approach.

BACKGROUND: Policymakers use simulation-based models to improve system feedback and model the reality of the problems in the system. This study uses the system dynamics approach to provide a model for predicting hospital bed shortages and determine the optimal policy in Shiraz, Southern Iran. METHODS: This study was designed based on Sterman's system dynamic modeling (SDM) process. Firstly, we determined the main variables affecting bed distribution using a mixed qualitative and quantitative study which includes scoping review, expert panel, Delphi, and DANP. Then, dynamic hypotheses were designed. Subsequently, we held several expert panels for designing the causal and stock-flow models, formulating and testing a simulation model, as well as developing various scenarios and policies. RESULTS: Dynamic modeling process resulted in four scenarios. All of the scenarios predicted a shortage of national hospital beds over a 20-year time horizon. Then, four policies were developed based on the changes in the number of beds and capacity of home care services; finally, the optimal policy was determined. CONCLUSIONS: Due to the high cost of setting up hospital beds, developing and supporting cost-effective home care services, strengthening the insurance coverage of these services, and improving the quantity and quality of community care, considering the real needs of the community could be considered as an optimal option for the future of the city.

Prototipo de multimedia educativa para la enseñanza-aprendizaje de los indicadores del recurso cama hospitalaria. Cuba, 2020 / Educational Multimedia Prototype for teach-learn Indicators of Hospital Bed Resource. Cuba, 2020

Introducción: En la Facultad de Tecnología de la Salud se estudia la carrera Sistemas de Información en Salud que incluye en su plan de estudios diversas asignaturas como Sistemas de Información de Estadísticas de Salud, en la que se incluye el estudio de los indicadores hospitalarios del recurso cama; materia que se imparte de forma tradicional y no tiene una herramienta tecnológica de apoyo que facilite el proceso educativo. Objetivo: Diseñar un prototipo de multimedia educativa que favorezca el auto-aprendizaje de los indicadores del recurso cama hospitalaria en la asignatura Sistemas de Información de Estadísticas de Salud de la carrera Sistemas de Información en Salud. Método: Se realizó un estudio de desarrollo tecnológico donde fueron encuestados estudiantes y se entrevistó a la profesora de la asignatura para la obtención de la información. Se utilizó la metodología de Proceso Unificado de Desarrollo y el Lenguaje Unificado de Modelado. Se emplearon las herramientas Visual Paradigm para el modelado, Axure para la creación del prototipo y Mediator para el futuro diseño de la multimedia. Resultados: Se identificaron los problemas de aprendizaje desde la visión de alumnos y profesores, lo que permitió diseñar el prototipo de multimedia educativa sobre los indicadores hospitalarios del recurso cama, que fue considerado útil y pertinente. Conclusiones: Se diseñó un prototipo de multimedia educativa que de manera combinada con el método actual de enseñanza facilitarán y efectuarán de forma dinámica las actividades en el proceso docente educativo(AU)

Introduction: Health Information Systems career is included In the Faculty of Health Technology; the career have in its curriculum subjects as Health Statistics Information Systems, in which the study of hospital resource bed indicators is carried out; the subject is taught in a traditional way and does not have a technological support tool that facilitates the educational process. Objective: To design an educational multimedia prototype that favors self-learning of the indicators of the hospital bed resource in the Health Statistics Information Systems subject of the Health Information Systems career. Method: A survey of students and interview of teachers permitted to obtain the information needed to carry out a study of technological development using Unified Development Process methodology and Unified Modeling Language; Visual Paradigm tools were used for modeling; Axure for prototyping and Mediator for future multimedia design. Results: there were identified learning problems from the perspective of students and teachers, which allowed the design of the educational multimedia prototype on hospital bed resource indicators, considering it useful and pertinent. Conclusions: The design of the educational multimedia prototype, combined with the current teaching method, will facilitate and dynamically carry out the activities in the educational teaching process(AU)