Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction.

Background: Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challenging to represent the function and dysfunction of such systems in a scientific manner.

The Maternal Looking Guide: a perinatal clinical tool to support the emerging mother-infant relationship'.

Background: This study explores maternal looking - the unidirectional looking by a mother at her newborn - as a precursor to mother-infant gaze.

Methods: Phase 1 used video as a means of detailed and disciplined observation to examine how mothers look at their newborns (n = 13). Using an iterative design, intensive analysis identified and categorised patterns of looking and looking-related behaviours.

Hospital's instability wedges.

In this study, we define a hospital congestion episode as a situation where the number of new patients needing admission is greater than the number of available beds in the hospital, and investigate the likelihood that the current day's midnight occupancy will exceed any specified threshold level. We demonstrate that this measure of risk exhibits a characteristic sensitivity phenomenon that we have named as hospital's instability wedge. In particular, it is seen that frequently even small changes in the numbers of patients admitted or discharged can dramatically change the risk of exceeding the threshold, thereby changing the risk of subsequent congestion episodes.

Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes.

Objective Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia.

Identifying risk factors and patterns for unplanned readmission to a general medical service.

Objective: To identify factors and patterns associated with 7- and 28-day readmission for general medicine patients at a tertiary public hospital.

Methods: A retrospective observational study was conducted using an administrative database at a general medicine service in a tertiary public hospital between 1 January 2007 and 31 December 2011. Demographic and clinical factors, as well as readmission patterns, were evaluated for the association with 7- and 28-day readmission.

Why do older people with multi-morbidity experience unplanned hospital admissions from the community: a root cause analysis.

Background: Increasing demand for hospital services by older people is a major concern for Australian health care providers. To date there has been little in-depth research that encompasses contextual and systems factors contributing to hospital admissions. The objective of this study was to determine the reasons why older patients experienced unplanned hospital admissions to a major public hospital.

Predicting admission of patients by their presentation to the emergency department.

Objective: The present study aims to determine the importance of certain factors in predicting the need of hospital admission for a patient in the ED.

Methods: This is a retrospective observational cohort study between January 2010 and March 2012. The characteristics, including blood test results, of 100,123 patients who presented to the ED of a tertiary referral urban hospital, were incorporated into models using logistic regression in an attempt to predict the likelihood of patients' disposition on leaving the ED.

Psychosocial risk factors which may differentiate between women with Functional Voice Disorder, Organic Voice Disorder and a Control group.

This study aimed to explore psychosocial factors contributing to the development of functional voice disorders (FVD) and those differentiating between organic voice disorders (OVD) and a non-voice-disordered control group. A case-control study was undertaken of 194 women aged 18-80 years diagnosed with FVD (n = 73), OVD (n = 55), and controls (n = 66). FVD women were allocated into psychogenic voice disorder (PVD) (n = 37) and muscle tension voice disorder (MTVD) (n = 36) for sub-group analysis.

Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services.

Background: Methods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions--risk adjusted cost-effectiveness (RAC-E) analysis--with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia.

Methods: Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework.

Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.

The efficient price: an opportunity for funding reform.

Objective: Proposed Australian healthcare reforms describe a move towards partial Commonwealth funding of public hospitals, whereby hospitals will be paid an 'efficient price' for each separation, incorporating both the costs and benefits of services. This paper describes a potential approach to setting the efficient price using risk adjusted cost-effectiveness (RAC-E) analysis.

Methods: RAC-E analysis uses a decision analytic framework to estimate lifetime costs and survival for individual patients, which are standardised by comparing observed and expected values.

Timeliness in discharge summary dissemination is associated with patients' clinical outcomes.

Rationale, Aims And Objectives: To determine the relation of the readmission rate of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch.

Methods: This was a retrospective study on discharge summaries of all discharges from the general medical service at a tertiary referral teaching hospital from January 2005 to December 2009. The main outcome measures were readmission rate to hospital within 7 or 28 days of discharge

Results: A total of 16 496 patient admissions were included in the analysis.

Stability of plasma creatinine concentrations in acute complex long-stay admissions to a general medical service.

Assessment of glomerular filtration rate (GFR) is essential for calculating safe dosages of renally cleared drugs. Formulae for estimating reliable GFRs assume that plasma creatinine concentrations are stable. This study evaluates the variability of plasma creatinine (PCr) concentrations in patients admitted acutely to hospital.

The selection of acute medical admissions for a short-stay unit.

Objective of this study is to evaluate the selection of patients to be admitted to a hospital medical short-stay unit (SSU) where acute medical admissions with a predicted length of stay of between 24 and 72 h are managed. This is a retrospective observational study evaluating outcomes of all admissions to the medical SSU between January 2005 and December 2008. Factors that influence inappropriate allocation of patients to the SSU or alternative longer stay medical units were evaluated.

Routine use of administrative data for safety and quality purposes--hospital mortality.

Worldwide, current practice is to report hospital mortality using the hospital standardised mortality ratio (HSMR). An HSMR is generated by comparing an indirectly standardised expected mortality rate against a hospital's observed mortality rate. A hospital's HSMR can be compared with the overall outcomes for all hospitals in a population, or with peer hospitals.

Outcomes of establishing an acute assessment unit in the general medical service of a tertiary teaching hospital.

Objective: To evaluate the impact of an acute assessment unit (AAU) on length of hospital stay (LOS), emergency department (ED) waiting times, direct discharge rate, unplanned readmission rate and all-cause hospital mortality of general medical patients.

Design And Setting: Retrospective comparison of data for general medical patients admitted to a tertiary teaching hospital in Adelaide, South Australia, before and after the establishment of an AAU (reference years, 2003 [before] and 2006 [after]).

Main Outcome Measures: Mean LOS, ED waiting times and all-cause hospital mortality during calendar years 2003 (pre-establishment) and 2006 (post-establishment).

Measurement for improvement: a survey of current practice in Australian public hospitals.

Objective: To identify patient safety measurement tools in use in Australian public hospitals and to determine barriers to their use.

Design: Structured survey, conducted between 4 March and 19 May 2005, designed to identify tools, and to assess current use of, levels of satisfaction with, and barriers to use of tools for measuring the domains and subdomains of: organisational capacity to provide safe health care; patient safety incidents; and clinical performance.

Participants And Setting: Hospital executives, managers and clinicians from a nationwide random sample of Australian public hospitals stratified by state and hospital peer grouping.