Publication: Cerrahi servislerde elektif cerrahi uygulamaların hazırlık süreci uygunluğu ve ekonomik yük açılarından değerlendirilmesi
Abstract
AMAÇ: Elektif cerrahi yapılan hastalarda hastane yararlanımını uygunluk ve maliyet üzerine olan etkileri bakımından değerlendirmek. GEREÇ ve YÖNTEM: Marmara Üniversitesi Tıp Fakültesi Hastanesi Cerrahi Bölümlerinde 1999 yılında elektif ameliyat yapılan hasta evreninden oluşturulan örneklem ile, hastaların hastaneye yatırılış ve ameliyat sonrası kalışları Uygunluk Değerlendirme Protokolü(AEP-Appropriateness Evaluation Protocol) sile değerlendirilmiştir. Uygunsuz yatış ve kalış sonucu, otelcilik hizmetleri ve personel giderlerinden kaynaklanan maliyet hesaplanmış ve sonuçları değerlendirilmiştir. BULGULAR: 601 hastadan 429'una(%71.4) yatırılarak (inpatient) ameliyat yapılmış, 172(%28.6) hastaya ise yatırılmadan (outpatient) cerrahi uygulanmıştır. İnpatient hastalarda %16 hastanın uygunsuz olduğu görülmüştür. Outpatient hastalarda ise uygunsuzluk saptanmamıştır. Toplam yatış günleri içinde %44.98 uygunsuz kalış saptanmıştır. Uygunsuz yatış ve kalışların maliyeti 38.900 USD olarak hesaplanmıştır. Örneklemin evreni temsil etme oranına göre hesaplandığında Cerrahi Bölümler için uygunsuz maliyet 370.476 USD olarak saptanmıştır. SONUÇ: Sonuç olarak bu çalışmada, UDP kullanılarak, elektif cerrahi uygulanan hastalarda yüksek oranda uygunsuz hastane kalışı bulunmuştur. Klinik uygulamalarda yapılacak değişiklikler ve sisteme ait problemlerin giderilmesi ile outpatient hasta hizmetlerinin kullanımı arttırılabilir ve bu şekilde pahalı inpatient hasta hizmetleri daha uygun kullanılabilir.
To evaluate appropriateness of admissions and impact of inappropriateness on cost for hospital utilisation in patients scheduled for elective surgery in hospital. MATERIAL&METHOD: Patient admissions and hospital day of care after operations were evaluated in patients who scheduled for elective surgery with AEP(Appropriateness Evaluation Protocol). Costs which resulted from personnel wages and hospital charges for bed were calculated to examine the cost of inappropriate admissions and stays. RESULTS: 429(71.4%) out of 601 patients underwent inpatient surgery and remaining 172(28.6%) patients underwent outpatient surgery. 16% of inpatient surgeries were found to be inappropriate. There was no inappropriate outpatient surgery. Inappropriate day of care was found to be 44.98% of total day of stays. Total cost of inappropriate admissions and days of care was calculated as 38.900 USD. It is postulated that total cost would have been raised to 370.476 USD if the result of cost had been projected to all patients underwent elective surgery at the hospital in 1999. COMMENT: In conclusion, this study found a high rate of inappropriate extended hospital stay by application of AEP in patients underwent elective surgery. Changes in clinical practice patterns and correction of systems problems that stand in the way of outpatient care could result in more appropriate use of expensive inpatient services.
To evaluate appropriateness of admissions and impact of inappropriateness on cost for hospital utilisation in patients scheduled for elective surgery in hospital. MATERIAL&METHOD: Patient admissions and hospital day of care after operations were evaluated in patients who scheduled for elective surgery with AEP(Appropriateness Evaluation Protocol). Costs which resulted from personnel wages and hospital charges for bed were calculated to examine the cost of inappropriate admissions and stays. RESULTS: 429(71.4%) out of 601 patients underwent inpatient surgery and remaining 172(28.6%) patients underwent outpatient surgery. 16% of inpatient surgeries were found to be inappropriate. There was no inappropriate outpatient surgery. Inappropriate day of care was found to be 44.98% of total day of stays. Total cost of inappropriate admissions and days of care was calculated as 38.900 USD. It is postulated that total cost would have been raised to 370.476 USD if the result of cost had been projected to all patients underwent elective surgery at the hospital in 1999. COMMENT: In conclusion, this study found a high rate of inappropriate extended hospital stay by application of AEP in patients underwent elective surgery. Changes in clinical practice patterns and correction of systems problems that stand in the way of outpatient care could result in more appropriate use of expensive inpatient services.