literature review on integrated bed and patient management 1

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LITERATURE REVIEW
ON
INTEGRATED BED AND PATIENT MANAGEMENT

Centre for Clinical Effectiveness
Monash Institute of Public Health
&
Planning & Development Unit
Southern Health

Jeremy Anderson
Vivienne Bernath
Jan Davies
Louise Greene
Sam Ludolf

January 2001

CONTENTS
TITLE ........................................................................................................................................... 1 CONTENTS ................................................................................................................................. 2 SUMMARY: FINDINGS OF THIS REVIEW ................................................................................. 3 Increasing demand for acute inpatient hospital admissions is universal .................................... 3 Organisational strategies offer most to control increasing demand............................................ 3 Commitment and planning are important.................................................................................... 3 The available evidence has limitations ....................................................................................... 3 CHAPTER ONE: MANAGING HOSPITAL ADMISSIONS........................................................... 4 Why is demand increasing?........................................................................................................ 4 Strategies to manage demand.................................................................................................... 4 Organisational strategies ............................................................................................................ 5 Patient level strategies ................................................................................................................ 6 CHAPTER TWO: PRE-ADMISSION PROCESSES ................................................................... 7 Pre-admission clinics, admission on day of surgery and day surgery ........................................ 7 Pre-admission clinics .................................................................................................................. 7 CHAPTER THREE – INITATIVES IN EMERGENCY DEPARTMENTS.................................... 12 Introduction — overcrowding, inappropriate admissions .......................................................... 12 Fast Track ................................................................................................................................. 14 CHAPTER FOUR – OBSERVATION WARDS .......................................................................... 20 General observation wards ....................................................................................................... 21 Observation wards specialising in patients from particular age groups.................................... 21 Observation wards specialising in the care of patients with particular clinical problems.......... 22 Economic analysis – efficiency and cost effectiveness ............................................................ 23 CHAPTER FIVE - HOSPITAL IN THE HOME ........................................................................... 24 Alternatives to hospitalisation ................................................................................................... 26 CHAPTER SIX - DISCHARGE PLANNING ............................................................................... 27 Discharge planning studies ....................................................................................................... 27 CHAPTER SEVEN - CARE COORDINATION .......................................................................... 33 CHAPTER EIGHT - CHRONIC FRAIL AGED PATIENTS......................................................... 39 Models of care for older patients in hospital ............................................................................. 39...
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