Impacto de un modelo centralizado de priorización de las camas hospitalarias como instrumento válido de gestión asistencial

Abstract

Objective: To determine the effectiveness of a model centred in the admission unit that prioritises the daily assignment of available hospital beds.

Material and methods: This model started on June 1st 2005 with the implementation of a series of interventions: 1) Definition of the proceedings of the admission unit; 2) A daily planning decision-making meeting; 3) Opening of a 24-hour emergency department holding unit; 4) Priority bed assignment system; and 5) Appropriateness of emergency medical and elective surgical admissions. We used 8 parameters obtained from the hospital automated database. The data have been analysed in three different annual periods: 2004 (before intervention), 2005 (intervention) and 2006 (after ntervention).

Results: Number of emergencies seen: 2004 (124,301), 2005 (123,390),2006 (129,389); number emergency admissions: 2004 (13,629), 2005 (14,649), 2006 (11,690); number of elective admissions: 2004 (12,320), 2005 (12,791), 2006 (13,615); ED admission rate: 2004 (11.0 %), 2005 (11.9 %), 2006 (9.2 %), P=.004; emergency pressure: 2004 (52.5 %), 2005 (53.4 %), 2006 (46.2 %), P=.002; ED mean length of stay per patient: 2004 (9h 45m), 2005 (6h 46m), 2006 (5h 39m); number of emergency admissions waiting for a hospital bed at 8 a.m: 2004 (5341), 2005 (4484), 2006 (2787); elective surgical interventions cancellation rate: 2004 (3.4 %), 2005 (3.7 %), 2006 (2.6 %), P=.002.

Conclusions: Centralized assignment of hospital beds by the admission unit has proved to be an effective tool for hospital management.