Factors influencing inappropriate hospitalization in Riyadh, Saudi Arabia: physicians' perspectives

This study investigated factors causing inappropriate hospitalization from the physicians' perspectives at government, primary and military hospitals in Riyadh, Saudi Arabia. A self-administered questionnaire to 250 physicians showed that the majority were aware of inappropriate admissions. Problems with inappropriate admissions occurred more frequently at public hospitals [both government and military] than private hospitals. The reasons believed to contribute most to inappropriate admission and hospitalization were the inability of the patient's family to take care of the patient, to satisfy the patient's request, and the absence of someone to get the patient out of the hospital

Assessment of diastolic dysfunction in hypertensive patients and its association with left ventricular mass index

Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. East Medical and Cardiology wards of Mayo Hospital Lahore. Study A descriptive cross-sectional study. 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students 't' tests. The percentage of left ventricular hypertrophy [LVH] was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age

Cost of acute stroke care at a tertiary care hospital in Karachi, Pakistan

To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan. It is also an important factor in development of public health policies and medical insurance plans. Average annual income in Pakistan is 4881 rupees [U$ 85]. Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from 1998-2001 at The Aga Khan University Hospital [AKUH], Karachi. Acute stroke care at AKUH usually includes routine laboratory investigation including Lipid profile, Magnetic resonance imaging/angiography [MRI/MRA], Echocardiogram, Carotid Doppler's ultrasound and medical management in the Stroke care unit. 443 patients were included in study. Age range was 25-98 years [Mean 58 years]. 269 [61%] were male. Length of hospital stay was 1 day; 67 patients, 2 days; 83 patients, 3 days; 70 patients, 4-5 days; 87 patients, 6-10 days; 75 patients, 11-30 days; 49 patients and more than 30 days; 12 patients. Average length of stay was five days and median length was three days. Average total cost was 70,714 rupees [U$1179] which included average radiology cost; 12,507 rupees [U$ 208], average laboratory cost; 8365 rupees [U$139], average pharmacy cost; 13,320 rupees [U$222] and average bed/room charges; 27, 552 rupees [U$459]. Length of hospital stay is the most important determinant of cost. Average total cost for patients who stayed for 1 day was 19,597 rupees [U$ 326], 2-3 days; 25,568 rupees [U$426], 4-7 days; 49,705 rupees [U$828], 8-30 days; 153,586 rupees [U$2559], more than 30 days; 588,239 rupees [U$9804]. Average cost for general ward was 60,574 rupees [U$1010], private ward was 74,880 rupees [U$1248] and intensive care unit was 155,010 rupees [U$2583]. Cost of acute stroke care is extremely high as compared to average national income at our hospital. Most important determinant of cost is length of hospital stay. Cost cutting measures and increased funding from state are necessary to increase the availability of acute stroke care