A capacidade de leitos hospitalares no Brasil, as internações no SUS, a migração demográfica e os custos dos procedimentos / Hospitals beds in Brazil, SUS inpatients, demographic migration and procedures costs

Objetivo: Avaliar, por meio de dados de vida real, a capacidade dos leitos hospitalares brasileiros versus as recomendações da Organização Mundial de Saúde (OMS), como esses leitos estão sendo utilizados, de onde vêm os pacientes, quanto isso custa, as diferentes patologias que têm chegado aos hospitais e o percentual de tempo de internação em leitos de cuidado intensivo. Métodos: Estudo retrospectivo histórico realizado entre julho de 2018 e junho de 2019 a partir de dados obtidos do Datasus e subsequentemente processados em MySQL para diferentes perspectivas. Todos os índices foram construídos por meio de quintis de dias de internação e posteriormente subdivididos em análises mais específicas, confrontadas com literatura específica do assunto e diferentes diretrizes internacionais. Resultados: O Sistema Único de Saúde (SUS) teve um total de 9.275.680 pacientes únicos internados durante o período de análise, tendo um custo total de R$ 183 bilhões, totalizando 63.817.613 de diárias hospitalares com uma média de 6,3 dias de internação, R$ 1.972,73 de custo médio por internação e R$ 286,73 de custo médio diário. Conclusão: O SUS e toda a sua estrutura em perspectiva histórica são bem recentes. Cabe ainda aprimorar os processos de atenção de rede primária (portas de entrada), bem como desenvolver e disseminar os processos de desospitalização (portas de saída/reintrodução para a atenção primária).

Objective: Through real-world evidence, evaluate the hospital beds capacity in Brazil versus WHO recommendations, how these hospital beds are used, where patients come from, how much does this cost, which different diseases are coming and the Intensive Units utilization. Methods: Retrospective study realized between July 2018 and June 2019 through Datasus data and processed on MySQL to different perspectives. All indexes have been organized on quintiles internment days and then sub analyzed in different perspectives, comparing with local literature and with international Guidelines. Results: National Health System (SUS) had 9.275.680 unique patients during the analyzed period, with a total cost of R$ 183 billions, and 63.817.613 hospitalization days diaries charged. The average length of stay was 6.3 days and it cost R$ 1.972,73 per patient. Conclusion: National Health System (SUS) is very recent on historic perspective. Whole system needs to improve primary health flows (entrance door) as well as develop and disseminate at home care process (exit door/reintroduction to primary care).

Management of Emergency Department Overcrowding (EDOC) in a Teaching Hospital

Emergency Department Overcrowding (EDOC) has been a longstanding problem. It is defined as a situation where the demand for emergency services exceeds the ability of an Emergency Department (ED) to provide quality care within appropriate time frames. Hospital beds closure or access block to ward admission is one of the most important cause of Emergency s e.g. disaster. A surge response entails even greater responses including implementing Department overcrowding. This could be compounded further in events of a patient surge eg affirmative measurement in order to mitigate the issue in tackling the situation. The steps in managing EDOC were: 1. Recognizing EDOC, 2. Initiating action, 3. Maintaining patient flow, 4. Setting clinical goals and 5. Deploying a Surge Team for Advance Triage or Fast Tract.

Research on Optimization Plan for the Arrangement of Hospital Bed:Modeling and Empirical Analysis / 医疗卫生装备

Objective To find an efficient plan for the arrangement of the beds in hospital so that the beds-operating efficiency can be raised and the requirement of patients can be perfectly met. Methods According to the data analyzed via the method of mathematical statistics, optimizing model was built and automatic stimulation program was generated as well as conducted by matlab software. Results The characteristics of bed-occupation condition was acquired by data analysis, the result of optimizing model was stimulated by program and the most efficient plan emerges which was obviously better than the original FCFS (First Come First Serve) Plan. Conclusion The mathematical model built up is of great maneuverability in the practical situation to ameliorate the management efficiency of hospital beds considerably.

A Study on the Regional Self-sufficiency for In-patient Care Services / 예방의학회지

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.