A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

BACKGROUND AND AIMS: Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). METHODS: A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. RESULTS: In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. CONCLUSION: Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures.

Reducing costs and avoiding hospital admissions: can mobile working help?

The UK has an increased length of hospital stay in comparison with other European countries, and the need for further investment in community services is required if patients are to truly receive care closer to home. The increase in hospital admissions over the last few years may be attributed to the ageing UK population, as well as poor management of long-term conditions. This may be due to variations in the service provision and availability of case managers and community matrons. The poor working relationships and fragmentation of health and social care services remain a significant issue, despite renewed calls to improve integrated working, which is considered fundamental to achieving a reduction in avoidable hospital admissions. Mobile working was introduced in the NHS to help reform community health-care practice and improve continuity of care. Among other things, it provides clinicians with access to electronic patient records in real time, thus helping to reduce delays in treatment. However, we have to bear in mind that a number of factors could hinder the reduction in hospital admissions.

El plan de alta de enfermería y su impacto en la disminución de reingresos hospitalario / The nursing discharge plan and its impact on the reduction of hospital readmissions

En 1984 surgió el plan de alta en enfermería en Estados Unidos. Éste fue incluido dentro del sistema Medicare con el propósito de reducir los costos del sistema de salud, por lo que este se extendió rápidamente a Europa y América Latina. En México existen pocos estudios sobre al plan de alta en enfermería, por lo que es necesario evaluar la trascendencia y el impacto de su aplicación. material y métodos: Se realizó un estudio transversal, descriptivo y cuantitativo en un hospital de tercer nivel. La población de estudio fueron las enfermeras con licenciatura del turno matutino. El instrumento de recolección estuvo dividido en cuatro apartados (datos generales, elaboración y contenido del plan, así como el impacto de su aplicabilidad). Resultados: Las recomendaciones del plan de alta se centran en: los medicamentos, los signos y síntomas de alarma, los cuidados en el hogar y las medidas higiénico-dietéticas con 81%. Los profesionales de enfermería lo aplican de forma oral y escrita en 79%. Más de 50% no registra esta actividad en el expediente clínico. Su aplicación contribuye con el derecho que tienen los pacientes de estar informados, además del impacto en los reingresos hospitalarios. Conclusiones: La aplicación del plan de alta en enfermería es una de las formas para fomentar la reintegración del paciente a la sociedad, ya que nos proporciona una visión completa, rápida y veraz del estado de salud del paciente.

In 1984, there is the nursing discharge plan in the U.S. and this is included in the Medicare system, in order to reduce costs in the health system, so this quickly spread to Europe and Latin America. In Mexico there are few studies on the Nursing discharge plan, so it is necessary to evaluate the significance and impact of the implementation. material and methods: We conducted a cross-sectional, descriptive, quantitative, in a tertiary hospital. The study population consisted of nurses with bachelor’s morning shift. The survey instrument was divided into four sections (general information, preparation and content of the plan and the impact of its applicability. Results: The plan’s recommendations focus on high.

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

Revenue cycle management.

Balancing cash in with cash out has never been more critical. Our foldout identifies where you might improve your revenue cycle and provides national benchmarking data.

When health information and fiscal management meet.

HIM professionals have skills that can allow them to contribute to the bottom line in many ways. The author describes areas where HIM expertise can make a difference in evaluating an organization's fiscal performance through analysis of services driven by health information.

Cashing in on out-of-state Medicaid claims!

In summary, billing out-of-state claims can be time-consuming but productive. It just takes time, information from the states and consistent follow-up. Unicare Corporation began billing out-of-state accounts in 1989. Providers referred accounts to us that they normally would have written off--either because the balances were too small, they were not enrolled, or they did not have a large enough staff to dedicate time to this payer. In 1997, Unicare recovered more than $92 million for our clients. We accomplished this by focusing on uninsured admissions, medical necessity and out-of-state claims processing for providers.