[Gastroenteritis outbreak associated with water consumption, possibly caused by Norwalk or Norwalk-like virus]. / Brote de gastroenteritis asociado al consumo de agua, posiblemente producido por virus tipo Norwalk o semejantes.

BACKGROUND: It is described an acute gastroenteritis outbreak of probable hydric transmission in Ontinyent (Valencia). It was declared on the 31st of January, 1992 and affected 3541 people according to the declaration done by the sanitary services who attended the patients. The clinical situation was characterized by the presence of profuse and watery diarrhoea, nausea, vomiting, abdominal pain and fever or febricula. METHODS: A preliminary study of the cases has been done, the information being treated with the classical method of descriptive epidemiology and a later study of the transversal observation type by means of a telephone inquiry. RESULTS: The results show that this outbreak affected approximately to a 30% of the population, and show the relation between consumption of water from the municipal water system and the outbreak, as well as the existence of a control population not affected for receiving a different water supply. CONCLUSION: Once rejected the bacterial origin for the results of the copro-cultivation done the analysis of the clinical and epidemiological characteristics of the outbreak, show a total agreement with the criteria described by Kaplan to characterize acute gastroenteritis outbreaks because of Norwalk-like virus.

How many days of hospitalization for an appendectomy?

The length of stay (LOS) of a surgical procedure is influenced both by the real need for medical and nursing care of the patient and also by the practice style of each unit, which can include unjustified stays. The aim of this work was to estimate the appropriate LOS for appendectomy and its differences with the LOS observed in practice. Two hundred and forty-nine medical records (249 admission days and 1447 successive stays) for patients over 6 years old who had had an appendectomy in 1992 were classified by Diagnosis Related Groups (DRG) and reviewed using the Appropriateness Evaluation Protocol. 1.6% of admission days and 31.7% of successive stays were assessed inappropriate. The appropriate LOS for appendectomy was 4.7 days as opposed to 6.8 days of observed LOS. For the DRG 167 (76.3% of the sample) appropriate LOS was 3.4 days (observed LOS 4.9 days). These results suggest the existence of an important proportion of avoidable hospital stays and provides a simple and low cost methodology for assessing the suitability of local hospitalization practices.

[What does the average stay say about the diagnosis-related groups?]. / Qué mide la estancia media de los grupos relacionados de diagnóstico?

BACKGROUND: The systems for classifying patients into homogeneous groups of resource consumption such as diagnosis related groups (DRG) use mean stay (MS) as the principal predictive variable of this consumer entity. The standard of MS for each DRG is usually defined as the MS of this DRG in one group of hospitals. This method omits the existence of unnecessary days of hospitalization which are added to the standard and may be identified by review of hospitalary use. METHODS: A retrospective review of the clinical need for 933 days of hospitalization (190 days of admission plus 743 successive stays for the same) in 190 cases of 167 DRG (appendicectomy without complications or comorbidity in those under the age of 70 years) in 8 public hospitals in Valencia (Spain) was performed by the Appropriateness Use Evaluation Protocol. RESULTS: Four days of admission (2.1%) and 284 successive stays (38.2%) were considered unnecessary from a clinical point of view. Necessary MS was estimated as 3.4 days for GRD vs the 5.1 days of MS observed. CONCLUSIONS: The common construction of standards of mean stay per disease demonstrates an important proportion of unnecessary use of hospitalization, the correction of which would allow a reduction in the mean costs of the process without a reduction in the quality of care.

[Prospective payment per case and length of stay at coordinated private hospitals]. / Pago prospectivo por caso y duración de la estancia en hospitales privados concertados.

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.