INTRODUCTION: Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes. METHODS: We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge. RESULTS: A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again. CONCLUSION Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.
Aftercare ; Aged ; Female ; Hospitalization ; Humans ; Length of Stay ; Male ; Patient Discharge ; Retrospective Studies ; Singapore

INTRODUCTION: Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as "gate-keepers" to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. METHODS: Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. RESULTS: Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger ( CONCLUSION Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs.
Emergency Service, Hospital ; Hospitalization ; Humans ; Length of Stay ; Neoplasms/therapy* ; Patient Admission ; Retrospective Studies ; Singapore/epidemiology*

OBJECTIVE: To provide the latest statistics about the length of hospital stay (LOS) and the number of hospitals where the patient was admitted (NHA) for patients with spinal cord injury (SCI) and to investigate the correlated demographic characteristics. METHOD: In total, 277 patients with SCI who were members of the Korea Spinal Cord Injury Association were included in the analysis. The survey was conducted by self-completed questionnaires to collect data on LOS, NHA, and demographic variables. RESULTS: Mean LOS was 13.5+/-9.7 months and the mean NHA was 2.7+/-1.4. Patients who suffered from SCI by traffic accidents showed a longer LOS and larger NHA than those with other causes. The mean LOS for patients with traumatic SCI was longer than that whose cause of injury was disease. Patients discharged in the 2000s had a longer LOS and a larger NHA than those discharged earlier. Other factors such as gender, age at the time of injury, neurological category, and ambulation capability did not result in a significant difference in either LOS or NHA. CONCLUSION: The mean LOS of domestic patients with SCI was longer than the values reported in foreign studies. Interestingly, neither neurological category nor functional status were related to LOS. These findings suggest that other factors such as socio-psychological factors, other than the medical state of the patient, have an effect on the LOS of patients with SCI in Korea.
Accidents, Traffic ; Hospitalization ; Humans ; Korea ; Length of Stay ; Patient Discharge ; Spinal Cord ; Spinal Cord Injuries ; Walking ; Surveys and Questionnaires

OBJECTIVE: To investigate the nutritional recovery status of children with moderate or severe malnutrition during hospitalization after discharge. METHODS: The children with moderate or severe malnutrition were given nutrition support during hospitalization. They received a regular follow-up and nutrition guidance after discharge. The weight-for-age and height-for-age Z-scores reaching above -2 SD were considered the nutrition criterion for ending follow-up. RESULTS: Among the 298 children with moderate or severe malnutrition, 174 (58.4%) reached the criterion for ending follow-up, 100 (33.6%) were lost to follow-up, 18 (6.0%) died, and 6 (2.0%) did not reach the criterion for ending follow-up after 18 months of follow-up. The children with malnutrition in the department of surgery had a significantly higher proportion of children reaching the criterion for ending follow-up than those in the department of internal medicine (P<0.05). The children with severe malnutrition had a significantly higher loss to follow-up rate than those with moderate nutrition (P<0.05). The majority of children with emaciation reached the criterion for ending follow-up at month 3 after discharge, while those with growth retardation reached such the criterion at months 3-6 after discharge. Up to 1 year after discharge, more than 80% of the children with different types of malnutrition reached the nutrition criterion for ending follow-up. CONCLUSIONS Most of the children with malnutrition who adhere to follow-up can reach the expected nutrition criterion within 1 year after discharge. The children with growth retardation have slower nutritional recovery than those with emaciation.
Child ; Child, Hospitalized ; Hospitalization ; Humans ; Malnutrition ; Nutritional Status ; Patient Discharge

OBJECTIVE: In June 28, 2012, a 'Hospitalization guideline for car accident patients' was announced to mediate the clash of opinions about the hospitalization of minor head trauma patients among doctors, patients and insurance companies. The guideline was issued to describe the patients' symptoms and emotions in detail after the injury. In this paper, evaluation for the guideline and suggestions for modifications was done. METHODS: Thirty-two doctors, 96 patients and 60 employees were each given surveys about the hospitalization guidelines, related personnels' attitude and evaluation of patients' emotional problems. The frequency, ratio and chi-square test were performed. RESULTS: Sixty-eight point eight percent of doctors, 79.8% patients and 91.6% insurance company employees agreed to the need for a guideline. Among the 68.8% doctors that supported the need for a guideline, 18.8% knew that the guideline actually existed. Sixty-nine point two percent of doctors said that they would apply the guideline once they were introduced to it. Among the announced guideline provisions, 'Glasgow coma score less than 15' and 'socially not suitable for discharge' required reevaluation since 40.6% all surveyors consented that these two criteria were not suitable. The consensus supporting the need for emotional evaluation came out to be 78.1%, 58.5%, 50.9% in doctors, patients and insurance employees respectively. CONCLUSION: Although a guideline for hospitalization of minor head injury patients is necessary, some part of it seems to be reevaluated and improved, especially for clauses related to the patient's emotional problems. These changes and revisions to the guideline require further speculation and research.
Coma ; Consensus ; Craniocerebral Trauma* ; Hospitalization* ; Humans ; Insurance ; Patient Admission

OBJECTIVES: This study describes the risk factors affecting the unexpected readmission of 261 patients who were discharged from a university hospital in Seoul. METHODS: This case-control study reviewed medical records of inpatients who had been discharged from a hospital between 1 August 1995 and 31 October 1995 after the treatment for general diseases. The cases were 68 patients who were readmitted unexpectedly within 28 days of discharge from an index stay, and the controls were 193 patients who were discharged without readmission during the study period. RESULTS: Logistic regression analysis results were as follows; Patients who had no operation during their hospital stay were more likely to be readmitted unexpectedly than patients who had operation. Patients who had 1 or 2 parts of their body being involved in treatment were more likely to be readmitted unexpectedly than patients who hand more than 3 parts of their body being involved in treatment. Patients who had complications after surgery were more likely to be readmitted unexpectedly than patients who had no complications. Insufficient discharge planning caused unexpected readmissions. CONCLUSIONS: Discharge planning education should be extended to health care providers. And the assessment of discharge planning should be evaluated. Readmission is often necessary for the treatment of related problems originating from initial hospitalization, which causes cost problems. Unexpected readmission is preventable and the models for readmission can serve as a valuable clinical tool for high risk patients.
Case-Control Studies* ; Education ; Hand ; Health Personnel ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Logistic Models ; Medical Records ; Patient Discharge ; Risk Factors ; Seoul

PURPOSE: To standardize hospital management of patients with simple congenital heart disease (CHD), we developed a protocol called the 'clinical pathway (CP)'and evaluated quality improvement in patient outcomes. METHODS: The study included a group of 60 patients with simple CHD who had surgery between June 1 and October 31, 1998. The control group included 48 patients who had surgery for the same disease during the corresponding time in 1997. Two CPs were developed according to state and place of residence of patients. Information on patients was reviewed including: education, physical examination, hospital stay, type of care and date of discharge from the hospital. The effect of each protocol on standard procedures was reviewed. After patient discharge additional performance information was assessed including: procedures used, duration of hospital stay, medical cost, treatment outcome, complications and parent satisfaction. RESULTS: The duration of hospital stay prior to surgery (1.8 days vs. 3.0 days), the ICU stay (1.3 days vs. 3.6 days), number of ward days after surgery (5.3 days vs. 7.9 days) and total number of hospital days (8.5 days vs. 14.7 days) were significantly shortened in the study group compared to the control group. The intubation time (P=0.000) and the frequency of laboratory studies (P=0.000) during the hospitalization decreased in the study group compared to the control group. The average medical costs of cases was also significantly lower in the study group (P=0.001). There were no deaths, readmissions or serious complications in the study group. A questionnaire survey of patient family members showed that they were satisfied with care; with more than 85 percent response rate to questionnaire items. CONCLUSION: Application of our new CP protocol shortens hospital stay and reduces medical costs while improving the quality of care for patients and their families. This CP protocol should now be considered for more complex CHD.
Critical Pathways* ; Health Care Costs ; Heart Defects, Congenital ; Heart* ; Hospitalization ; Humans ; Intubation ; Length of Stay ; Parents ; Patient Discharge ; Physical Education and Training ; Quality Improvement ; Surveys and Questionnaires ; Thoracic Surgery*

PURPOSE: This study is designed to evaluate the current situation of interhospital transports of critical ill patients requiring emergency care. METHODS: Using a clinical prospective 162 interhospital transports of ill patients by ambulance were evaluated in 2 hospitals. Patients were divided into severe & mild to moderate group by modified-ESI. We evaluated the state of patients, vital sign, monitoring of patient's state, hospitalization or transportation. Data were collected by mean of comprehensive form filled by a physician at the receiving hospital. RESULTS: The receiving hospital were notified prior to the transport in 57.4%. Pretransport information about the patients were adequate in 75% and no data in 9.9%. In 10.4% of the transports, the patients arrived at the receiving hospital in an agonized state. In 80.8% of the transports admitted and 7.4% of the patients were transfer to the other hospital. CONCLUSION: It appears that there are no established guidelines for the emergency transport of critical ill patients in Korea.
Ambulances ; Emergencies ; Emergency Medical Services ; Felodipine ; Hospitalization ; Humans ; Korea ; Patient Transfer ; Prospective Studies ; Transportation ; Vital Signs

INTRODUCTION: The eosinophilic phenotype of chronic obstructive pulmonary disease (COPD) has been demonstrated to respond better to corticosteroids and associated with better outcomes. This review aims to clarify the correlation of blood eosinophilia and outcomes patients with COPD exacerbations.

METHODS: This is a review of cohorts and case-control studies that looked into eosinophilia and outcomes in exacerbations using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The primary study outcome was length of hospitalization; other outcomes include readmission and mortality rate within one year, in-patient mortality, and need for mechanical ventilation.

RESULTS: Six studies were included in the review. Patients with blood eosinophilia had significantly shorter hospital stay compared to non-eosinophilic patients (mean difference 0.68 days [95% CI 1.09,0.27]). Eosinophilic patients had significantly less frequent readmissions (OR 0.69 [95% CI 0.55,0.87]) but there was no statistically significant difference in the one-year mortality rate (OR 0.88 [95% CI 0.73, .06]). Analysis showed a trend toward lower in-patient mortality among eosinophilic patients (OR 0.53 [95% CI 0.27,1.05]). Furthermore, COPD patients with eosinophilia had significantly less need for mechanical ventilation during an exacerbation (OR 0.56 [95% CI 0.35,0.89]).

CONCLUSION: COPD patients with blood eosinophilia had significantly shorter hospital stay, less frequent readmissions, and are less likely to require mechanical ventilation compared to the non-eosinophilic phenotype. 

Human ; Length Of Stay ; Patient Readmission ; Respiration, Artificial ; Hospital Mortality ; Hospitalization ; Pulmonary Disease, Chronic Obstructive ; Eosinophilia ; Adrenal Cortex Hormones ; Phenotype

PURPOSE:The characteristics of hospitalized patients in neonatal intensive care units (NICUs), including hospitalization costs (HC) and National Health Insurance (NHI) status were studied. METHODS:We gathered the following data from 7 hospitals in Korea during 2006: the distribution of patients according to birth weight (BW), and the duration of the hospital stay according to BW and HC. RESULTS:The patients who were admitted to the NICU consisted of high-risk neonates, including low birth weight or premature neonates, which comprised 50% of all neonates admitted to the NICU. The duration of hospitalization was 75-90 days for neonates with BW <1,000 g, 45-60 days for neonates with BW between 1,000 and 1,499 g, and approximately 15 days for neonates with BW between 2,000 and 2,499 g. The portion of the HC covered by the NHI was 77.1%, 22.9% of the total HC was not covered by the NHI (19.5% was included in the list, but not covered by the NHI and 3.4% was not listed, but covered by the NHI). The average total HC per person was 4,360,000 won, and the HC covered and not covered by the NHI were 3,677,000 won and 1,007,000 won, respectively. The mean HC were as follows; 35,000,000 won for a BW <500 g, 18,000,000 won for a BW between 500 and 999 g, 16,000,000 won for a BW between 1,000 and 1,499 g, and 4,200,000 won for a BW between 1,500 and 1,999 g. CONCLUSION:Not only premature, but also ill neonates were under the care of the NICU. The HC increased as the BW decreased and the hospitalization period increased. The proportion of the patient's financial burden is >25% of the total HC. For this matter, additional NHI is needed.
Birth Weight ; Hospitalization ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Korea ; Length of Stay ; National Health Programs ; Patient Admission