Delayed discharge for non-clinical reasons (bed-blocking) in Cantabria 2007-2015: Impact of the phenomenon and characteristics of the cases

RESUMEN: Alta retardada por motivos no clínicos se define como “el período de estnacia continuada tras el paciente ser considerado para el alta clínica, no pudiendo abandoner el hospital por razones no médicas”. Supone un uso ineficiente de la cama de hospitalización de agudos. La evidencia muestra características relacionadas: edad avanzada, pérdida de capacidad functional o ingreso urgente. Nuestro objetivo es cuantificar el número de casos con estancia inadecuada e identificar características del paciente y del proceso de atención relacionadas. Se llevó a cabo un estudio descriptivo en el Hospital Valdecilla (Cantabria, España), en el período 2007-2015. Mediante análisis bivariado y regression lineal se determinaron asociaciones entre períodos de estancia y costes, características del paciente y del contexto. Fueron identificados 3.015 casos, con 21.119 días de estancia prolongada. Media de estancia prolongada 7,34 [DE 15.88]. 28,7% de los casos con solo un día de retraso. Edad media 77,28 [DE 11.95]. Más del 66,0% eran mayores de 75. Las siguientes características se relacionaron con mayor estancia prolongada: complejidad, tratamiento quirúrgico, patología circulatoria y esperar a ser dado de alta a domicilio o centro residencial.ABSTRACT: Bed blocking or delayed discharge is the “period of continued stay after a patient is deemed medically fit to leave hospital but is unable to do so for non-medical reasons”. It represents an inefficient use of acute hospital beds. The evidence to date describes characteristics associated with bed blocking: older age, lack of functional ability or emergency care. Our aim was to quantify the number of cases and inappropriate hospital days and identify patient characteristics and healthcare service use associated. A descriptive retrospective study was conducted at a general university hospital in Hospital Valdecilla (Cantabria, España), during 2007-2015. Bivariate tests and linear regression were carried out to determine associations between periods of stay, costs and the patient, care and social characteristics. 3,015 cases were identified, 21,119 days of delayed stay. Mean length of delayed 7.34 (SD 15.88). 28.7% of the cases with only one day of delayed stay. Mean age was 77.28 (SD 11.95). Up to 66.0% were older than 75The following characteristics were related with a longer delayed stay: complexity, surgery, vascular pathology and waiting for be discharge to home or nursing home.El presente trabajo se ha financiado con: El Premio al Mejor Proyecto a desarrollar en Cantabria en la 18ª edición de la Convocatoria Nacional Proyectos de Investigación “Enfermería Valdecilla, convocado por la Fundación Instituto de Investigación Marqués de Valdecilla- IDIVAL y otorgado en Santander el 23 de noviembre de 2016

Clinical practice outcomes and differential results in maternal and neonatal morbidity among pregnant women in Spain who are candidates for a normal birth: a cross-sectional study

OBJECTIVE: To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates. DESIGN: A cross-sectional study. SETTING: A tertiary Hospital in Cantabria (Northern region of Spain). PARTICIPANTS: The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315). RESULTS: Secondary registers were accessed to review the main indicators of care and the outcome of births. The ?2 test or the Student's t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p<0.001). Regarding caesarean sections, these were carried out in 19.32% of the candidate births, compared with 26.79% of non-candidate births (p<0.001). Furthermore, there were statistically significant differences between the groups according to the type of birth, the need for instrumental birthing methods, the existence of perineal tears, Apgar scores and the requirement for the infant to be admitted to the neonatal intensive care unit. CONCLUSIONS: Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports

Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost

Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007?2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups? weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recover

Relationship of Binge Drinking with Impairments Affecting Memory and Executive Function among University Students: A Cross-Sectional Study in Northern Spain

Binge drinking (BD) is a common practice among college students. Alcohol consumption may affect brain structures that continue to develop in early adulthood. The aim of this study was to analyze the relationship of BD with impairments affecting memory and executive function among university students. A cross-sectional study was conducted among students (aged 18?30 years) enrolled for the academic year 2018?2019 at the Faculty of Nursing of the University of Cantabria (Spain). Data collection included sociodemographic and academic information, together with alcohol and drug use information, collected by means of a semi-structured questionnaire. A battery of validated tests was used to gather neuropsychological variables. A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. No differences were found in memory tests. Regarding executive function, better performance in the Stroop Color andWord Test was observed in non-BD but the results were not statistically significant. In conclusion, no relationship was found between memory and executive function and BD, although better performance in executive function, specifically inhibitory control, was observed in non-BD

Excessive alcohol consumption and binge drinking in college students

Background: Binge drinking (BD) refers to a pattern of alcohol consumption characterized by the consumption of large amounts of alcohol in a short period of time followed by periods of abstinence. This drinking pattern is prevalent worldwide, mainly among young people. Excessive alcohol consumption is the spectrum of consumption patterns that may have or have had health consequences, and includes the concepts of risky alcohol use, harmful alcohol use and alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the latter two are currently grouped into alcohol use disorder (AUD) according to the fifth edition of the DSM (DSM-5). Due to the high prevalence of BD among young people, especially university students, as well as the important consequences of its practice, a study was conducted to evaluate excessive alcohol consumption and its relationship with the practice of BD in university students. Methods: A cross-sectional study was conducted among students (aged 18-30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing at a university in northern Spain. Data collection included sociodemographic information, and alcohol use information, collected using a semi-structured questionnaire. To measure the excessive alcohol consumption, this study used the Alcohol Use Disorders Identification Test (AUDIT). Results: A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. Up to 14.77% of non-BD participants and 66.67% of BD participants were classified as risky drinkers (AUDIT Total geq 8 in men or geq 6 in women) (p < 0.001). Up to 3.41% of the non-BD and 24.07% of the BD were drinkers with harmful alcohol use and probable alcohol dependence (AUDIT Total geq 13) (p < 0.001). A total of 5.68% of non-BD and 42.59% of BD were AUD drinkers (AUDIT Total geq 9 in males or geq 8 in females) (p < 0.001). In addition, statistically significant differences were found between the BD and non-BD groups in the responses to each of the AUDIT items, as well as in the total score and also in the scores of the three domains of the questionnaire. Conclusions: Excessive alcohol consumption is frequent among university students, especially among those who practice BD

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain

Background: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. Objective: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. Methods: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (?²) were used. Results: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). Conclusions: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia

Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study

ABSTRACT: Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.Funding: This research has been subsidised by the Valdecilla Health Research Institute (IDIVAL). Project awarded as the best project to be developed in Cantabria in the 18th call for research projects "Enfermería Valdecilla". The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

Relationship between Depressive Symptoms, Personality, and Binge Drinking among University Students in Spain

Binge drinking (BD) is a common practice among college students. Alcohol consumption has been related to depressive symptoms and certain personality factors, although less is known about the relationship of these variables with BD. The aim of this study was to analyze the relationship of BD with depressive symptoms and personality in university students. We performed a cross-sectional study among students (aged 18?30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing of the University of Cantabria (Spain). Sociodemographic, academic, and alcohol and other drug use information was collected by means of a semi-structured questionnaire. The Beck Depression Inventory-II was used to measure depressive symptomatology and the Neo Five-Factor Inventory was used for personality. A total of 142 participants were included, 88.03% of which were women. Up to 38.03% were classified as BD. Concerning depressive symptoms, 7.41% of BD were at the moderate-severe level compared to 3.41% of non-BD (p = 0.7096). Regarding personality, the median score for extraversion of BD was 35 (Q1 = 29, Q3 = 40), 32 (Q1 = 28, Q3 = 36) in non-BD (p = 0.0062), conscientiousness scored 34 (Q1 = 30.5, Q3 = 38) points in non-BD, 31.50 (Q1 = 27, Q3 = 37) in BD (p = 0.0224). In conclusion, BD students have higher levels of extraversion and lower levels of responsibility than non-BD students. No significant differences were found between the level of depressive symptomatology between BD and non-BD students

Evolution of legislation and crimes based on sexual identity or orientation in Spain: a retrospective observational study (2011-2021)

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011?2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people

Determinants of smoking in teenagers : gender differences

El tabaco es la principal causa de muerte actualmente. La feminización del hábito tabáquico actual ocasionará en el futuro un aumento de la carga de enfermedad y muerte atribuible al tabaco en mujeres. La presente monografía pretende describir la situación entre nuestros adolescentes, que determinantes influyen en que varones y mujeres adolescentes consuman tabaco y cómo intervenir de forma efectiva para prevenirlo. La diferencia de género en consumo de tabaco tiende a desaparecer y las mujeres adolescentes comienzan a fumar antes y en mayor proporción. Existen diferencias de género en cuanto a las ventajas percibidas del tabaco. Las mujeres son más vulnerables a la influencia de amigos y familiares y temen más fracasar a la hora de dejar de fumar. Se recomienda intervenir en prevención de consumo de tabaco en la adolescencia temprana. Es importante atender al género e implicar a la familia tanto en prevención de inicio como en cesación del hábito de fumar.ABSTRACT. Tobacco is the most important cause of death today. The current feminization of smoking result in an increased burden of disease and death in women attributable to tobacco in the future. This paper aims to describe the situation between our teenagers, which determinants influence adolescent males and females who consume tobacco and how to effectively to prevent it. The gender difference in tobacco habits tends to disappear and female adolescents begin smoking earlier and in greater proportion. There are gender differences in terms of the perceived advantages of smoke. Women are more vulnerable to the influence of family and friends and are more afraid of failing when quitting. It is recommended preventing consumption of tobacco in early adolescence. It is important to look after gender and involve family in both prevention and cessation of smoking.Grado en Enfermerí