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3 results

  • 10 - Health Information

  • from Section II
  • Edited by Jo. M. Martins, Indra Pathmanathan, David T. Tan, Shiang Cheng Lim, Pascale Allotey
  • Book:
    Systems Thinking Analyses for Health Policy and Systems Development
    Published online:
    04 September 2021
    Print publication:
    26 August 2021, pp 337-366
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  • Summary

    Health information has been a major instrument in the assessment of health status in Malaysia, the planning and implementation of health services and the evaluation of health outcomes. Earlier, population censuses and estimates, plus the registration of births and deaths, were complemented by surveys of living conditions. Registration of notifiable diseases added to the assessment of the incidence of infectious diseases and progress made in their management; this was later extended to some non-communicable diseases. Health services research and household surveys have become regular features to support health intervention planning and possible changes. Registration of health professionals and inventories of health facilities give an indication of their availability. Initially, health financing information related mostly to the public sector. More recently, the compilation of national health accounts has given annual health expenditure estimates for both the public and private sectors. Progressively, information technology enhanced the collection, analysis and dissemination of health information and the provision of clinical services, such as in the case of telehealth.

  • Factors associated with failure of emergency wait-time targets for high acuity discharges and intensive care unit admissions

  • Ivy Cheng, Merrick Zwarenstein, Alex Kiss, Maaret Castren, Mats Brommels, Michael Schull
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 20 / Issue 1 / January 2018
    Published online by Cambridge University Press:
    18 May 2017, pp. 112-124
    Print publication:
    January 2018
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  • Objective

    Ontario established emergency department length-of-stay (EDLOS) targets but has difficulty achieving them. We sought to determine predictors of target time failure for discharged high acuity patients and intensive care unit (ICU) admissions.

    Methods

    This was a retrospective, observational study of 2012 Sunnybrook Hospital emergency department data. The main outcome measure was failing to meet government EDLOS targets for high acuity discharges and ICU emergency admissions. The secondary outcome measures examined factors for low acuity discharges and all admissions, as well as a run chart for 2015 – 2016 ICU admissions. Multiple logistic regression models were created for admissions, ICU admissions, and low and high acuity discharges. Predictor variables were at the patient level from emergency department registries.

    Results

    For discharged high acuity patients, factors predicting EDLOS target failure were having physician initial assessment duration (PIAD)>2 hours (OR 5.63 [5.22-6.06]), consultation request (OR 10.23 [9.38-11.14]), magnetic resonance imaging (MRI) (OR 19.33 [12.94-28.87]), computed tomography (CT) (OR 4.24 [3.92-4.59]), and ultrasound (US) (OR 3.47 [3.13-3.83]). For ICU admissions, factors predicting EDLOS target failure were bed request duration (BRD)>6 hours (OR 364.27 [43.20-3071.30]) and access block (AB)>1 hour (OR 217.27 [30.62-1541.63]). For discharged low acuity patients, factors predicting failure for the 4-hour target were PIAD>2 hours (OR 15.80 [13.35-18.71]), consultation (OR 20.98 [14.10-31.22]), MRI (OR 31.68 [6.03-166.54]), CT (OR 16.48 [10.07-26.98]), and troponin I (OR 13.37 [6.30-28.37]).

    Conclusion

    Sunnybrook factors predicting failure of targets for high acuity discharges and ICU admissions were hospital-controlled. Hospitals should individualize their approach to shortening EDLOS by analysing its patient population and resource demands.