A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

Purpose We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice. Methods Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th). Results 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%. Conclusions Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

The Effect of Technology Investments on Hospital Budget and Patient Safety: A Simulation for Emergency Department

One of the most important problems for hospital management is long waiting times. Especially in Emergency Departments, which are very crowded in terms of the number of applicants, patients wait for a long time without any treatment. Long waiting times between stations affect the total length of stay of the patients in this department. In this case, it directly affects patient safety. Furthermore, patients can leave from hospitals because of not to take effective and rapid treatment or lack of resource. Patient satisfaction is negatively affected and the brand value of these hospitals may decrease. All these events trigger hospital budget also. Hospital managers who faced these problems before, should first review all their existing processes, identify roadmaps and plan improvements. They are able to make use of advanced technologies and make investment decisions for improvement processes. However, investment decisions can be quite costly and can effect of hospital budget economically. Therefore, the use of simulations to compare the results of investment decisions can provide much more accurate decisions. The purpose of this study is to support hospital managers in making decisions by monitoring the impact of investment decisions (technology or resource investment) on the hospital budget. Both investment decisions will be simulated comparatively, patient processes and resource planning will be improved by creating a sustainable management model with RFID Technology

Managing Activity-Based Funding Using Costing Data and Activity-Based Budgets

This chapter will show how detailed information from an activity-based costing (ABC) system can be used to support activity-based funding (ABF) by providing management with a detailed perspective of the activity and how it can be used to internally model the allocation of target activity to build an activity-based budget (ABB). By building a set of internal cost weights based on ABC data, this chapter will show how activity forecast in a funding agreement can be broken up and applied to the individual cost centers that contributed to the activity in the current year. Building an ABB provides an evidence base for the overarching hospital budget and encourages the adoption of a focus on efficiency by hospital departments.