During Saskatchewan's healthcare reform of the 1990s, the number of acute hospital beds in Saskatoon District Health was cut in half. The emergency room and outpatient facilities were not able to accommodate an increasing number of patients needing urgent assessments and medical procedures. In this article, we describe the development, implementation and utilization of a day medicine program. This description may be useful to others planning healthcare delivery to medical patients, especially in a setting of resource constraint.
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References
1.
WilsonTHoltT. Complexity and clinical care. British Medical Journal2001; 3223: 685–8.
2.
PlsekPEWilsonT. Complexity, leadership, and management in healthcare organizations. British Medical Journal2001; 323: 746–9.
3.
TulijapurkarSLiNBoeC. A universal pattern of mortality decline in the G7 countries. Nature2000; 15: 789–92.
4.
PolderJJBonneuxLMeerdingWJvan der MaasPJ. Age-specifiic increases in healthcare costs. European Journal o Public Health2002; 12: 57–62.
5.
FoxPJKohatsuNMaxWArnsbergerP. Estimating the costs of caring for people with Alzheimer disease in California: 2000–2040. Journal of Public Health Policy2001; 22: 88–97.
6.
BoyleJPHoneycuttAANarayanKMHoergerTJGeissLSChenH. Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the U.S. Diabetes Care2001; 24: 1936–40.
7.
KrahnMDCoombsALevyIG. Current and projected annual direct costs of screening asymptomatic men for prostate cancer using prostate-specifiic antigen. Canadia Medical Association Journal1999; 160: 49–57.
8.
ParmleyWW. Cost-effectiveness of reperfusion strategies. American Heart Journal1999; 138: S142–52.
9.
CohenDJTairaDABerezinRCoxDAMoriceMCStoneGW. Cost-effectiveness of coronary stenting in acute myocardial infarction: Results from the stent primary angioplasty in myocardial infarction (stent-PAMI) trial. Circulation2001; 104: 3039–45.
10.
HillegassWBNewmanARRacoDL. Glycoprotein Iib/IIIa receptor therapy in percutaneous coronary intervention and non-ST-segment elevation acute coronary syndromes. Estimating the economic implications. Pharmacoeconomics2001; 19: 41–55.
11.
Heart Protection Study Collaborative Group.MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomized placebo-controlled trial. Lancet2002; 360: 7–22.
12.
LloraJDelgado-RodriguezM. Competing risks analysis using Markov chains: Impact of cerebrovascular and ischemic heart disease in cancer mortality. International Journal of Epidemiology2001; 30: 99–101.
13.
LukeRT. Healthcare in the United States: Current and future challenges. Managed Care Quarterly2001; (10 Suppl): 2–6.
14.
LiuLHaderJBrossartBWhiteRLewisS. Impact of rural hospital closures in Saskatchewan, Canada. Social Science and Medicine2001; 52: 1793–804.
15.
Health Services Utilization and Research Commission.Hospital and home care study. The Commission; 1998.
GutkinC. ER: A Canadian Drama. Canadian Family Physician2000; 46: 748.
18.
RichP.Seventy percent of country's FP practices closed to new patients: Survey. Canadian Medical Association Journal2001; 165: 1519.
19.
SladeSBusingN. Weekly work hours and clinical activities of Canadian family physicians: Results of the 1997/1998 National Family Physician Survey of the College of Family Physicians of Canada. Canadian Medical Association Journal2002; 166(11): 1407–11.
20.
Health Services Utilization and Research Commission.Emergency room utilization study. The Commission; 1997.
21.
WinickoffRNFischerMAAugustBJ. Appropriateness of short-stay admissions for procedures in six Veterans Affairs hospitals. QRB Quality Review Bulletin1991; 17: 386–91.
22.
AndersenFHPedersenILNielsenMOEhlersDPFredensborgNHomegaardSN. Alternatives to acute admission to a city hospital. Is it possible to reduce the number of acute admissions?Ugeskr Laeger1994; 156: 4233–6.
23.
LongMJ. Variation in outpatient procedure rates in Canadian teaching hospitals. Clinical Performance and Quality Healthcare1994; 2: 16–22.
24.
KahnKL. The effiicacy of ambulatory cardiac caheterization in the hospital and free-standing setting. American Heart Journal1986; 111: 152–67.
25.
OldroydKGPhadkeKVPhilipsRCarsonPHClarkeMDavisJA. Cardiac catheterization by the Judkins technique as an outpatient procedure. British Medical Journal1989; 298: 875–6.
26.
BruceDGClarkEMDanesiGACampbellLVChisholmDJ. Outpatient initiation of insulin therapy in patients with diabetes mellitus. The Medical Journal of Australia1987; 146: 19–22.
27.
SchraibmanIGMilneAARoyleEM. Home versus in-patient treatment for deep vein thrombosis (Cochrane Review). Cochrane Database of Systemic Reviews2001; 2: CD003076.
28.
CapizziSAPrakashUB. Chest roentgenography after outpatient thoracentesis. Mayo Clin Proceedings1998; 73: 948–50.
29.
LeskyLGHershmanWY. Practical approaches to a major educational challenge. Training students in the ambulatory setting. Archives of Internal Medicine1995; 155: 897–904.
30.
JacobsenEWKeoughWLDaltonBEGiansiracusaDF. A comparison of inpatient and outpatient experiences during an internal medicine clerkship. American Journal of Medicine1998; 104: 159–62.
31.
O'MalleyPGOmoriDMLandryFJJacksonJKroenkeK. A prospective study to assess the effect of ambulatory teaching on patient satisfaction. Academic Medicine1997; 72: 1015–7.
32.
LiuLHaderJBrossartBWhiteRLewisS. Impact of rural hospital closures in Saskatchewan, Canada. Social and Science Medicine2001; 52: 1793–804.
33.
To fiind published reports of similar units, we used severa Medline search strategies with the following key words: “internal medicine” and (“ambulatory” or “clinic” or “outpatient”) and (“procedures” or “healthcare delivery”). We reviewed the abstracts of articles, and full articles where possible, for mention of urgent care and outpatient procedure facilities. We also did an Internet search using the Google search engine. We selected those describing care for adult internal medicine patients referred in or to a tertiary care centre.
34.
RaineyJBRuckleyCV. Work of a day-bed unit 1972–78. British Medical Journal1979; 22: 714–7.
35.
TriulziMCostantineDAuxilliaFFabianiPOttoneM. The “diagnostic day hospital.” A proposal for functional support by hospital services and primary care. Annali di Igiene/Annals of Hygiene1989; 1: 255–65.
36.
FinckeBGGaehdeSARubinsHB. The medical day hospital. A new concept in ambulatory medical education. Archives of Internal Medicine1990; 150: 533–6.
37.
PallaritoK. Physician's center treating very ill on outpatient basis. Modern Healthcare1995; 25: 32.
38.
AbdullahNLemaireJBSchaeferJPCampbellNC. Development of an internal medicine urgent assessment clinic and preliminary description of referred patients. Annals of the Royal College of Physicians and Surgeons of Canada2000; 33: 416–8.
39.
MacPhersonDSLofgrenRP. Outpatient internal medicine preoperative evaluation: A randomized clinical trial. Medical Care1994; 32: 498–507.
40.
HuiELumCMWooJOrKHKayRL. Outcomes of elderly stroke patients. Day hospital versus conventional medical management: Results of a randomized controlled trial. Stroke1995; 26: 1616–9.
41.
ChapmanDBTorpyJ. Development of a heart failure center: A medical center and cardiology practice join forces to improve care and improve costs. American Journal of Managed Care1997; 3: 431–7.
42.
CamposJG SotoRodriguezBEAlvarezGFJValenzuelaMFPenafiielCMCastilloGJ. Outpatient emergency care i pneumology. A method to alleviate pressure on emergency services. Archives of Broncopneumology1997; 33: 268–71.
43.
SchwartzmanKDuquetteGZaoudeMDionMLagaceMPoitrasJ. Respiratory day hospital: A novel approach to acute respiratory care. Canadian Medical Association Journal2001; 165: 1067–71.
44.
Of adult internal medicine patients seen in ambulatory care over a six-month period, 9,242 were seen in the mall as outpatients, 4,622 were seen in departmental clinics and 2,023 were seen in the previously established medical day care (psoriasis, endoscopy, plasmapheresis and specialized endocrine tests).
45.
SchwartzmanKDuquetteGZaoudeMDionMLagaceMPoitrasJ. Respiratory day hospital: A novel approach to acute respiratory care. Canadian Medical Association Journal2001; 165: 1067–71.
46.
SheppardSIliffeS. Hospital at home versus in-patient hospital care (Cochrane Review). Cochrane Database of Systemic Reviews2001; 3.
47.
JacobsPHallEM. Estimating the cost of outpatient hospital care. Healthcare Management Forum1995; 8: 36–8.
48.
BerwickDM. A primer on leading the improvement of systems. British Medical Journal1996; 312: 619–622.
