Background: The COVID-19 pandemic created pressure on healthcare systems worldwide. Hospitals have developed strategies to efficiently address the demand for inpatient beds.
Objective: This paper examines changes in length of stay at a southern academic medical center and documents the intervention efforts aimed at providing high quality care and reduced lengths of stay.
Methods: Data include 3,279 patients receiving inpatient treatment for COVID-19 between March 29, 2020, and October 31, 2021. The study data mirrors the three major waves of COVID-19 pandemic in Alabama as reported in Johns Hopkins’ coronavirus resource center. To account for the chronological change in care processes, we interviewed Hospitalists and categorized the interventions by month, June 2020-February 2021. We examined changes in average length of stay and differences in sociodemographic characteristics among the three waves using ANOVA and chi-square tests. Socio-demographic factors analyzed include age, gender, race/ethnicity, marital status, and insurance.
Results: The average length of stay, ICU admissions, and 30-day readmissions each decreased in the second and third waves compared to the first wave. Statistically significant differences were found for ICU admission, age, and insurance for hospitalized patients among waves.
Conclusions: This study contributes to the COVID-19 literature by providing the chronological evolution of ALOS and interventions during the pandemic by highlighting the case of a southern academic medical center.

Objective: Matching safety and quality improvements to the complexity of healthcare, Gold Coast Mental Health and Specialist Services implemented a new response to clinical incidents: the Gold Coast Clinical Incident Response Framework (GC-CIRF). It utilises a Restorative Just Culture (RJC) framework and Safety II principles. This paper evaluates its impact.
Methods: Staff surveys measured perceptions of just culture and second victim experiences. Quality of recommendations were compared before and after implementation. For the 19 incidents that occurred after the implementation of GC-CIRF, audits of the review processes were undertaken, measuring several components.
Results: Results show significant improvement in staff perceptions of just culture and second victim experiences. Review of incident review data showed several shifts in line with Safety II and RJC. The process audit demonstrated inclusion of a broad range of stakeholders, and significant improvements in the quality and strength of recommendations.
Conclusions: Embedding RJC and Safety II concepts into the incident review process is associated with improved measures of culture and review outputs. The integration of Safety II concepts and support of cultural shifts will require further work and committed leadership at all levels.

Objective: Inaccuracies in Current Procedural Terminology (CPT) coding entries for surgical procedures have a profound impact on hospital systems and surgeon compensation for services. We sought to characterize the variations of surgical CPT entry at a multi-site academic medical center and estimate the financial burden implicated by improper code entry.
Methods: A mixed methods study was conducted to evaluate variations in CPT entry across an academic center. Semi-structured interviews with 8 surgical schedulers were conducted and analyzed to understand the current scheduling process. Coding data for surgical procedures performed within a 31-day period during September and October 2020 within the large healthcare system were assessed for appropriate CPT code entry. Reimbursement for the 2020 fiscal year was then analyzed to determine the impact of pre-operative CPT code accuracy on reimbursements and denials.
Results: Interviews revealed a lack of standardization in the surgical scheduling process across the hospital system. Lack of standardized onboarding and variations in workflow contributed to difficult cross coverage for schedulers and errors in CPT entry. On quantitative analysis, the accuracy of pre-operative CPT code entry was poor with only 59.3% of pre-operative CPT code entries being correct. In the 2020 fiscal year, $5.4 million was lost due to problems related to CPT code entry.
Conclusions: Variations and lack of standardization in CPT code entry can greatly contribute to financial losses and disrupt surgical scheduling. Standardization of workflow and CPT entry schemes can help minimize scheduling complications and enhance the quality of care provided to patients.

Objective: Constant availability of inpatient beds in an intensive care unit (ICU) is part of the resilience of health systems, especially in an emergency context, namely in public health. This study aims to appraise the management of inpatient waiting lines in the ICU of Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) in Benin, in March-April 2022.
Methods: This was an analytic cross-sectional study of inpatients or their relatives and staff, selected by convenience and reasoned choice, respectively, carried out from March 21 to April 15, 2022. Logistic regression was used to identify associated factors with queues management.
Results: Altogether 55 patients were surveyed. On a daily basis, 13 ± 1 patients were hospitalized in 18 functional beds for 3 ± 1 admissions and 3 ± 1 discharges. The average bed occupancy rate was 89.8% ± 3.8%; the average waiting time before patient care was 3.6 ± 1.2 minutes and the traffic intensity were 0.03. Per hour, the odds of having a patient were 33.29%, with a 97% chance of a bed being occupied. The probability that an admitted patient would spend a whole week there was 37%. Only patient arrival flow was significantly associated with insufficient queuing management. There was also a lack of inpatient beds and technical boards. The construction of two wards and the installation of seven additional beds could improve queues management.
Conclusions: The management of AF in our study site depends mainly on the daily flow of arriving patients, but also on the number of available hospital beds, the working organization and the existing technical and structural measures. Addressing these parameters will significantly improve the situation.

Background: Healthcare systems have to prepare for climate change’s health impact, while reducing healthcare’s contribution to global warming. Most evaluations of healthcare’s greenhouse gas emissions involve national level methodologies.
Objective: As sustainability metrics become a key factor in hospital management, the paper describes a method for quantifying emissions at a large tertiary care hospital in Singapore.
Methods: Hospital operational and financial data was used to determine the greenhouse gas effect of the hospital. Emission factors from government and academic sources were used for on-site and purchased energy emissions. Spend based emission factors from the environmentally-extended multiregional input-output (EE-MRIO) Eora database were used for other indirect emissions. This provided the total carbon footprint across the various scopes.
Results: The hospital had an annual carbon footprint of 245,962 tonnes of carbon dioxide equivalents (CO₂e). Scope 1 emissions accounted for 4,223 tonnes of CO₂e, scope 2 for 38,380 tonnes of CO₂e and scope 3 for 165,190 tonnes of CO₂e. Operating carbon totalled 207,793 tonnes of CO₂e, and 38,169 tonnes of scope 3 CO₂e was attributed to capital expenditure projects. Medical equipment, pharmaceutical supplies and electricity were the largest contributors to the hospital’s carbon footprint.
Conclusions: Identifying key areas contributing to emissions can enable targeted approaches in reducing a hospital’s carbon footprint, better preparing the hospital as the carbon economy evolves to include the healthcare sector.