Costs of managing urinary and faecal incontinence in a sub-acute care facility: A "bottom-up" approach

Aims: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. Materials and Methods: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or subacute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. Results: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. Conclusions: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carets. (C) 2004 Wiley-Liss, Inc.

Chaos Theory as an Approach to Understanding MICE in Time of Crisis

MICE (meetings, incentives, conventions, and exhibitions), has generated high foreign exchange revenue for the economy worldwide. In Thailand, MICE tourists are recognized as ‘quality’ visitors, mainly because of their high-spending potential. Having said that, Thailand’s MICE sector has been influenced by a number of crises following September 11, 2001. Consequently, professionals in the MICE sector must be prepared to deal with such complex phenomena of crisis that might happen in the future. While a number of researches have examined the complexity of crises in the tourism context, there has been little focus on such issues in the MICE sector. As chaos theory provides a particularly good model for crisis situations, it is the aim of this paper to propose a chaos theory-based approach to the understanding of complex and chaotic system of the MICE sector in time of crisis.