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Freyne, Aideen, and Margo Wrigley. "Acute inpatient admissions in a community oriented old age psychiatry service." Irish Journal of Psychological Medicine 14, no. 1 (March 1997): 4–7. http://dx.doi.org/10.1017/s0790966700002810.
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AbstractObjective: This study reviewed all inpatient admissions in a community oriented old age psychiatry service with the aim of assessing the appropriateness of admission criteria, obtaining a profile of those admitted, and providing information about service utilisation.Method: A retrospective chart review of all first inpatient admissions from 1989-1993 was carried out. Information concerning sociodemographic and clinical variables, and outcome measures in terms of discharge destination, was obtained.Results: There were 205 first admissions in the study period. There were 37 patients (18%) admitted on an involuntary basis. One per cent of admissions were not assessed at home prior to admission. Six patients had no formal psychiatric disorder, of the remainder 53% had an organic, and 47% a functional psychiatric disorder. Of those admitted 68% were discharged to their original destination. Patients with dementia were more likely to be discharged to nursing homes. Other discharge destinations were also used.Conclusions: The policy of initial domiciliary assessment of all referrals prior to admission is feasible in the majority of cases. Defined admission criteria clarify reasons for admission, and ensures appropriate use of beds. The range of discharge destinations highlights the need for maintaining close ongoing links with other service providers.
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Verma, Aman, Christian Rochefort, Guido Powell, and David Buckeridge. "Hospital readmissions and the day of the week." Journal of Health Services Research & Policy 23, no. 1 (January 2018): 21–27. http://dx.doi.org/10.1177/1355819617750185.
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Objectives Patients discharged from hospitals on a Friday (Friday discharges) are readmitted sooner (a shorter time-to-emergency-readmission) than those discharged on any other day of the week. To evaluate the cost-effectiveness of increasing weekend capacity, the effect estimate of Friday discharge on time-to-emergency-readmission needs to be precise. However, precise effect estimation is complicated by the confounding effect of differing healthcare-seeking behaviour and admission practices, and therefore different admission probability, by day of the week. The objective of this research was to examine how differing admission probability by day of the week influences the effect of discharge day on time-to-emergency-readmission. Methods We used a Markov model to determine how day of the week admission probability would theoretically affect the time-to-emergency-readmission for Friday and Wednesday discharges. We tested this in a cohort of patients who have had a history of respiratory illness, using a Cox proportional hazards model to fit the time-to-emergency-readmission to any Quebec hospital as a function of the day of the week of discharge and admission. We fitted another Cox model with an additional time-varying covariate for the current day of the week, to model differing admission probabilities by day of the week. Results Our Markov model showed that if admission probability is lower on the weekends, Friday discharges will be readmitted later (longer time-to-emergency-readmission) than Wednesday discharges. Using hospital admission data, we found that Friday discharges were readmitted slightly earlier than Wednesday discharges (HR: 1.03, 95% CI: (1.02, 1.05)). After adding a time-varying covariate for the current day of the week, the length of time-to-emergency-readmission for a Friday discharge increased, but it was still earlier than a Wednesday discharge (HR: 1.04, 95% CI: (1.01, 1.07)). Conclusions The lower admission probabilities on the weekend confound the effect of Friday discharge on time-to-emergency-readmission by increasing the time-to-emergency-readmission. This confounding effect causes an underestimate of the effect of Friday discharge on time-to-emergency-readmission.
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Mortensen, P. B., and W. W. Eaton. "Predictors for readmission risk in schizophrenia." Psychological Medicine 24, no. 1 (February 1994): 223–32. http://dx.doi.org/10.1017/s0033291700026982.
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SynopsisReadmission risk was assessed at the first and subsequent discharges in a total Danish national sample consisting of 8705 first admitted patients who had been discharged alive at least once with a diagnosis of schizophrenia. Predictors for readmission risk were identified using the Cox proportional hazards model. Following the first discharge, 19% of the surviving patients had not been readmitted after 10 years of follow-up. Readmission risk increased with the number of previous admissions. At the first discharge readmission risk decreased with increasing age and was significantly predicted by clinical subtype and gender. At later discharges (5th, 10th, and 15th) the effect of these variables gradually disappeared. At the 15th discharge readmissions were mainly predicted by the duration of the latest admission and discharge periods. Both the increase in readmission risk with the number of previous admissions and the evolving pattern of predictors for readmission risk are interpreted as supporting the existence of a smaller subpopulation among schizophrenic patients with frequent relapses.
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Everard, Mark. "Diagnosis, admission, discharge." Paediatric Respiratory Reviews 10 (June 2009): 18–20. http://dx.doi.org/10.1016/s1526-0542(09)70009-0.
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McDaid, Edel, Elaine Ross, and Lisa Cogan. "88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.50.
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Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.
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Lewer, Dan, Brian Eastwood, Martin White, Thomas D. Brothers, Martin McCusker, Caroline Copeland, Michael Farrell, and Irene Petersen. "Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study." PLOS Medicine 18, no. 10 (October 5, 2021): e1003759. http://dx.doi.org/10.1371/journal.pmed.1003759.
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Background Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.
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Lewer, Dan, Brian Eastwood, Martin White, Thomas D. Brothers, Martin McCusker, Caroline Copeland, Michael Farrell, and Irene Petersen. "Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study." PLOS Medicine 18, no. 10 (October 5, 2021): e1003759. http://dx.doi.org/10.1371/journal.pmed.1003759.
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Background Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.
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Ou, Lixin, Jack Chen, Lis Young, Nancy Santiano, La-Stacey Baramy, and Ken Hillman. "Effective discharge planning - timely assignment of an estimated date of discharge." Australian Health Review 35, no. 3 (2011): 357. http://dx.doi.org/10.1071/ah09843.
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Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissions and admissions via the emergency department, to assess the variance between EDD and the actual date of discharge (ADD), and to explore the determinants of delayed discharge in a tertiary referral centre, Sydney, Australia. Methods. Primary data from a convenience sample of 1958 admissions for allocation of EDDs were linked with administrative data. The window for assigning EDDs for planned admissions was 24 h, for admissions via the emergency department it was 48 h. Logistic regression models were used to examine the key factors associated with an EDD being assigned within 24 h or 48 h of an admission. An ordinal logistic regression model was used to explore the determinants of delayed discharge. Results. Only 13.4% of planned admissions and 27.5% of admissions via the emergency department were allocated a timely EDD. Older patients, patients with significant burdens of chronic morbidity (OR = 0.903; P = 0.011); and patients from a non-English-speaking background (OR = 0.711; P = 0.059) were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD. Conclusions. The prevalence of the timely assignment of an EDD was low and was lowest for planned admissions. The current Charlson Index score is an effective tool for identifying patients who are more likely to experience delayed discharge. What is known about the topic? Failure to assign an EDD is one of the major barriers to implementing effective discharge. Establishing an EDD for a patient within 24 h of an admission is thought to be a measure of efficient and high quality discharge planning. What does this paper add? Older patients, patients with significant burdens of chronic morbidity, and patients from a non-English-speaking background were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD. What are the implications for practitioners? A significant gap existed between policy and the implementation of assigning EDD in a large sample of discharges. Effective discharge planning may be obstructed by failure to assign an EDD at the time of admission.
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Okoh, Alexis K., Emaad Siddiqui, Cassandra Soto, Nehal Dhaduk, Sameer Hirji, Rajiv Tayal, Chunguang Chen, Leonard Y. Lee, and Mark J. Russo. "Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 16, no. 4 (June 16, 2021): 373–78. http://dx.doi.org/10.1177/15569845211013355.
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Objective The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience. Methods We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period. Results Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 ( P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 ( P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure. Conclusions Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.
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Tullo, E., C. Dotchin, and S. Jaiswal. "502 OUTCOMES OF HOSPITALISED PATIENTS WITH COVID-19 SIX MONTHS AFTER INDEX ADMISSION." Age and Ageing 50, Supplement_2 (June 2021): ii14—ii18. http://dx.doi.org/10.1093/ageing/afab119.11.
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Abstract Introduction Early outcomes for hospitalised patients with covid-19, including admissions to critical care and mortality have been widely published. Less is known about the longer-term patient outcomes such as readmissions, deaths after discharge and level of care required on discharge. Methods Following an audit of 360 consecutive admissions of patients with covid-19 requiring level 1 inpatient care in spring 2020, we collated data about mortality, readmissions, and residential status for the same cohort at six months after index admission. Results The cohort had a median age of 78: 70% survived to discharge. Median length of stay was nine days (range 1–90). Of 252 patients discharged, a further 35 (14%) had died by six-month follow-up. 95 patients (38%) required at least one further hospital admission in the following six-month period. 40 (16%) of discharged patient required increased support, defined as new or increased package of care or an alternative interim or permanent change of residence. (Table 1). Table 1 emailed separately as will not transfer into this space Of the 40 patients requiring increased support on discharge, 7 (18%) died, 15 (38%) returned to their preadmission residential status, and 17 (43%) still required increased support. Conclusions Covid-19 has a high mortality rate in those admitted to hospital. Patients receiving level 1 care in hospital and surviving to discharge have a high risk of readmission or death in the following six-months. For those requiring increased support on discharge, the majority do not return to their pre-admission residential status.
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Banerjee, Somalee, Amy Alabaster, Alyce S. Adams, Renee Fogelberg, Nihar Patel, and Kelly Young-Wolff. "Clinical impacts of an integrated electronic health record-based smoking cessation intervention during hospitalisation." BMJ Open 13, no. 12 (December 2023): e068629. http://dx.doi.org/10.1136/bmjopen-2022-068629.
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ObjectiveTo assess the effects of an electronic health record (EHR) intervention that prompts the clinician to prescribe nicotine replacement therapy (NRT) at hospital admission and discharge in a large integrated health system.DesignRetrospective cohort study using interrupted time series (ITS) analysis leveraging EHR data generated before and after implementation of the 2015 EHR-based intervention.SettingKaiser Permanente Northern California, a large integrated health system with 4.2 million members.ParticipantsCurrent smokers aged ≥18 hospitalised for any reason.ExposureEHR-based clinical decision supports that prompted the clinician to order NRT on hospital admission (implemented February 2015) and discharge (implemented September 2015).Main outcomes and measuresPrimary outcomes included the monthly percentage of admitted smokers with NRT orders during admission and at discharge. A secondary outcome assessed patient quit rates within 30 days of hospital discharge as reported during discharge follow-up outpatient visits.ResultsThe percentage of admissions with NRT orders increased from 29.9% in the year preceding the intervention to 78.1% in the year following (41.8% change, 95% CI 38.6% to 44.9%) after implementation of the admission hard-stop intervention compared with the baseline trend (ITS estimate). The percentage of discharges with NRT orders increased acutely at the time of both interventions (admission intervention ITS estimate 15.5%, 95% CI 11% to 20%; discharge intervention ITS estimate 13.4%, 95% CI 9.1% to 17.7%). Following the implementation of the discharge intervention, there was a small increase in patient-reported quit rates (ITS estimate 5.0%, 95% CI 2.2% to 7.8%).ConclusionsAn EHR-based clinical decision-making support embedded into admission and discharge documentation was associated with an increase in NRT prescriptions and improvement in quit rates. Similar systemic EHR interventions can help improve smoking cessation efforts after hospitalisation.
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Cornes, Michael P., Graham Danks, Sanna Elgaddal, Mohammed Jawad, Jayne Tonks, Elisabeth Ries, Clare Ford, and Rousseau Gama. "Early availability of laboratory results increases same day ward discharge rates." Clinical Chemistry and Laboratory Medicine (CCLM) 56, no. 11 (October 25, 2018): 1864–69. http://dx.doi.org/10.1515/cclm-2018-0261.
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Abstract Background: Delayed discharge reduces hospital efficiency and inconveniences patients. Most hospitals discharge in the afternoon, whereas the most common admission time is mid-morning. Consequently, new patients wait for the beds of patients who are fit to be discharged. Earlier discharge may, therefore, improve patient flow. We investigated the impact of early phlebotomy with early availability of laboratory results on patient discharge rates and discharge time. Methods: Discharge rates, discharge time and sample turnaround time were assessed before (1 October 2014 to 31 December 2014) and after (1 October 2015 to 31 December 2015) introduction of earlier phlebotomy with availability of laboratory results prior to the ward rounds on two surgical wards. Results: Following the intervention, over 95% of results were available before 8:30 am in 2015 as compared to less than 1% in 2014. Specimen turnaround times were similar in both study periods. Even after adjustment for age, gender, admission type and length of admission, the same day discharge rate was higher in 2015 compared to 2014 (60% vs. 52%; p<0.002), but time of discharge was unchanged. Conclusions: Early availability of blood results prior to ward rounds increased ward discharges but did not affect discharge time.
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Tarvonen-Schröder, Sinikka, Tuuli Niemi, and Mari Koivisto. "Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination." Advances in Rehabilitation Science and Practice 12 (January 2023): 275363512311579. http://dx.doi.org/10.1177/27536351231157966.
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Background: Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim: The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods: On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results: 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion: The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
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Gordon, Steven A., David Garber, Zahrah Taufique, Qianhui Shao, Milan R. Amin, J. Thomas Roland, and Babak Givi. "Improving On-time Discharge in Otolaryngology Admissions." Otolaryngology–Head and Neck Surgery 163, no. 2 (January 7, 2020): 188–93. http://dx.doi.org/10.1177/0194599819898910.
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Objective We conducted a quality improvement project to increase the rate of discharges before noon (DBN) in the otolaryngology department at a tertiary care center. Methods Based on a Plan-Do-Study-Act framework, monthly discharge data and observed-to-expected (O:E) length of stay were collected and shared with the department members monthly. A target of 43% DBN was predetermined by the center (Plan). The following interventions were implemented (Do): discharge planning starting at the time of admission, focus on early attending-to-resident team communication, placement of discharge order prior to rounding, and weekly reminders to the entire department. Results Discharges were monitored for 3 years. For the year prior to this study, a minority of patients were discharged before noon (12 months: 75 of 190, 36%). During the first 6 months of monitoring (Study), no significant improvement was identified (34 of 95, 36%). After interventions, performance significantly improved (31 months: 250 of 548, 68%). The performance was consistently above the predetermined target of 43%. During the study time, O:E length of stay remained below the predetermined target (O:E ratio, 0.90; hospital target, 0.93). Discussion Comprehensive discharge planning beginning at the time of admission, weekly reminders, and improved communication (Act) can help to prioritize DBN and increase the percentage of discharges before noon. Implications for Practice By utilizing a quality improvement framework, significant improvements in timely discharge can be achieved and sustained with changes in workflow and departmental culture. These changes can be achieved without increases in resources or prolonging the length of stay.
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Lyall, Ros, and Maria Kelly. "Specialist psychiatric beds for people with learning disability." Psychiatric Bulletin 31, no. 8 (August 2007): 297–300. http://dx.doi.org/10.1192/pb.bp.106.011700.
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Aims and MethodTo examine the use of specialist psychiatric beds for people with learning disability, created following the closure of a long-stay institution. Admission and discharge data were examined, including history of previous institutional admission, diagnosis at discharge and number of subsequent readmissions.ResultsOut of 348 admission episodes, 59 were accounted for by 40 patients who were previously resident in the long-stay institution. Most admissions were for new patients from the community. Over time, admissions to the specialist unit decreased when occupancy reached and persisted at 100%, coinciding with a significant rise in admissions of adults with learning disability to general adult psychiatric wards.Clinical ImplicationsResettlement after closure of long-stay learning disability institutions has not been accompanied by a high readmission rate for former residents, but neither has there been a decreasing need for psychiatric beds for those with learning disability and severe psychiatric disturbance. Most of these admissions are for people with learning disability who are relatively new to the service. There has been a persistent problem with full occupancy of these beds, which reflects delayed discharges indicating a lack of community resources and an increasing demand for admission.
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Ochuko-Emore, M. "Discharge destination of patients from a psychogeriatric unit." European Psychiatry 26, S2 (March 2011): 845. http://dx.doi.org/10.1016/s0924-9338(11)72550-0.
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ObjectivesTo determine the discharge destination of patients admitted to a psychogeriatric unit.MethodsRecords of all patients discharged from an in-patient psychogeriatric unit between 1st July 2009 and 30th June 2010 were examined. The diagnosis, residence at admission, length of stay and discharge destination were recorded.ResultsThere were ninety-four discharges over the study period. Four of the patients were admitted and discharged twice. The mean age was 76.7 years (range 65–95 years). 52.1% (n = 49) were diagnosed with dementia and 47.9% (n = 45) with functional mental illness. The average length of stay was 67.4 days for dementia compare to 74.2 days for functional mental illness. 17.1% (n = 6/32) of patients with dementia and 84.2% (n = 32/38) of patients with functional mental illness resident at home at the time of admission were discharged home.ConclusionThis finding suggests that patients with functional mental illness are more likely to be discharge back to their homes compared with patients with dementia.
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Muir, A., and S. Paul. "An audit of medical and nursing records of 100 emergency short-term (< 7 dys) psychiatric admissions to acute adult wards in Dumfries." European Psychiatry 26, S2 (March 2011): 748. http://dx.doi.org/10.1016/s0924-9338(11)72453-1.
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IntroductionThe study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.ObjectivesTo evaluate the recorded admission and discharge processes in the medical and nursing notes.To record relevant clinical characteristics of the admission and the patient.AimsTo assess recorded admission and discharge processes against standards defined in the protocol.MethodsA random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.Results51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.ConclusionsThe recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.
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Peltonen, Laura-Maria, Louise McCallum, Eriikka Siirala, Marjaana Haataja, Heljä Lundgrén-Laine, Sanna Salanterä, and Frances Lin. "An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care." BioMed Research International 2015 (2015): 1–12. http://dx.doi.org/10.1155/2015/868653.
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The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients’ admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
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Blankenship, Jean S., and Susan A. Winslow. "Admission-Discharge-Teaching Nurses." JONA: The Journal of Nursing Administration 33, no. 1 (January 2003): 11–13. http://dx.doi.org/10.1097/00005110-200301000-00003.
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Greenhalgh, Ben, Hina Anwar, Rosemary Hedley, Celine Perkins, and Rachel Shaw. "Are medications with anti-cholinergic properties prescribed and reviewed appropriately on a male older person's organic ward?" BJPsych Open 7, S1 (June 2021): S79—S80. http://dx.doi.org/10.1192/bjo.2021.250.
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AimsPatients admitted to Roker ward (male organic psychiatric ward) should have a decreased anticholinergic burden of medication on discharge compared to admission. This will be demonstrated by a reduced score on the Anticholinergic Cognitive Burden (ACB) scale on discharge compared to admission. Target: 80%.Where new medicines with anticholinergic burden are prescribed during admission, there should be evidence that the anticholinergic properties of these medications have been considered prior to prescribing (via documentation in care co-ordination reviews or progress notes). Target: 100%MethodElectronic records were searched for all discharges from Roker ward between 1/1/2019 – 31/12/2019. For each record the follwing information was recorded: demographics; primary diagnosis; total ACB score on admission; and total ACB score on discharge. For all new medications started with an ACB score of over zero, records were searched to establish whether there was evidence that the anticholinergic properties of these medications had been considered.Result47 patients were identified who were discharged over the time period in question. 30 patients had no difference in ACB score between admission and discharge; 10 patients had a reduction in ACB score and 5 patients had an increase. A total of 9 new medications with ACB scores over zero had been started during all admissions; there were no occasions where there was documented evidence to show that the anticholinergic burden of these medications had been considered.Conclusion27% of patients had a reduction in their total ACB score during admission; the target was 80%.The reasons for starting medications with an ACB score of greater than 1 were documented in 0% of cases; the target was 100%.As both targets were missed by a significant margin, it was recognised that there were significant areas for improvement. The following plan was therefore implemented: 1.Following discussion with the ward consultant and ward pharmacist, regular prescriber meetings have been set up which involve senior nursing staff, medical staff and pharmacy – anticholinergic burden is calculated for each patient as part of these meetings2.A re-audit is recommended after 6 months.
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Cheng, SST, and CH Chung. "A Retrospective Study of Patients Discharged within 24 Hours after Emergency Admission in a Public General Hospital." Hong Kong Journal of Emergency Medicine 9, no. 3 (July 2002): 139–44. http://dx.doi.org/10.1177/102490790200900304.
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Objectives To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission. Design Retrospective study. Setting Emergency admission in a public general hospital in Hong Kong. Patients Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission. Main outcome measures Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients. Results During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastroduodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty. Conclusions The issue of ‘discharge within 24 hours’ should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization.
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Mellesdal, L., R. A. Kroken, O. Lutro, T. Wentzel-Larsen, E. Kjelby, K. J. Oedegaard, H. A. Jørgensen, and L. Mehlum. "Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study." European Psychiatry 29, no. 4 (May 2014): 246–52. http://dx.doi.org/10.1016/j.eurpsy.2013.06.006.
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AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.
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Wijlaars, Linda PMM, Pia Hardelid, Jenny Woodman, Janice Allister, Ronny Cheung, and Ruth Gilbert. "Contribution of recurrent admissions in children and young people to emergency hospital admissions: retrospective cohort analysis of hospital episode statistics." Archives of Disease in Childhood 100, no. 9 (May 18, 2015): 845–49. http://dx.doi.org/10.1136/archdischild-2014-307771.
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ObjectiveTo examine the contribution of recurrent admissions to the high rate of emergency admissions among children and young people (CYP) in England, and to what extent readmissions are accounted for by patients with chronic conditions.DesignAll hospital admissions to the National Health Service (NHS) in England using hospital episode statistics (HES) from 2009 to 2011 for CYP aged 0–24 years. We followed CYP for 2 years from discharge of their first emergency admission in 2009. We determined the number of subsequent emergency admissions, time to next admission, length of stay and the proportion of injury and chronic condition admissions measured by diagnostic codes in all following admissions.Results869 895 children had an index emergency admission in 2009, resulting in a further 939 710 admissions (of which 600 322, or 64%, were emergency admissions) over the next 2 years. After discharge from the index admission, 32% of 274,986 (32%) children were readmitted within 2 years, 26% of these readmissions occurring within 30 days of discharge. Recurrent emergency admission accounted for 41% of all emergency admissions in the 2-year cohort and 66% of inpatient days. 41% of index admissions, but 76% of the recurrent emergency admissions, were in children with a chronic condition.ConclusionsRecurrent admissions contribute substantially to total emergency admissions. They often occur soon after discharge, and disproportionately affect CYP with chronic conditions. Policies aiming to discourage readmissions should consider whether they could undermine necessary inpatient care for children with chronic conditions.
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Tsai, Kai-Li, Ay-Chen Lee, and Patrick Asubonteng Rivers. "Hospital Re-Admissions: An Empirical Analysis of Quality Management in Taiwan." Health Services Management Research 14, no. 2 (May 2001): 92–103. http://dx.doi.org/10.1177/095148480101400203.
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This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.
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Tsai, Kai-Li, Ay-Chen Lee, and Patrick Asubonteng Rivers. "Hospital re-admissions: an empirical analysis of quality management in Taiwan." Health Services Management Research 14, no. 2 (May 1, 2001): 92–103. http://dx.doi.org/10.1258/0951484011912582.
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This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.
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Williams, Teresa, and Gavin Leslie. "Delayed discharges from an adult intensive care unit." Australian Health Review 28, no. 1 (2004): 87. http://dx.doi.org/10.1071/ah040087.
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Objective: Intensive Care Unit (ICU) services are expensive, and therefore appropriate utilisation is imperative. Delayed discharges impact on the efficiency and effectiveness of ICU services. This study examines the prevalence and reasons for delayed discharge. Method: Cross sectional study. We enrolled a prospective sample of all patients admitted to a 22-bed ICU over a 6-month period. Medical staff in ICU informed nursing shift coordinators when patients could be discharged. Nursing shift coordinators maintained a record of discharge times, delays and reasons for delay. Discharge was considered delayed if the patient was not relocated from the ICU within 8 hours of being considered eligible by ICU medical staff. Results: Of 652 recorded discharges, 176 were delayed (27%). Unavailable ward beds (81%) were cited as the main reason for delay in discharge. Median delay time was 21.3 hours (range, 10 minutes to 26 days). These delays were predicted by greater patient acuity on ICU admission, patient deterioration while waiting for transfer to the ward, principal admitting diagnosis, discharge destination and weekend discharge. Conclusion: Improvement in bed management and discharge processes (the only factors directly controllable by the hospital) is essential to reduce delays in discharge from ICU. Reducing discharge delays would free up beds for other admissions; may result in a cost saving for the hospital through more efficient resource utilisation; and, ultimately, would benefit patients.
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Zahreddine, Nada, Rahna Theruvath Chalil, and Sohail Abrar. "Prevalence and Correlates of Benzodiazepines' Prescriptions in an Inpatient Setting." BJPsych Open 8, S1 (June 2022): S117. http://dx.doi.org/10.1192/bjo.2022.349.
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AimsThe National Institute for Health and Care Excellence guidelines state that benzodiazepines (BZD) should not be taken for longer than four weeks. However, there are no recommendations specifically addressing the use and misuse of BZD in inpatient settings and their prescription at discharge. A recent study (Panes et al., 2020) recommended aiming for BZD’ total withdrawal or, at least, dose reduction at discharge to reduce the risk of misuse in the community which can lead to dependence and serious side effects. Our study aimed to 1. describe BZD’ prescriptions on an acute female ward, before admission, during admission, at the time of discharge and at four and eight weeks post-discharge, 2. identify potential sociodemographic, clinical and therapeutic correlates/predictors of BZD’ prescriptions, 3. develop a strategy to reduce BZD’ prescriptions or, at least, to reduce the dose of BZD prescribed at discharge.MethodsData collection was done retrospectively through electronic medical and prescribing records and included admissions to Avocet Ward, between May and October 2021. Variables collected were age, ethnicity, length of stay, Mental Health Act status, diagnosis, comorbid drugs or alcohol misuse, Home Treatment Team involvement at discharge, community teams, prescriptions of regular and Pro Re Nata BZD and “z-drugs” prior to admission, during admission, at discharge, and at 4 weeks and 8 weeks post-discharge, maximum dose of regular BZD during admission and the dose at discharge.ResultsAmong the 59 admissions included, 25.4% had BZD before admission, 81.4% during admission (with a mean maximum dose of regular BZD of 38.8 mg (SD = 17.3) of diazepam equivalent), 50.8% at discharge (with a mean dose of 28.5 mg (SD = 18.5) of regular BZD), 35.6% 4 weeks post-discharge and 27.1% 8 weeks post-discharge. The odds of having regular BZD during admission were 7.4 times more likely for those on regular BZD before admission after controlling for other variables (95%CI: 1.1, 50). The maximum dose of regular BZD during admission was positively correlated with the dose of regular BZD at discharge (r(15) = .67, p < .01). Among the regular BZD prescribed during admission (N = 23), 26.1% were fully discontinued by the time of discharge and 43.5% were titrated down, while 30.4% remained at the same maximum dose prescribed during admission.ConclusionBZD prescriptions are common at discharge from inpatient settings and can be associated with BZD misuse in the community. We suggest strategies to avoid this issue.
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Washington, Francine, Samantha Bull, and Ceri Woodrow. "The Transforming Care agenda: admissions and discharges in two English learning disability assessment and treatment units." Tizard Learning Disability Review 24, no. 1 (March 8, 2019): 24–32. http://dx.doi.org/10.1108/tldr-04-2018-0012.
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Purpose The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these. Design/methodology/approach A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda. Findings There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision. Practical implications The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial. Originality/value This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism.
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Schmid, Olive, Bonnie Bereznicki, Gregory Mark Peterson, Jim Stankovich, and Luke Bereznicki. "Persistence of Adverse Drug Reaction-Related Hospitalization Risk following Discharge." International Journal of Environmental Research and Public Health 19, no. 9 (May 4, 2022): 5585. http://dx.doi.org/10.3390/ijerph19095585.
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This retrospective cohort study analyzed the administrative hospital records of 91,500 patients with the aim of assessing adverse drug reaction (ADR)-related hospital admission risk after discharge from ADR and non-ADR-related admission. Patients aged ≥18 years with an acute admission to public hospitals in Tasmania, Australia between 2011 and 2015 were followed until May 2017. The index admissions (n = 91,550) were stratified based on whether they were ADR-related (n = 2843, 3.1%) or non-ADR-related (n = 88,707, 96.9%). Survival analysis assessed the post-index ADR-related admission risk using (1) the full dataset, and (2) a matched subset of patients using a propensity score analysis. Logistic regression was used to identify the risk factors for ADR-related admissions within 90 days of post-index discharge. The patients with an ADR-related index admission were almost five times more likely to experience another ADR-related admission within 90 days (p < 0.001). An increased risk persisted for at least 5 years (p < 0.001), which was substantially longer than previously reported. From the matched subset of patients, the risk of ADR-related admission within 90 and 365 days more than doubled in the patients with an ADR-related index admission (p < 0.0001). These admissions were often attributed to the same drug class as the patients’ index ADR-related admission. Cancer was a major risk factor for ADR-related re-hospitalization within 90 days; other factors included heart failure and increasing age.
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Young, Daniel L., Elizabeth Colantuoni, Lisa Aronson Friedman, Jason Seltzer, Kelly Daley, Binqing Ye, Daniel J. Brotman, and Erik H. Hoyer. "Prediction of Disposition within 48-hours of Hospital Admission Using Patient Mobility Scores." Journal of Hospital Medicine 15, no. 9 (December 18, 2019): 540–43. http://dx.doi.org/10.12788/jhm.3332.
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Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 805) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95%CI:67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.
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Tulloch, A. D., A. S. David, and G. Thornicroft. "Exploring the predictors of early readmission to psychiatric hospital." Epidemiology and Psychiatric Sciences 25, no. 2 (February 23, 2015): 181–93. http://dx.doi.org/10.1017/s2045796015000128.
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Background.Aims of this study are to explore the associations of readmission to psychiatric hospital over time, to develop a statistical model for early readmission to psychiatric hospital and to assess the feasibility of predicting early readmission.Method.The sample comprised 7891 general psychiatric discharges in South London, taken from a large anonymised repository of electronic patient records. We initially explored time to readmission using Cox regression – this included investigation of time-dependent effects. Subsequently, we used logistic regression to create a predictive model for 90-day readmission. We investigated the effect on readmission of a set of variables that included demographic variables, diagnosis and legal status during the index admission, previous service use, housing variables and individual item scores on the Health of the Nation Outcome Scales (HoNOS) at admission and at discharge.Results.Fifteen per cent of those discharged were readmitted within 90 days. Cox regression demonstrated that the estimated baseline hazard of readmission declined steeply after discharge and that the effects of several predictors, especially diagnosis, changed over time – most notably, personality disorder was associated with increased readmission relative to schizophrenia at the time of discharge, but did not significantly differ by 1-year postdischarge. In the logistic regression, increased readmission was associated with personality disorder diagnosis; shorter length of the index admission (excepting zero length admissions); number of discharges in the preceding 2 years; and having a high score at discharge on the HoNOS overactive and aggressive behaviour item, cognitive problems item or hallucinations and delusions items. Detention under Section 3 or a forensic section of the Mental Health Act during the index admission was associated with reduced readmission. The coefficient of discrimination for the logistic regression, which is equivalent to r2, was 0.04 and the estimated area under the receiver operating curve was 0.65.Conclusions.The association found between early readmission and personality disorder diagnosis merits further investigation, as does the possible trade-off between reduction in length of stay and increased readmission. Other novel findings such as the associations found with HoNOS item scores also merit replication. As with previous studies, we found that the rate of readmission declines steeply after hospital discharge, so that the period immediately subsequent to discharge is a period of comparatively high risk. However, prediction of early readmission within this high-risk group remains challenging – it seems most likely that many unmeasured influences operate subsequent to the time of discharge.
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Phalak, Manoj, Ravi Sharma, Santanu Bora, Varidh Katiyar, Akshay Ganeshkumar, Norudeen Khan, Vivek Tandon, et al. "Re-Admissions of ‘Unknown’ Traumatic Brain Injury Patients – Inadequacy of Rehabilitative Services in a Developing Country." Neurology India 72, no. 2 (March 2024): 304–8. http://dx.doi.org/10.4103/ni.ni_706_21.
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Background: In neurosurgical practice, continuous care after discharge and the ability to detect subtle indicators of clinical deterioration are mandatory to prevent the progression of a disease. The care of ‘unknown’ patients discharged to rehabilitation homes may not have this privilege, especially in resource-poor countries such as India. Objective: We have attempted to study the causes and outcomes of re-admissions of ‘unknown’ patients with previous traumatic brain injury (TBI) to estimate the quality of nursing care in our rehabilitation centers. Material and Methods: The electronic hospital records of all consecutive ‘unknown’ TBI patients with unplanned re-admissions at our institute from January 2014 to December 2018 were retrospectively reviewed and analyzed for the factors determining the risk and outcomes of re-admission. Results: Out of 245 patients sent to rehabilitation homes at discharge, 47 patients (19.18%) were re-admitted. A total of 33 patients (70%) were re-admitted between 1 month and 1 year. Out of these, 38 patients (80.9%) were re-admitted because of preventable causes. Fifteen patients (31.9%) died during the hospital stay. The rest of the 32 (68%) patients were discharged after the management of the concerned condition with an average hospital stay of 9 ± 11.1 days. The average Glasgow coma scale (GCS) at re-admission of the patients who died was 6 (range 3–11). Two patients were brought in the brain dead status, whereas 20 patients (42.6%) had a GCS of 5 or below at the time of re-admission. The risk of mortality among patients with non-preventable causes was 88.9% (8/9) compared to preventable causes 18.4% (7/38). However, preventable causes for re-admission are much more common, resulting in nearly a similar overall contribution to mortality. Conclusions: There is a high rate of mortality and morbidity in ‘unknown’ patients with TBI because of poor post-discharge care in developing countries. Because preventable causes are the major contributor to re-admissions, the re-admission rate is a good indicator of a lack of adequate rehabilitative services. The need for improving the post-discharge management of ‘unknown’ patients with TBI in resource-poor countries cannot be over-emphasized.
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Ayalon-Dangur, Irit, Adi Turjeman, Bar Basharim, Noa Bigman-Peer, Einat Magid, Hefziba Green, Tzippy Shochat, Alon Grossman, Jihad Bishara, and Noa Eliakim-Raz. "Re-Admission of COVID-19 Patients Hospitalized with Omicron Variant—A Retrospective Cohort Study." Journal of Clinical Medicine 11, no. 17 (September 2, 2022): 5202. http://dx.doi.org/10.3390/jcm11175202.
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In accordance with previous publications, re-admission rates following hospitalization of patients with COVID-19 is 10%. The aim of the current study was to describe the rates and risk factors of hospital re-admissions two months following discharge from hospitalization during the fifth wave due to the dominant Omicron variant. A retrospective cohort study was performed in Rabin Medical Center, Israel, from November 2021 to February 2022. The primary outcome was re-admissions with any diagnosis; the secondary outcome was mortality within two months of discharge. Overall, 660 patients were hospitalized with a diagnosis of COVID-19. Of the 528 patients discharged from a primary hospitalization, 150 (28%) were re-admitted. A total of 164 patients (25%) died throughout the follow-up period. A multi-variable analysis determined that elevated creatinine was associated with a higher risk of re-admissions. Rates of re-admissions after discharge during the Omicron wave were considerably higher compared to previous waves. A discharge plan for surveillance and treatment following hospitalization is of great importance in the management of pandemics.
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Badgery-Parker, Tim, Antonia W. Shand, Jane B. Ford, Mary G. Jenkins, Jonathan M. Morris, and Christine L. Roberts. "Multifetal pregnancies: preterm admissions and outcomes." Australian Health Review 36, no. 4 (2012): 437. http://dx.doi.org/10.1071/ah11106.
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Objective. To describe the rates of antenatal hospital admission during twin or higher order multifetal pregnancies, and the admission outcomes as discharge undelivered, transfer to higher care, or spontaneous or elective delivery. Methods. Cohort study using linked birth and hospital data. The cohort comprised women who gave birth to twins or higher order multiple infants of ≥ 24 weeks gestation in 2001–2008 and who were admitted to hospital in weeks 20–36 of the pregnancy. Results. In 63.4% of 10 779 twin pregnancies and 99.5% of 197 triplet and quadruplet pregnancies, the woman was admitted to hospital at least once in weeks 20–36 of the pregnancy, for a total 10 985 admissions. Almost half the admissions (46.3%) ended in discharge without delivery, 10.7% in transfer to higher care, 21.1% in spontaneous labour and birth, and 21.8% in elective delivery (induction or prelabour Caesarean section). The reason for admission was preterm labour in 34.2% of admissions. Conclusions. Hospital admission during pregnancy is common for women with multifetal pregnancies, with many of these admissions resulting in preterm birth. This is the first study to report the rate of pregnancy admissions for women with multifetal pregnancies, and provides a baseline for future studies of hospital use in this population. What is known about the topic? Multifetal pregnancies are high risk and require greater medical care than singleton pregnancies. However, few studies specifically examine multifetal pregnancies, and most pregnancy studies exclude them, so there is little known about the resource use of this group. What does this paper add? This is the first paper to report population rates of hospital admission during pregnancy for women with multifetal pregnancies. We report the admission rates, and the admission outcomes as discharge undelivered, transfer to higher care or spontaneous or elective delivery. What are the implications for practitioners? Most women with multifetal pregnancies are admitted to hospital at least once during the pregnancy, with 51% of these admissions resulting in preterm delivery. Of those discharged undelivered, 60% were admitted for 1 day or less. This has implications for resource use, proposed place of birth and for practitioners advising pregnant women.
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Braaf, Sandra, Sascha Rixon, Allison Williams, Danny Lieu, and Elizabeth Manias. "Pharmacist-patient medication communication during admission and discharge in specialty hospital settings: implications for person centered healthcare." International Journal of Person Centered Medicine 4, no. 2 (January 19, 2015): 90–105. http://dx.doi.org/10.5750/ijpcm.v4i2.446.
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Background Hospital admission and discharge are critical transition points for patients’ medication management. Effective communication between pharmacists and patients at these transition points has the potential to mitigate medication incidents. Previous research has examined communication among community pharmacists and patients. Limited research has explored the complexities of communication between hospital pharmacists and patients during admission and discharge interactions.Objective To explore the complexities of pharmacist-patient medication communication during medication admission and discharge in specialty hospital settings.Methods The study was conducted at a metropolitan Australian public hospital. An exploratory qualitative design was used involving the methods of semi-structured interviews and participant observation. Interviews and observations were undertaken in five specialty settings: cardiothoracic care, intensive care, emergency care, oncology care and perioperative care. A comprehensive thematic analysis of the data was performed.Results Twelve pharmacists and 69 patients participated in interviews and observations for the study. Over 200 hours of observational data were collected. In total, 26 medication admissions and 35 medication discharges were observed. Pharmacists regulated communication with patients by using structured communication tools. When providing or gathering information, pharmacists controlled the level of patient engagement. Words used in pharmacist-patient communication were sometimes ambiguous and occasionally miscommunication resulted. Patients sought minimal information from pharmacists.Conclusions Pharmacists need to apply patient-centered principles, and encourage active patient involvement, in admission and discharge conversations.
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Dexter, F., K. Pearson, D. L. Griffiths, and P. Jebson. "Surgical ICU Underutilization Does not Significantly Discourage Discharge." Health Services Management Research 9, no. 4 (November 1996): 238–42. http://dx.doi.org/10.1177/095148489600900403.
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An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.
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Lee, M., A. Warren, B. Zolotarev, J. Henderson, and M. George. "Anticholinergic burden in inpatient psychogeriatric population – Do we care?" European Psychiatry 33, S1 (March 2016): S187. http://dx.doi.org/10.1016/j.eurpsy.2016.01.417.
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BackgroundAlthough recent studies have found that there is significant association between anticholinergic and cognitive impairment, especially in the elderly population, there seems to be minimal emphasis on anticholinergic burden (ACB) when prescribing medications to the inpatient psychogeriatric population.AimTo evaluate the prescribing patterns in Older Person Mental Health Inpatient Unit (OPMHU), whether the ACB Score on admission has been reviewed for lowest possible ACB while maintaining therapeutic effects. A protocol will be developed to ensure that ACB is reviewed for future admissions and discharges.MethodologyFifty patients admitted and discharged from OPMHU are recruited retrospectively from 30th September 2015, excluding outliers and deceased patients. For those who had multiple admissions during that period, only the most recent admission would be included for evaluation. Individual ACB score is calculated on admission and discharge based on pharmacist final medication summary. Their mental health records are also audited for any documented ACB review by the treating team, while making note for any pre-existing cognitive impairment.ResultACB has not been taken into consideration in all patients by the treating team on admission as well as when prescribing medications on discharge. Hence, it is unsurprising that the ACB score showed an increment of 30% on discharge (3.25) when compared to the admission score (2.5).ConclusionThe study found that although ACB poses significant risks on cognitive impairment, this knowledge has not been employed pragmatically. A protocol should be developed to ensure that ACB is evaluated and managed accordingly.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Jain, Viral G., Peter J. Greco, and David C. Kaelber. "Code Status Reconciliation to Improve Identification and Documentation of Code Status in Electronic Health Records." Applied Clinical Informatics 26, no. 01 (2017): 226–34. http://dx.doi.org/10.4338/aci-2016-08-ra-0133.
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Summary Background: Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues. Objective: To study the tools, workflow, and impact of clinical decision support (CDS) for CSR. Methods: We established rules for CS implementation in our EHR. At admission, a CS is required as part of a patient’s admission order set. Using standard CDS tools in our EHR, we built an interruptive alert for CSR at discharge if a patient did not have the same inpatient (current) CS at discharge as that prior to admission CS. Results: Of 80,587 admissions over a four year period (2 years prior to and post CSR implementation), CS discordance was seen in 3.5% of encounters which had full code status prior to admission, but Do Not Resuscitate (DNR) CS at discharge. In addition, 1.4% of the encounters had a different variant of the DNR CS at discharge when compared with CS prior to admission. On pre-post CSR implementation analysis, DNR CS per 1000 admissions per month increased significantly among patients discharged and in patients being admitted (mean ± SD: 85.36 ± 13.69 to 399.85 ± 182.86, p<0.001; and 1.99 ± 1.37 vs 16.70 ± 4.51, p<0.001, respectively). Conclusion: EHR enabled CSR is effective and represents a significant informatics opportunity to help honor patients’ end-of-life wishes. CSR represents one example of non-medication reconciliation at transitions of care that should be considered in all EHRs to improve care quality and patient safety.
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Mkanta, William N., Neale R. Chumbler, Kai Yang, Romesh Saigal, Mohammad Abdollahi, Maria C. Mejia de Grubb, and Emmanuel U. Ezekekwu. "An Examination of the Likelihood of Home Discharge After General Hospitalizations Among Medicaid Recipients." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 54 (January 1, 2017): 004695801771178. http://dx.doi.org/10.1177/0046958017711783.
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Ability to predict discharge destination would be a useful way of optimizing posthospital care. We conducted a cross-sectional, multiple state study of inpatient services to assess the likelihood of home discharges in 2009 among Medicaid enrollees who were discharged following general hospitalizations. Analyses were conducted using hospitalization data from the states of California, Georgia, Michigan, and Mississippi. A total of 33 160 patients were included in the study among which 13 948 (42%) were discharged to their own homes and 19 212 (58%) were discharged to continue with institutional-based treatment. A multiple logistic regression model showed that gender, age, race, and having ambulatory care-sensitive conditions upon admission were significant predictors of home-based discharges. Females were at higher odds of home discharges in the sample (odds ratio [OR] = 1.631; 95% confidence interval [CI], 1.520-1.751), while patients with ambulatory care-sensitive conditions were less likely to get home discharges (OR = 0.739; 95% CI, 0.684-0.798). As the nation engages in the continued effort to improve the effectiveness of the health care system, cost savings are possible if providers and systems of care are able to identify admission factors with greater prospects for in-home services after discharge.
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Talbert, Alison, Moses Ngari, Christina Obiero, Amek Nyaguara, Martha Mwangome, Neema Mturi, Nelson Ouma, Mark Otiende, and James Berkley. "Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study." BMJ Open 13, no. 1 (January 2023): e067482. http://dx.doi.org/10.1136/bmjopen-2022-067482.
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ObjectivesTo describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya.DesignRetrospective cohort study.SettingSecondary level hospital.ParticipantsYI aged less than 60 days admitted to hospital from January 2009 to December 2019: 12 271 admissions in 11 877 individuals. YI who were resident within a Kilifi Health and Demographic Surveillance System (KHDSS): n=3625 with 4421 admissions were followed-up for 1 year after discharge.Primary and secondary outcome measuresInpatient and 1-year post-discharge mortality, the latter in KHDSS residents.ResultsOf 12 271 YI admissions, 4421 (36%) were KHDSS-resident. Neonatal sepsis, preterm complications and birth asphyxia accounted for 83% of the admissions. The proportion of YI among under-5s admissions increased from 19% in 2009 to 34% in 2019 (Ptrend=0.02). Inpatient case fatality was 16%, with 66% of the deaths occurring within 48 hours of admission. The introduction of free maternity care in 2013 was not associated with a change in admissions or inpatient mortality among YI. During 1-year post-discharge, 208/3625 (5.7%) YI died, 64.3 (95% CI 56.2 to 73.7) per 1000 infant-years. 49% of the post-discharge deaths occurred within 1 month of discharge, and 49% of post-discharge deaths occurred at home. Both inpatient and post-discharge deaths were associated with low admission weight. Inpatient mortality was associated with clinical signs of disease severity, while post-discharge mortality was associated with the length of hospitalisation, leaving against advice and referral to a specialised hospital.ConclusionsYIs accounted for an increasing proportion of paediatric admissions and their overall mortality remains high. Post-discharge mortality accounts for a lower proportion of deaths but mortality rate is higher than among children aged 2–59 months. Services to address post-discharge mortality are needed and should focus on infants at higher risk.
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Shammas, Nicolas W., Ryan Kelly, Jon Lemke, Ram Niwas, Sarah Castro, Christine Beuthin, Jackie Carlson, et al. "Assessment of Time to Hospital Encounter after an Initial Hospitalization for Heart Failure: Results from a Tertiary Medical Center." Cardiology Research and Practice 2018 (2018): 1–4. http://dx.doi.org/10.1155/2018/6087367.
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Background. Hospital inpatient readmissions for patients admitted initially with the primary diagnosis of heart failure (HF) can be as high as 20–25% within 30 days of discharge. This, however, does not include admissions for observations or emergency department (ED) visits within the same time frame and does not show a time-dependent hospital encounter following discharge after an index admission. We present data on time-dependent hospital encounter of HF patients discharged after an index admission for a primary diagnosis of HF. Methods. The study recruited patients from 2 hospitals within the same health system. 500 consecutive admissions with the ICD diagnosis of HF were reviewed by inclusion and exclusion screening criteria. The 166 eligible remaining patients were tracked for post hospital discharge encounters consisting of hospital admissions, observation stays, and ED visits. Only those with a primary diagnosis of heart failure were included. Demographics were recorded on all patients. Days until hospital inpatient readmissions or hospital encounters were displayed in Kaplan–Meier plots. Results. A total of 166 patients met inclusion criteria (mean age 79.3 years, males 54%). For the first 90 days following the index admission, there were a total of 287 follow-up visits (1.7 per patient), 1158 total hospitalization days (2.6 per visit, 7.0 per patient, and 8.6 per 100 days at risk), and 21 deaths (12.7%). At 30 days, 25% and 52% of patients had an inpatient readmission or a hospital encounter, respectively. The median time to inpatient readmission was 117 days and to hospital encounter was 27 days. Conclusion. Time-dependent excess days in acute care (unplanned inpatient admission, outpatient observation, and ED visit) rather than 30-day hospital inpatient readmission rate is a more realistic measure of the intensity of care required for HF patients after index admission.
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Knapik, Piotr, Dawid Borowik, Daniel Cieśla, and Ewa Trejnowska. "Epidemiology and clinical characteristics of patients discharged from the ICU in a vegetative or minimally conscious state." PLOS ONE 16, no. 6 (June 25, 2021): e0253225. http://dx.doi.org/10.1371/journal.pone.0253225.
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Purpose A significant percentage of patients are discharged from intensive care units (ICU) with disorders of counciousness (DoC). The aim of this retrospective, case-control study was to compare patients discharged from the ICU in a vegetative state (VS) or minimally conscious state (MCS) and the rest of ICU survivors, and to identify independent predictors of DoC among ICU survivors. Methods Data from 14,368 adult ICU survivors identified in a Silesian Registry of Intensive Care Units (active in the Silesian Region of Poland between October 2010 and December 2019) were analyzed. Patients discharged from the ICU in a VS or MCS were compared to the remaining ICU survivors. Pre-admission and admission variables that independently influence ICU discharge with DoC were identified. Results Among the 14,368 analyzed adult ICU survivors, 1,064 (7.4%) were discharged from the ICU in a VS or MCS. The percentage of patients discharged from the ICU with DoC was similar in all age groups. Compared to non- DoC ICU patients, they had a higher mean APACHE II and SAPS III score at admission. Independent variables affecting ICU discharge with DoC included unconsciousness at ICU admission, cardiac arrest and craniocerebral trauma as primary cause of ICU admission, as well as a history of previous chronic neurological disorders and cerebral stroke (p<0.001). Conclusion Discharge in a VS and MCS was relatively frequent among ICU survivors. Discharge with DoC was more likely among patients who were unconscious at admission and admitted to the ICU due to cardiac arrest or craniocerebral trauma.
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Andrews, Shirley. "Discharge planning begins with admission." Journal of Vascular Nursing 26, no. 3 (September 2008): 89. http://dx.doi.org/10.1016/j.jvn.2008.06.011.
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TUCKER, MIRIAM E. "Admission HbA1c Aids Discharge Planning." Hospitalist News 5, no. 8 (August 2012): 17. http://dx.doi.org/10.1016/s1875-9122(12)70169-4.
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Wesolowski, Michael S. "Admission/Discharge unit alleviates overcrowding." AORN Journal 51, no. 3 (March 1990): 861–69. http://dx.doi.org/10.1016/s0001-2092(07)66633-2.
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Moore, Brian J., Rosanna M. Coffey, Kevin C. Heslin, and Ernest Moy. "Admissions after discharge from an emergency department for chest symptoms." Diagnosis 3, no. 3 (September 1, 2016): 103–13. http://dx.doi.org/10.1515/dx-2016-0014.
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AbstractBackground:Often patients who present to the emergency department (ED) with chest symptoms return to the hospital within 30 days with the same or closely related symptoms and are admitted, raising questions about quality of care, timeliness of diagnosis, and patient safety. This study examined the frequency of and patient characteristics associated with subsequent inpatient admissions for related symptoms after discharge from an ED for chest symptoms.Methods:We used data from the 2012 and 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) from eight states to identify over 1.8 million ED discharges for chest symptoms.Results:Approximately 3% of ED discharges experienced potentially related subsequent admissions within 30 days – 0.2% for acute myocardial infarction (AMI), 1.7% for other cardiovascular conditions, 0.5% for respiratory conditions, and 0.6% for mental disorders. Logistic regression results showed higher odds of subsequent admission for older patients and those residing in low-income areas, and lower odds for females and non White racial/ethnic groups. Privately insured patients had lower odds of subsequent admission than did those who were uninsured or covered by other programs.Conclusions:Because we included multiple diagnostic categories of subsequent admissions, our results show a more complete picture of patients presenting to the ED with chest symptoms compared with previous studies. In particular, we show a lower rate of subsequent admission for AMI versus other diagnoses. ED physicians and administrators can use the results to identify characteristics associated with increased odds of subsequent admission to target at-risk populations.
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Chow, Victor A., Kathleen Shannon Dorcy, Stephen H. Petersdorf, Kelda M. Gardner, Pamela S. Becker, Roland B. Walter, John M. Pagel, et al. "Evaluation of Early Discharge After Hospital Treatment of Neutropenic Fever In Acute Myelogenous Leukemia (AML)." Blood 116, no. 21 (November 19, 2010): 3806. http://dx.doi.org/10.1182/blood.v116.21.3806.3806.
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Abstract Abstract 3806 Background: Hospital admission for neutropenic fever in patients with AML is standard practice. However, discharge practices vary once patients become afebrile, with many patients hospitalized until rise in the absolute neutrophil count (ANC) to > 500/μL (ANC recovery). Data to support this practice are sparse. We hypothesized that patients admitted for neutropenic fever, particularly if in complete remission (CR) or about to enter CR following the chemotherapy course associated with neutropenic fever, might be safely discharged earlier (ED). Benefits of ED are less exposure to hospital pathogens, reduced cost, increased availability of beds for patients more in need of urgent care, and potentially, enhanced psychological well-being. Methods: We identified patients age 18–70 with newly diagnosed AML who were admitted to the University of Washington Medical Center with neutropenic fever between January 2008 and May 2010. We compared subsequent (within 30 days of discharge) deaths, intensive care unit (ICU) admissions, and readmissions for neutropenic fever according to discharge ANC, regarded as a numerical variable using the Mann-Whitney U test and as < 500/μL vs. > 500/μL using the Fisher Exact test. We used the Mann-Whitney U or Spearman correlation to analyze the relation between ANC at discharge and other covariates that might have affected outcome: age, ECOG performance status at admission for neutropenic fever, days inpatient, remission status, and type of infection (pneumonia, gram negative bacteremia, other). Results: We evaluated 49 patients discharged after admission for neutropenic fever, 26 of whom were discharged with an ANC < 500/μL. 35 of the patients were in CR or entered CR following the chemotherapy course associated with their neutropenic fever admission. Patients who were discharged with lower ANC were more likely to be readmitted with neutropenic fever (Mann-Whitney U p = 0.03), although this was not true using ANC categorized as < vs. > 500/μL (Fisher Exact p = 0.24, 95% confidence interval -0.47, 0.11). There was no relation between ANC at discharge and subsequent admission to an ICU (Mann-Whitney U p = 0.50, Fisher Exact p = 0.64, 95% confidence interval 0.2, 0.34 using the 500/μL ANC cut off). One patient died: a 55 year old discharged with ANC 0/μL after successful treatment of neutropenic fever died 19 days after hospital readmission with fever of unknown origin. Stenotrophomonas maltophilia pneumonia and sepsis were discovered 14 days after readmission. Assuming a beta distribution and rates of death of 1/26 for discharge with ANC < 500/μL and 0/23 for discharge with ANC > 500/μL, the probability that a discharge ANC with < 500/μL is associated with a higher death rate is 0.019. The number of events was too small for a multivariate analysis. However, patients with better performance status (< ECOG 2) or who spent a shorter time in hospital after admission for neutropenic fever were more likely to be discharged with lower ANC (Fisher exact p = 0.09 and Spearman p = 0.02 respectively), while the likelihood of discharge with ANC < 500/μL was unrelated to age, remission status, or type of infection. Thus we examined the relation between ANC and readmission for neutropenic fever separately in patients with better or worse performance status and in patients who spent more or less than the median time (8 days) in hospital after admission for neutropenic fever. This analysis indicated that patients discharged with lower ANC were more likely to be readmitted only if they had spent more than 8 days in hospital or if they were performance status < 2. Conclusions: Our results suggest that an ANC of 500/μL is an excessively high cut off for discharge following hospitalization for neutropenic fever. The rate of rise of the ANC, as well as its absolute value, may also play a role. Disclosures: No relevant conflicts of interest to declare.
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Dye, Stephen, Faisil Sethi, Thomas Kearney, Elizabeth Rose, Leia Penfold, Malcolm Campbell, and Koravangattu Valsraj. "Modelling admission lengths within psychiatric intensive care units." BMJ Health Care Inform 30, no. 1 (March 2023): e100685. http://dx.doi.org/10.1136/bmjhci-2022-100685.
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Objectives To examine whether discharge destination is a useful predictor variable for the length of admission within psychiatric intensive care units (PICUs). Methods A clinician-led process separated PICU admissions by discharge destination into three types and suggested other possible variables associated with length of stay. Subsequently, a retrospective study gathered proposed predictor variable data from a total of 368 admissions from four PICUs. Bayesian models were developed and analysed. Results Clinical patient-type grouping by discharge destination displayed better intraclass correlation (0.37) than any other predictor variable (next highest was the specific PICU to which a patient was admitted (0.0585)). Patients who were transferred to further secure care had the longest PICU admission length. The best model included both patient type (discharge destination) and unit as well as an interaction between those variables. Discussion Patient typing based on clinical pathways shows better predictive ability of admission length than clinical diagnosis or a specific tool that was developed to identify patient needs. Modelling admission lengths in a Bayesian fashion could be expanded and be useful within service planning and monitoring for groups of patients. Conclusion Variables previously proposed to be associated with patient need did not predict PICU admission length. Of the proposed predictor variables, grouping patients by discharge destination contributed the most to length of stay in four different PICUs.
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Vinci, Antonio, Giuseppe Furia, Vittoria Cammalleri, Vittoria Colamesta, Patrizia Chierchini, Ornella Corrado, Assunta Mammarella, et al. "Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy." PLOS ONE 19, no. 1 (January 24, 2024): e0294785. http://dx.doi.org/10.1371/journal.pone.0294785.
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Introduction Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. Material and methods Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. Results 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. Discussion and conclusions Delayed discharge may cause a “bottleneck” in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\system level) and social issues (on patient’s level).
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Arinola, Ganiyu Olatunbosun, Abdulfattah Adekunle Onifade, Kehinde Adigun, and Mosunmade Babatunde Oshingbesan. "Serum levels of IFN-γ and IL-4 in hospitalised COVID-19 patients – evidence of reduced cytokine storm in discharged patients." European Journal of Clinical and Experimental Medicine 21, no. 4 (December 30, 2023): 750–55. http://dx.doi.org/10.15584/ejcem.2023.4.14.
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Introduction and aim. Coronavirus disease 2019 is characterised by cytokine storm and it was managed with repurposed drugs, however the effect of this treatment on cytokine storm is unknown. The aim of the study was to investigate the effect of repurposed management on serum Th1 pro-inflammation cytokine (IFN-γ) and Th2 anti-inflammation cytokine (IL-4) in COVID-19 patients. Material and methods. The levels of IFN-γ and IL-4 were determined in sera from 45 COVID-19 patients at admission followed-up till discharge after repurposed treatment using ELISA. The mean levels and proportions above normal reference ranges of IFN-γ and IL-4 were compared in COVID-19 at admission and discharge. Results. The mean values of IFN-γ and IL-4 were significantly higher in COVID-19 patients at admission compared with discharged COVID-19 patients whereas IFN-γ:IL-4 ratio was significantly higher in discharged COVID-19 patients compared with admitted COVID-19 patients. Significantly higher proportion of COVID-19 patients at discharge had IFN-γ within the normal reference ranges compared with COVID-19 patients at admission whereas the proportions of COVID-19 patients at discharge and COVID-19 patients at admission having IL-4 within the normal reference ranges were the same. Conclusion. Cytokine storm was evidenced in COVID-19 patients at admission and repurposed treatment suppressed pro-inflammation cytokine (IFN-γ) in most discharged COVID-19 patients.