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Cerjak, Frances K. "PRE-ADMISSION PLANNING." Journal For Healthcare Quality 8, no. 1 (January 1986): 8–9. http://dx.doi.org/10.1111/j.1945-1474.1986.tb00248.x.
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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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Nasir, Syed Sameer, and Alva B. Weir. "ICU deaths in patients with advanced cancer: Criteria to decrease potentially inappropriate admissions and analysis of advance planning discussions." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 47. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.47.
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47 Background: A significant number of advanced cancer admissions to intensive care unit (ICU) are inappropriate, as they do not prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. Methods: We established four criteria for ICU admissions in advanced cancer patients: post procedure complication, recent cancer diagnosis, good performance status and life expectancy of > 6 months. We reviewed charts of all patients who died in the ICU at a university-affiliated hospital between 2005-2010. We then identified advanced cancer patients and looked for presence or absence of these criteria. We also reviewed evidence of advance planning discussions (APDs), prior to ICU admission to evaluate their benefit in preventing inappropriate admissions. Results: 421 deaths occurred in ICU between 2005-2010. 52 patients had advanced cancer. 27% were diagnosed with cancer one month or less prior to admission. 40% had ECOG performance status of 0-1. 27% had life expectancy of more than 6 months and 15% were admitted for post procedure complications. Overall, 37% did not satisfy any of our reasonable criteria at the time of ICU admission. In our chart review for evidence of APDs, 31% had completed APDs prior to ICU admission. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs indicating desire for limited medical intervention. Patients lacking both reasonable admission criteria and APDs were 15%. Conclusions: Incorporating proposed admission criteria in ICU admission guidelines may prevent significant number of inappropriate, advanced cancer admissions to the ICU, thus avoiding ineffective, aggressive interventions and delay in timely access to high-quality hospice and palliative care. Our data confirms other data in suggesting that a simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions. [Table: see text]
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Bennett, D. Tyson, Homer “Bucky” Wesley, and Marion Dana-Wesley. "Planning for Imminent Change in College Admissions: Research on Alternative Admission Criteria." Journal of College Student Retention: Research, Theory & Practice 1, no. 1 (May 1999): 83–92. http://dx.doi.org/10.2190/rkjd-gx0l-kbqa-bpax.
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Larson, S. M. "416: Multidiscliplinary Intervention of Admission Planning." Biology of Blood and Marrow Transplantation 14, no. 2 (February 2008): 149. http://dx.doi.org/10.1016/j.bbmt.2007.12.426.
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Li, Jialing, Li Luo, and Guiju Zhu. "Patient Mix Optimization in Admission Planning under Multitype Patients and Priority Constraints." Computational and Mathematical Methods in Medicine 2021 (March 18, 2021): 1–13. http://dx.doi.org/10.1155/2021/5588241.
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Hospital beds are one of the most critical medical resources. Large hospitals in China have caused bed utilization rates to exceed 100% due to long-term extra beds. To alleviate the contradiction between the supply of high-quality medical resources and the demand for hospitalization, in this paper, we address the decision of choosing a case mix for a respiratory medicine department. We aim to generate an optimal admission plan of elective patients with the stochastic length of stay and different resource consumption. We assume that we can classify elective patients according to their registration information before admission. We formulated a general integer programming model considering heterogeneous patients and introducing patient priority constraints. The mathematical model is used to generate a scientific and reasonable admission planning, determining the best admission mix for multitype patients in a period. Compared with model II that does not consider priority constraints, model I proposed in this paper is better in terms of admissions and revenue. The proposed model I can adjust the priority parameters to meet the optimal output under different goals and scenarios. The daily admission planning for each type of patient obtained by model I can be used to assist the patient admission management in large general hospitals.
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Bishop-Williams, Katherine, Lea Berrang-Ford, Jan Sargeant, David Pearl, Shuaib Lwasa, Didacus Namanya, Victoria Edge, et al. "Understanding Weather and Hospital Admissions Patterns to Inform Climate Change Adaptation Strategies in the Healthcare Sector in Uganda." International Journal of Environmental Research and Public Health 15, no. 11 (October 29, 2018): 2402. http://dx.doi.org/10.3390/ijerph15112402.
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Background: Season and weather are associated with many health outcomes, which can influence hospital admission rates. We examined associations between hospital admissions (all diagnoses) and local meteorological parameters in Southwestern Uganda, with the aim of supporting hospital planning and preparedness in the context of climate change. Methods: Hospital admissions data and meteorological data were collected from Bwindi Community Hospital and a satellite database of weather conditions, respectively (2011 to 2014). Descriptive statistics were used to describe admission patterns. A mixed-effects Poisson regression model was fitted to investigate associations between hospital admissions and season, precipitation, and temperature. Results: Admission counts were highest for acute respiratory infections, malaria, and acute gastrointestinal illness, which are climate-sensitive diseases. Hospital admissions were 1.16 (95% CI: 1.04, 1.31; p = 0.008) times higher during extreme high temperatures (i.e., >95th percentile) on the day of admission. Hospital admissions association with season depended on year; admissions were higher in the dry season than the rainy season every year, except for 2014. Discussion: Effective adaptation strategy characteristics include being low-cost and quick and practical to implement at local scales. Herein, we illustrate how analyzing hospital data alongside meteorological parameters may inform climate-health planning in low-resource contexts.
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SULLIVAN, MICHELE G. "With Hyperglycemia, Start Discharge Planning at Admission." Hospitalist News 4, no. 7 (July 2011): 8. http://dx.doi.org/10.1016/s1875-9122(11)70136-5.
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Hendrix, Robert A., Aliya Ferouz, and Charles K. Bacon. "Admission Planning and Complications of Direct Laryngoscopy." Otolaryngology–Head and Neck Surgery 110, no. 6 (June 1994): 510–16. http://dx.doi.org/10.1177/019459989411000607.
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Increasingly, third party payers are challenging the necessity of a hospital admission for endoscopic procedures. Direct laryngoscopy (DL), with or without open, rigid esophagoscopy or flexible, fiberoptic bronchoscopy, was evaluated for the incidence of perioperative complications and associated risk factors. A retrospective review of 200 in-patient admissions between 1987 and 1990 for direct laryngoscopy or panendoscopy is presented. Complications were classified as major for untoward events that required hospitailzation for proper management. Complications were otherwise considered minor. The incidence of major complications was at least 19.5%, with minor complications occurring in 21% of patients. The total population was partitioned into subsets according to the occurrence of major complications, minor complications, and no complications. For the total population and each subset, distributions were developed by age, sex, habitus, physical status level, diagnosis of molignancy, presence of a malignant lesion in the aerodigestive tract, or medical history of head and neck surgery or radiation therapy. Statistical analysis indicates that these parameters do not offer reliable predictors of which patients are at risk for minor or major complications. It is concluded that all patients who undergo direct laryngoscopy are most safety managed in an in-hospital setting for a period on the order of 24 hours.
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Hulshof, Peter J. H., Martijn R. K. Mes, Richard J. Boucherie, and Erwin W. Hans. "Patient admission planning using Approximate Dynamic Programming." Flexible Services and Manufacturing Journal 28, no. 1-2 (April 18, 2015): 30–61. http://dx.doi.org/10.1007/s10696-015-9219-1.
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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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Riise, Atle, and Edmund K. Burke. "Local search for the surgery admission planning problem." Journal of Heuristics 17, no. 4 (September 11, 2010): 389–414. http://dx.doi.org/10.1007/s10732-010-9139-x.
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Zheng, Wei, and Rizos Sakellariou. "Budget-Deadline Constrained Workflow Planning for Admission Control." Journal of Grid Computing 11, no. 4 (May 23, 2013): 633–51. http://dx.doi.org/10.1007/s10723-013-9257-4.
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Heng, Joseph, Ramy Sedhom, and Thomas J. Smith. "Advance care planning and terminal intensive care unit admissions for cancer patients: We can do better." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23000-e23000. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23000.
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e23000 Background: Terminal oncology intensive care unit (ICU) admissions are associated with high healthcare costs and decreased quality of life. Chemotherapy can be given in non-curative settings to optimize symptom control, but use of it at the end of life does not improve longevity. In addition, goals of care are too often not addressed for patients at high risk of death. Methods: We carried out a retrospective review identifying patients of a large academic cancer center who were admitted to and expired in an ICU between January 1, 2017 to December 31, 2018. Results: 120 patients met inclusion criteria. Median age was 58 years. Only 15.0% (n = 18) of all patients had advance directives. The majority of patients (94.1%, n = 113) were FULL CODE on admission. Median duration of admission was 10 days. Median time to death from ICU admission was 7.5 days. 65.0% (n = 78) of all patients were intubated, while 15.0% (n = 15) received CPR. 58.3% (n = 70) of the study population had solid malignancies; of note, 97.1% (n = 68) of these patients were metastatic at presentation and had a median ECOG performance status of 2. Patients with metastatic solid tumors typically have a more indolent course of progression compared to patients with hematologic malignancies. However, only 23.5% (n = 16) had discussed goals of care or code status with their outpatient oncologists, despite many seeing them within the last month prior to admission (83.8%, n = 57). Similarly, only 4.0% (n = 2) of patients with hematologic malignancies had advance care planning discussions with their oncologists prior to their terminal ICU admission. 27.5% (n = 33) of all patients had an inpatient palliative care consult. The inpatient pulmonary/critical care team had a high rate of inpatient code status transitions, with 85.6% (n = 97) of FULL CODE admissions transitioning to DNR/DNI. Conclusions: These findings reflect contemporary practice at a major academic cancer center. Despite most patients having regular contact with their outpatient oncologists, the intensity of health care utilization noted highlights a need to optimize recognition of patients at high risk of death and to engage patients in advance care planning discussions to avoid terminal ICU admissions.
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Munang, L. A., J. H. W. Rimer, K. Ralston, L. Kirby, K. Robertson, and S. Box. "164 Standardised Anticipatory Care Planning in Care Homes Reduces Unscheduled Hospital Admissions." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.125.
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Abstract Background Anticipatory care planning (ACP) is a proactive person-centred approach for “thinking ahead”, exploring and recording a person’s goals and preferred actions when their health deteriorates. As a key part of Comprehensive Geriatric Assessment of frail patients, care home (CH) residents would benefit from ACP. Introduction West Lothian has 16 care homes with 853 residents. Between Oct—Dec 2017, 5.21% of CH residents were admitted to hospital each month. Some of these admissions could have been avoided had there been robust ACP in place. Methods In 2017 West Lothian Health and Social Care Partnership appointed a GP lead for Care Homes. Through standardising ACP for CH residents, the goal was to improve the pathway for managing medical emergencies and reduce unnecessary unscheduled care calls and admissions. In 2019 this role was taken over by a team of 2WTE Advanced Nurse Practitioners and 1WTE Staff Nurse. Outcome measures include hospital admission rates, number of ACPs in place and uptake of ACP training amongst CH staff. Interventions In collaboration with the Medicine of the Elderly Department at St John’s Hospital, a standardised ACP Summary document was developed for use in all CHs. A medical advice and emergency flowchart was created to reduce unnecessary hospital admissions. An continuous education programme was delivered across all CH staff to facilitate and implement this. Results Medical admission rates from CHs have decreased by 60% from 6 to 2.2 admissions per week. The largest reduction is in CHs with full ACP use. Conclusions Standardised ACP significantly reduces the number of medical admissions. Continuous education and training is crucial in maintaining its implementation, and ensuring its routine use throughout CHs in West Lothian.
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Sularto, Sularto, Wahyudi Wahyudi, and Sukmawati Sukmawati. "The Admission of New Students Based on Online System at SMAN 2 Singkawang." JETL (Journal Of Education, Teaching and Learning) 3, no. 2 (September 1, 2018): 336. http://dx.doi.org/10.26737/jetl.v3i2.772.
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<p>The application of online-based student admission aims to provide the widest possible opportunity for every citizen to obtain a fast, transparent and accountable registration service. The purpose of the research carried out at the State Senior High School 2 Singkawang (SMAN 2 Singkawang) was to describe the online-based prospective student admission planning at SMAN 2 Singkawang, organizing admissions based on online students at SMAN 2 Singkawang, the implementation of prospective participants online-based students at SMAN 2 Singkawang, online admission supervision of prospective students at SMAN 2 Singkawang, as well as an online evaluation of new student candidates at SMAN 2 Singkawang. The approach used in this study is qualitative research on the type of case study research. The results of the research that have been conducted include 1) Planning the recruitment process of online-based prospective students conducted by the agency and the school; 2) Organizing in the acceptance of new students through the division of committee work; 3) Implementation of new online-based student admissions is carried out in accordance with existing technical instructions; 4) Supervision carried out in new student admission activities is carried out by the principal as the head of the education unit and also as the person in charge of the activity; 5) On this online-based new student admission activity, it has run well. But there are those that are the main focus of supporting activities are the internet and electricity networks, so that these two facilities must be ensured in good condition.</p>
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Brodsky, Max A., Brandi L. McClain, Jeannie Byrd, Dionna O. Roberts, Brittany Danielle Melvin, Mark Rodeghier, Michael R. DeBaun, and Adetola A. Kassim. "Risk Factors for 30-Day Re-Admission in Adults with Sickle Cell Disease." Blood 124, no. 21 (December 6, 2014): 4086. http://dx.doi.org/10.1182/blood.v124.21.4086.4086.
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Abstract Background: Re-admission to the hospital within 30 days is a measure for quality care and a point of emphasis for reducing health care costs in individuals with chronic disease. Potentially modifiable risk factors for 30 day re-admission in children with sickle cell disease (SCD) includes not being seen in the SCD clinic within 30-days of discharge (OR 7.7, 95% CI 2.4–24.4), 3 or more admissions in the previous 12 months (OR 7.3, 95% CI 2.8–18.9) and co-morbid asthma (OR 2.9, 95% CI 1.2–7.3) (Pediatr Blood Cancer. 2009 Apr;52(4):481-5). Limited data exists regarding potentially modifiable risk factors for 30-day re-admission in adults with SCD. The primary objective of this study was to define modifiable risk factors for 30-day re-admission in adults with SCD, leading to a prospective intervention study to decrease re-admission rates. Procedure: At a tertiary care center, we performed a retrospective analysis of the medical records, from 2010 to 2013, to determine risk factors for 30-day re-admission in adults with SCD. Initial admission was defined as the first admission associated with uncomplicated vaso-occlusive pain episode in each focus year (2011- 2013). To decrease bias associated with multiple admissions from the same individual, the first admission for vaso-occlusive pain in each year was evaluated as the index admission for each record. Cases and controls were defined as adults with SCD initially admitted for pain and subsequently re-admitted to the hospital within 30 days of the initial admission. A multi-variable logistic regression analysis was performed on seven postulated risk factors. All data was collected and double checked by a single reviewer, and at least 10% of the chart was checked by a medical student for further assurance of accuracy. Results : A total of 158 first admissions and 49 re-admissions (31%) were evaluated. The mean age of the cohort was 30.38 (IQR 13.55 years). The median time to re-admission was 10 days (IQR 19 days). Approximately 50% of the cohort was not evaluated in the outpatient setting by the hematology team within 30 days post-discharge. Upon discharge patients either were not given a follow up appointment (35%) or were given an appointment beyond 30 days of discharge (13%). Only two predictors were significantly associated with re-admission within 30 days: not having a primary care provider listed in the electronic medical record (odds ratio 0.35, 95% CI 0.146-0.858; p = 0.022) and the number of hospital admissions due to vaso-occlusive pain in the prior year (odds ratio 1.28, 95% confidence interval 1.15-1.42; p < 0.001), table and figure below. Five covariates were not significantly associated with re-admission within 30 days: age (odds ratio 0.982, 95% CI 0.94-1.02; p = 0.369), sex (odds ratio 0.715, 95% CI 0.28-1.81, p =0.481), hemoglobin phenotype (odds ratio 0.50, 95% CI 0.19-1.287; p = 0.15), median lifetime oxygen saturation (odds ratio 0.892, 95% CI 0.75-1.05; p = .186), and presence of government insurance (odds ratio 1.90, 95% CI 0.67-5.37; p =0.222). Conclusions: Not having a primary care provider listed in the electronic medical record and multiple admissions in the prior year are potentially modifiable risk factors for re-admission within 30 days in adults with SCD. In addition, discharge planning with a hematology visit scheduled within a week of discharge may also impact the 30-day re-admission rate. We recently introduced a strategy focused on improved discharge planning, ensuring a primary care provider for every adult patient with SCD and targeted therapeutic intervention for those with high admissions. Table: Multivariable analysis of risk factors for 30-day re-admission in adults with sickle cell disease over a course of 3 years. A total of 158 admissions were evaluated with 31% being re-admissions within 30 days. Sig. Odds ratio 95% C.I.for EXP(B) Lower Upper Age Upon Admission to the Hospital 0.369 0.982 0.944 1.021 Sex 0.481 0.715 0.281 1.817 Hemoglobin Phenotype 0.152 0.504 0.197 1.287 Median Lifetime Oxygen Saturation Level 0.186 0.892 0.753 1.057 Primary Care Provider 0.022 0.354 0.146 0.858 Government Insurance 0.222 1.907 0.676 5.378 Number of Hospitalizations Due to Vaso-Occlusive Pain in the Prior Year 0.000 1.278 1.148 1.422 Figure. A graph depicting the predicted probablity of a re-admission within 30 days in indivdiuals with and without hospitalization versus the number of hospitalizations in the prior years. Figure. A graph depicting the predicted probablity of a re-admission within 30 days in indivdiuals with and without hospitalization versus the number of hospitalizations in the prior years. Disclosures No relevant conflicts of interest to declare.
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Sockolow, Paulina S., Kathryn H. Bowles, Carl Pankok, Yingjie Zhou, Sheryl Potashnik, and Ellen J. Bass. "Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern." Home Health Care Management & Practice 33, no. 3 (February 1, 2021): 193–201. http://dx.doi.org/10.1177/1084822321990775.
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During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days. We examined admissions nurses’ visit pattern decision-making and whether it is influenced by documentation available before and during the first home visit, agency standards, other disciplines being scheduled, and electronic health record (EHR) use. This observational mixed-methods study included admission document analysis, structured interviews, and a think-aloud protocol with 18 nurses from 3 diverse HHC agencies (6 at each) admitting 2 patients each (36 patients). Findings show that prior to entering the home, nurses had an information deficit; they either did not predict the patient’s visit frequency and episode duration or stated them based on experience with similar patients. Following patient interaction in the home, nurses were able to make this decision. Completion of documentation using the EHR did not appear to influence visit pattern decisions. Patient condition and insurance restrictions were influential on both frequency and duration. Given the information deficit at admission, and the delay in visit pattern decision making, we offer health information technology recommendations on electronic communication of structured information, and EHR documentation and decision support.
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Kieffer, WKM, DV Michalik, K. Gallagher, I. McFadyen, J. Bernard, and BA Rogers. "Temporal variation in major trauma admissions." Annals of The Royal College of Surgeons of England 98, no. 2 (February 2016): 128–37. http://dx.doi.org/10.1308/rcsann.2016.0040.
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Introduction Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. Methods Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. Results There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). Conclusions The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.
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Sidgwick, Peter, James Fraser, Peter-Marc Fortune, and Renee McCulloch. "Parallel planning and the paediatric critical care patient." Archives of Disease in Childhood 104, no. 10 (January 31, 2019): 994–97. http://dx.doi.org/10.1136/archdischild-2018-315222.
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A growing number of children with life-limiting conditions (LLCs) are being cared for in paediatric critical care (PCC) settings. Children with LLCs admitted to PCC are at a high risk of developing complications and many die after prolonged admissions. Relatively few of these patients and their parents or carers have had documented discussions about their wishes for care in the event of a serious clinical deterioration before admission to PCC. There is a need for improved understanding of (1) how parents arrive at decisions regarding what is best for their child at times of critical illness and (2) the role of parallel planning and advance care plans in that process. This review examines the complexities of decision-making in children with LLCs who are admitted to PCC settings.
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Zibelli, Allison, Katie Holland, and Emily Wei. "Causes of Cancer Re-Admissions: A Patient-Centered Approach." JCO Oncology Practice 16, no. 8 (August 2020): e734-e740. http://dx.doi.org/10.1200/jop.19.00518.
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PURPOSE: Patients with a cancer diagnosis have a high risk of re-admission during the 30 days after discharge. Clinicians, payers, and patients consider this to be an indicator of care quality. The causes of re-admission remain poorly understood. Retrospective chart reviews, used in most re-admission research, provide limited information regarding the causes of, and methods to reduce, re-admissions. This project sought to elicit the insights of those most affected by re-admission: the patients themselves. METHODS: We interviewed patients with cancer who were re-admitted to 2 urban teaching hospitals when they were hospitalized during their second admission. Trained interviewers used a semistructured interview guide to gather information on events just before the second admission, the patients’ understanding of the cause of re-admission, and the patients’ views about their readiness for discharge at the previous admission. Interviews were transcribed and analyzed, and themes were identified and explored. RESULTS: Three major themes were identified. First, most patients saw their re-admission as caused by problems that could not be treated in an outpatient setting. Second, the patients felt that they did not have sufficient resources at home to manage their care. Furthermore, the patients did not see the outpatient care team as a resource that they could call on for assistance. As a result, most of the decisions to return to the hospital were made by the patients themselves. CONCLUSION: The decision that leads to re-admission often happens at home, in response to unmanageable needs. Strengthening the bond between the care team and the patient, with the aim of providing care in the most appropriate setting, could decrease re-admissions in patients with cancer. Possible interventions include home visits, enhanced discharge planning, and telehealth services.
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Elam, Carol L., Daniel C. Seaver, Peter N. Berres, and Barbara F. Brandt. "An Overview of Admission Processes for Medical, Dental, Pharmacy, Physical Therapy, and Physician Assistant Programs." NACADA Journal 20, no. 1 (March 1, 2000): 24–32. http://dx.doi.org/10.12930/0271-9517-20.1.24.
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Advisors commonly meet with students interested in pursuing a career in a health profession. This paper addresses the admission processes used by medical, dental, pharmacy, physical therapy, and physician assistant programs. Advice on helping students gather information about the professions, seek health-related experience, and prepare academically competitive portfolios is presented. Admission procedures across the health professions are discussed, including the application timelines, as well as institutional use of standardized tests, interviews, and letters of evaluation to make selection decisions. By being better informed about the admissions process in the health professions, advisors can assist students in planning their undergraduate educational experiences.
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Bielinska, Anna-Maria, Stephanie Archer, Adetokunbo Obanobi, Gehan Soosipillai, Lord Ara Darzi, Julia Riley, and Catherine Urch. "Advance care planning in older hospitalised patients following an emergency admission: A mixed methods study." PLOS ONE 16, no. 3 (March 5, 2021): e0247874. http://dx.doi.org/10.1371/journal.pone.0247874.
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Introduction Although advance care planning may be beneficial for older adults in the last year of life, its relevance following an emergency hospitalisation requires further investigation. This study quantifies the one-year mortality outcomes of all emergency admissions for patients aged 70+ years and explores patient views on the value of advance care planning following acute hospitalisation. Method This mixed methods study used a two-stage approach: firstly, a quantitative longitudinal cohort study exploring the one-year mortality of patients aged 70+ admitted as an emergency to a large multi-centre hospital cohort; secondly, a qualitative semi-structured interview study gathering information on patient views of advance care planning. Results There were 14,260 emergency admissions for 70+-year olds over a 12-month period. One-year mortality for admissions across all conditions was 22.6%. The majority of these deaths (59.3%) were within 3 months of admission. Binary logistic regression analysis indicated higher one-year mortality with increasing age and male sex. Interviews with 20 patients resulted in one superordinate theme, “Planning for health and wellbeing in the spectrum of illness”. Sub-themes entitled (1) Advance care planning benefitting healthcare for physical and psycho-social health, (2) Contemplation of physical deterioration death and dying and 3) Collaborating with healthcare professionals to undertake advance care planning, suggest that views of advance care planning are shaped by experiences of acute hospitalisation. Conclusion Since approximately 1 in 5 patients aged 70+ admitted to hospital as an emergency are in the last year of life, acute hospitalisation can act as a trigger for tailored ACP. Older hospitalised patients believe that advance care planning can benefit physical and psychosocial health and that discussions should consider a spectrum of possibilities, from future health to the potential of chronic illness, disability and death. In this context, patients may look for expertise from healthcare professionals for planning their future care.
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Chung, Alexandria, Rachel M. Reeves, Harish Nair, Harry Campbell, Rachel M. Reeves, You Li, Harry Campbell, et al. "Hospital Admission Trends for Bronchiolitis in Scotland, 2001–2016: A National Retrospective Observational Study." Journal of Infectious Diseases 222, Supplement_7 (August 14, 2020): S592—S598. http://dx.doi.org/10.1093/infdis/jiaa323.
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Abstract Background Bronchiolitis is the commonest cause of respiratory related hospital admissions in young children. This study aimed to describe temporal trends in bronchiolitis admissions for children under 2 years of age in Scotland by patient characteristics, socioeconomic deprivation, and duration of admission. Methods The national hospital admissions database for Scotland was used to extract data on all bronchiolitis admissions (International Classification of Disease, Tenth Revision, code J21) in children <2 years of age from 2001 to 2016. Deprivation quintiles were classified using the 2011 Scottish Index of Multiple Deprivation. Results Over the 15-year study period, admission rates for children under 2 years old increased 2.20-fold (95% confidence interval [CI], 1.4–3.6-fold) from 17.2 (15.9–18.5) to 37.7 (37.4–38.1) admissions per 1000 children per year. Admissions peaked in infants aged 1 month, and in those born in the 3 months preceding the peak bronchiolitis month—September, October, and November. Admissions from the most-deprived quintile had the highest overall rate of admission, at 40.5 per 1000 children per year (95% CI, 39.5–41.5) compared with the least-deprived quintile, at 23.0 admissions per 1000 children per year (22.1–23.9). The most-deprived quintile had the greatest increase in admissions over time, whereas the least-deprived quintile had the lowest increase. Zero-day admissions, defined as admission and discharge within the same calendar date, increased 5.3-fold (5.1–5.5) over the study period, with the highest increase in patients in the most-deprived quintile. Conclusions This study provides baseline epidemiological data to aid policy makers in the strategic planning of preventative interventions. With the majority of bronchiolitis caused by respiratory syncytial virus (RSV), and several RSV vaccines and monoclonal antibodies currently in clinical trials, understanding national trends in bronchiolitis admissions is an important proxy for determining potential RSV vaccination strategies.
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Batista, Ana, Jorge Vera, and David Pozo. "Multi-objective admission planning problem: a two-stage stochastic approach." Health Care Management Science 23, no. 1 (January 15, 2019): 51–65. http://dx.doi.org/10.1007/s10729-018-9464-4.
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Adan, I. J. B. F., and J. M. H. Vissers. "Patient mix optimisation in hospital admission planning: a case study." International Journal of Operations & Production Management 22, no. 4 (April 2002): 445–61. http://dx.doi.org/10.1108/01443570210420430.
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COID, J., N. KAHTAN, A. COOK, S. GAULT, and B. JARMAN. "Predicting admission rates to secure forensic psychiatry services." Psychological Medicine 31, no. 3 (April 2001): 531–39. http://dx.doi.org/10.1017/s003329170100366x.
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Background. The planning and development of secure forensic psychiatry services for mentally disordered offenders in England and Wales has proceeded independently within different regional areas. However, certain mental disorders, offenders, and offending behaviour are all more prevalent in geographical areas characterized by socio-economic deprivation and social disorganization. Failure to consider these factors has led to inadequate service provision in some areas and inequity in funding. A new model is required to predict admissions to these services as an aid to resource allocation.Method. Actual admissions (N=3155) to high and medium secure psychiatric services for seven of 14 (pre-reorganization) Regional Health Authorities, 1988–94. Expected admissions were calculated for each district using 1991 census data adjusted for under-enumeration. Standardized psychiatric admission ratios were calculated and a range of social, health status, and service provision data were used as explanatory variables in a regression analysis to determine variation between districts.Results. Actual psychiatric admissions varied from 160% above to 62% below expected for age, sex, and marital status, according to patients' catchment area of origin, measured according to deciles of the distribution of underprivileged area scores at ward level. The most powerful explanatory variables included a composite measure of social deprivation, ethnicity and availability of low secure beds at regional level.Conclusion. Admission rates to secure forensic psychiatry services demonstrate a linear correlation with measures of socio-economic deprivation in patients catchment area of origin. A model was developed to predict admissions from District Health Authorities and is recommended for future use in resource allocation. Identification of factors that explain higher admission rates of serious offenders with mental disorder from deprived areas is a priority for future research.
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Ideon, Erge, and Eve Aruvee. "Mathematics Admission Test Remarks." Rural Sustainability Research 36, no. 331 (December 1, 2016): 4–9. http://dx.doi.org/10.1515/plua-2016-0007.
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Abstract Since 2014, there have been admission tests in mathematics for applicants to the Estonian University of Life Sciences for Geodesy, Land Management and Real Estate Planning; Civil Engineering; Hydraulic Engineering and Water Pollution Control; Engineering and Technetronics curricula. According to admission criteria, the test must be taken by students who have not passed the specific mathematics course state exam or when the score was less than 20 points. The admission test may also be taken by those who wish to improve their state exam score. In 2016, there were 126 such applicants of whom 63 took the test. In 2015, the numbers were 129 and 89 and in 2014 150 and 47 accordingly. The test was scored on scale of 100. The arithmetic average of the score was 30.6 points in 2016, 29.03 in 2015 and 18.84 in 2014. The test was considered to be passed with 1 point in 2014 and 20 points in 2015 and 2016. We analyzed test results and gave examples of problems which were solved exceptionally well or not at all.
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Frederick, C., and AN Hotter. "Discharge planning for the head-injured patient." Critical Care Nurse 11, no. 6 (June 1, 1991): 42–45. http://dx.doi.org/10.4037/ccn1991.11.6.42.
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Galeas, Jose Nahun, Stuart H. Packer, Susan Sakalian, Royston Browne, and Adam Binder. "Decreasing initiation of chemotherapy time in elective patients admitted to an inpatient hematology malignancy unit." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 120. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.120.
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120 Background: At our institution, we observed that 86% (n = 25) of patients admitted for elective chemotherapy experienced a delay (greater than 6 hours) in initiating their treatment. Methods: We measured time from admission to chemotherapy administration (Defined from time of vital signs taken at admission until time of chemotherapy administration) in patients admitted for elective chemotherapy. Key process measures were identified and monitored (i.e, time from admission to laboratory exam results, time from admission to chemotherapy signed, time from chemotherapy signed to chemotherapy released by nurse from the EMR). We collected data every two weeks. After collecting data and utilizing performance improvement tools such as a pareto chart and PICK chart, we developed multiple PDSA cycles as described in Table 1. Results: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 25 hours to 8.85 hours. Median time to lab draws decreased from 2.33 hours to -0.63 hours. There was no change in time from signature to nurse releasing the chemotherapy. We noticed more providers were signing the chemotherapy prior to patient admission and more patients were receiving pre-admission alkalinization strategies. Conclusions: By implementing new admission workflows, optimizing our use of the EMR to communicate among providers, and improving pre-admission planning we were able to reduce our time to chemotherapy for elective admissions by 64.6%. Improvement still needed to meet our goals and fully standardize the processes as part of our daily workflow.[Table: see text]
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Hulshof, Peter J. H., Richard J. Boucherie, Erwin W. Hans, and Johann L. Hurink. "Tactical resource allocation and elective patient admission planning in care processes." Health Care Management Science 16, no. 2 (January 4, 2013): 152–66. http://dx.doi.org/10.1007/s10729-012-9219-6.
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Wrigley, Heather, Lauren Standerwick, Trevor Chan, Sunita Ghosh, and Jessica Simon. "Patient Acceptance of Advance Care Planning Guidebook Distribution at Hospital Admission." Journal of Palliative Medicine 19, no. 7 (July 2016): 690–91. http://dx.doi.org/10.1089/jpm.2016.0096.
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Cohen, Daniel H. "Hospital Status Admission Determination." Professional Case Management 17, no. 6 (2012): 258–64. http://dx.doi.org/10.1097/ncm.0b013e31825df850.
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&NA;. "Hospital Status Admission Determination." Professional Case Management 17, no. 6 (2012): 265–66. http://dx.doi.org/10.1097/ncm.0b013e318270ba33.
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McFeely, Aoife, Cliona Small, Susan Hyland, Jonathan O'Keeffe, Graham Hughes, and Diarmuid O'Shea. "309 The Growing Need for Advance Care Planning Discussion: An Admission to Die for?" Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.199.
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Abstract Background Older people living in nursing homes (NHs) are among the most frail and vulnerable in our community. Over the last 5 years, a review of our local NH admission database revealed a 7% increase in the number of unscheduled hospital attendances from NHs (1015 in 2012/13 vs 1435 in 2016/17). Additionally we have seen an increase in the number of NH residents experiencing ≥2 unscheduled re-admissions within one year (21.1% in 2012/13 vs 30.45% in 2016/17). Our aim was to examine the proportion of patients from NHs who died within 24 hours of presentation, prompting a review of methods that could prevent inappropriate hospital transfers and promoting dignified and comfortable end of life care. Methods A prospective database was collected between 01/01/2016 - 31/12/2017. This recorded all emergency admissions of older people from NHs recording length of stay, readmission rates and mortality. The data was retrospectively analysed, looking specifically at patients who died in hospital ≤ 24 hours Results Of 1435 ED admissions, 49 patients (3.4%) died in hospital ≤ 24 hours after presentation. Of these, 31 patients (61%) died in palliative care suites. 8 patients (16.3%) died in the ED. Conclusion A small number of NH residents presenting to our hospital died within 24 hours. A large proportion of these patients died in a palliative care suite, suggesting poor prognosis was identified rapidly after presentation. We wonder if some of these hospital transfers were avoidable and could certain patients have experienced less disruptive deaths in their NHs? Advanced Care Planning can be difficult for all involved. However, it plays an essential role in ensuring people receive the right care, at the right time, in the right place, from the right team. We support the collaborative roles of a palliative care CNS or Geriatric ANP, and integration with NH Outreach services, to facilitate early decision-making and promote better end of life care.
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El-Quliti, Said Ali, Abdul Hamid Mohamed Ragab, Reda Abdelaal, Ali Wagdy Mohamed, Abdulfattah Suliman Mashat, Amin Yousef Noaman, and Abdulrahman Helal Altalhi. "A Nonlinear Goal Programming Model for University Admission Capacity Planning with Modified Differential Evolution Algorithm." Mathematical Problems in Engineering 2015 (2015): 1–13. http://dx.doi.org/10.1155/2015/892937.
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This paper proposes a nonlinear Goal Programming Model (GPM) for solving the problem of admission capacity planning in academic universities. Many factors of university admission capacity planning have been taken into consideration among which are number of admitted students in the past years, total population in the country, number of graduates from secondary schools, desired ratios of specific specialties, faculty-to-students ratio, and the past number of graduates. The proposed model is general and has been tested at King Abdulaziz University (KAU) in the Kingdom of Saudi Arabia, where the work aims to achieve the key objectives of a five-year development plan in addition to a 25-year future plan (AAFAQ) for universities education in the Kingdom. Based on the results of this test, the proposed GPM with a modified differential evolution algorithm has approved an ability to solve general admission capacity planning problem in terms of high quality, rapid convergence speed, efficiency, and robustness.
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Smith, Thomas E., Morgan Haselden, Tom Corbeil, Fei Tang, Marleen Radigan, Susan M. Essock, Melanie M. Wall, et al. "Relationship Between Continuity of Care and Discharge Planning After Hospital Psychiatric Admission." Psychiatric Services 71, no. 1 (January 1, 2020): 75–78. http://dx.doi.org/10.1176/appi.ps.201900233.
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Smith, Alexander K., Angela Poppe Ries, Baohui Zhang, James A. Tulsky, Holly G. Prigerson, and Susan D. Block. "Resident Approaches to Advance Care Planning on the Day of Hospital Admission." Archives of Internal Medicine 166, no. 15 (August 14, 2006): 1597. http://dx.doi.org/10.1001/archinte.166.15.1597.
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Hasan, M. Shameem, Sanat Kumar Barua, M. Nasiruddin Mahmud, AHM Kamal, M. Enayetullah, and M. Rezaul Karim. "Disease Profile and Death Pattern Among Children Admitted in a Medical College Hospital." Bangladesh Journal of Child Health 36, no. 2 (December 22, 2012): 66–70. http://dx.doi.org/10.3329/bjch.v36i2.13081.
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Background: An understanding of epidemiological trend in hospital admissions, including diseases and death pattern, is critical for health care planning, appropriate resource allocation & improving existing services facilities. Objectives: To evaluate the disease and death pattern of children admitted in the department of Child Health, Chittagong Medical College Hospital (CMCH), Chittagong. Materials and Methods: This was a retrospective study. The case records of all patients admitted in the department from Jan 1, 2008 to Dec 31, 2010 were analyzed. Result: Total 38,692 children were admitted during this study period; among them total 1897(4.9%) patient died. Infant and under five age groups constitute 45.2% and 75.9% respectively, total admission whereas deaths from the same groups were 43.7% & 79.3% respectively. Bronchopneumonia (22%), acute watery diarrhea (15%), hereditary hemolytic anemia (12%), and bronchiolitis (10%), topped the first four positions in each of the three years of admission. Septicemia and encephalitis, with a case fatality rate of 24% and 35% respectively, were found as top two causes of death. Highest case fatality rate was found in hepatic encephalopathy (54%). Other common causes of death include meningitis (19%), severe malaria (21%), leukemia (22%), severe malnutrition with complications (11%), and congenital heart diseases (12%) Conclusion: Comprehensive evaluation of admission and death related findings of this study will help to determine possible gaps in patient care and planning for more effective case-management strategies. DOI: http://dx.doi.org/10.3329/bjch.v36i2.13081 Bangladesh J Child Health 2012; VOL 36 (2) : 66-70
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Ansari, Zahid, Norman Carson, Adrian Serraglio, Toni Barbetti, and Flavia Cicuttini. "The Victorian Ambulatory Care Sensitive Conditions Study: reducing demand on hospital services in Victoria." Australian Health Review 25, no. 2 (2002): 71. http://dx.doi.org/10.1071/ah020071.
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Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable ifpreventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare systemin Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12 100 admissions for diabetes complicationsin Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using theseindicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.
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Soomro, G. Mustafa, Tom Burns, and Azeem Majeed. "Socio-economic deprivation and psychiatric referral and admission rates – an ecological study in one London borough." Psychiatric Bulletin 26, no. 5 (May 2002): 175–78. http://dx.doi.org/10.1192/pb.26.5.175.
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AIMS AND METHODWe retrospectively investigated the association between the Jarman and Townsend indices of deprivation and referral rates to community mental health teams (CMHTs) and in-patient admissions rates, including the contribution of general practice factors to these rates. The samples consisted of all community/out-patient referrals and admissions to four CMHTs over 1 year.RESULTSLow positive correlation was found between community/out-patient referral rates for all diagnoses and psychosis with the Jarman index, and between both the indices and admission rates for all diagnoses and non-psychosis. Referrals from general practitioners (GPs) varied nearly 40-fold and were not related to either indices, fundholding status or having practice manager or practice nurse.CLINICAL IMPLICATIONSOverall, the Jarman index appears to be a more useful index for planning psychiatric service provision. However, because of the small correlation with referral and admission rates, deprivation indices in themselves would be of limited value, as there may be other relevant factors that require investigating. GP characteristics investigated did not predict referral rates.
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Miano, Wendy Rowehl, Paula Silverman, Frank Colella, Bernadette McQuigg, Heather Hines, Santina Ciarallo, Lalena Whittington, and Sarah Belcher. "Elective chemotherapy admission pilot and work-flow improvements to reduce excess days." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 101. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.101.
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101 Background: The Inpatient (Inpt) Oncology Service at University Hospitals Seidman Cancer Center, a large urban academic NCI Comprehensive Cancer Center was charged with identifying opportunities to link patient (pt) quality improvement and decreased length of stay (LOS) in pts admitted for elective chemotherapy (EC). Historically, EC admissions were delayed due to pt variables, inpt bed availability, and chemotherapy order entry errors. Often chemotherapy was not initiated until late evening on day of admission, resulting in increased LOS. Safety concerns associated with late starts included fewer pharmacy resources, lower nurse/pt ratio, and no onsite APRN. Methods: A 2-month pilot was conducted, using an intervention group (IG) and control (C) group representing usual care (UC). The IG group was a subset with oropharyngeal pts and C group, all other EC admissions. Pre-registration and bed placement processes were reviewed. Workflow changes for IG included chemotherapy order set entered in electronic medical record 48 hours before admission, labs drawn day before admission, and weekly huddle including admitting, inpt and outpatient (Outpt) teams to review upcoming week’s admissions. IG pts were pre-scheduled for am admission. Inpt oncology services incorporated admissions into morning workflow. Census was taken above cap to accommodate IG patients. Time parameters were tracked from point of pt arrival in Admitting to initiation of EC. Results: There were 32 pts in the 2-month pilot study; 14 in the IG and 9 in UC. Mean admit time was 0900 (range 0730-1030) for IG and 1200 noon (range 1000-1600) for UC. Initiation of EC before 1500 occurred in 93% of IG compared to 11% of UC pts. This resulted in an average decreased LOS for IG of 1.1 day compared to UC. Pt and family comments included appreciation of predictable admit time and LOS. Conclusions: Because of the 8-week pilot success, these EC workflow changes have been implemented across Oncology services. Weekly huddles and coordination of clinical services across inpt and outpt settings continue to show advantage of proactive planning and troubleshooting before the day of EC admission. More importantly, EC pt safety and experience has improved with these work-flow changes.
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Prater, Laura C., Thomas Wickizer, Julie K. Bower, and Seuli Bose-Brill. "The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice?" American Journal of Hospice and Palliative Medicine® 36, no. 12 (May 14, 2019): 1089–95. http://dx.doi.org/10.1177/1049909119848987.
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Purpose: This study aimed to determine the impact of advanced care planning (ACP) on potentially avoidable hospital admissions at the end of life (EOL) among a sample of hospice-referred patients with cancer, in order to present actionable considerations for the practicing clinician. Methods: This study was designed as a retrospective cohort using electronic health record data that assessed likelihood of hospital admissions in the last 30 days of life for 1185 patients with a primary diagnosis of cancer, referred to hospice between January 1, 2014, and December 31, 2015, at a large academic medical center. Inverse probability treatment weighting based on calculated propensity scores balanced measured covariates between those with and without ACP at baseline. Odds ratios (ORs) were calculated from estimated potential outcome means for the impact of ACP on admissions in the last 30 days of life. Results: A verified do-not-resuscitate (DNR) order prior to the last 30 days of life was associated with reduced odds of admission compared to those without a DNR (OR = 0.30; P < .001). An ACP note in the problem list prior to the last 30 days of life was associated with reduced odds of admission compared to those without an ACP note (OR = 0.71, P = .042), and further reduced odds if done 6 months prior to death (OR = 0.35, P < .001). Conclusions: This study shows that dedicated ACP documentation is associated with fewer admissions in the last 30 days of life for patients with advanced cancer referred to hospice. Improving ACP processes prior to hospice referral holds promise for reducing EOL admissions.
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Kurian, Christine, Jennifer Hong, Andrea Sweeney, Laetitia N'Dri, Karen Walsh, and Adam Binder. "Evaluating risk characteristics for patients who die within 30 days of hospitalization." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 161. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.161.
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161 Background: Advanced cancer patients often receive aggressive end of life care despite questionable benefit. As a result, there are ongoing efforts to improve end of life care and coordinate palliative care supportive services. This study is an expansion of a previous study performed examining descriptive data in a population of oncology patients who died within 30 days of admission. Here, we compare patients who died within 30 days of admission against those who survived to evaluate differences in patient characteristics and healthcare utilization. Methods: Adult oncology patients who were admitted from 10/1/2018-3/30/2019 at an academic medical center were evaluated. Two groups of patients were studied–oncology patients who died within thirty days of admission and those who survived. The patients were selected using ICD-10 codes, EMR systems support, and manual chart review. Additionally, we examined demographic (i.e. gender, ethnicity, cancer diagnosis) and clinical characteristics (i.e. level of care, code status, previous palliative care consult, palliative care consult in the hospital, nutrition status, clinical trial status, advance care planning, hospice enrollment). Statistical analysis included chi-squared and ANOVA tests, and logistic regression models. Results: A total of 267 patients were included in the analysis. For all patients in the study, 38% had a change in code status during their admission. 26% of patients had palliative care involvement and 23% were known to palliative care prior to admission. Twenty three percent spent the duration of their admission in the ICU for their end of life care. Significant mortality-level variation was found compared to overall mean number of admissions for the past 6 months (ANOVA F=25.3, p<0.0001). We conducted a logistic regression and adjusted for ethnicity, number of admits in the last 6 months, and length of stay to identify the outcome of patients who died within 30 days of admission vs. those who did not. Factors associated with increased odds of mortality included the number of admits in the last 6 months (OR 1.753, 95% CI: 1.397-2.200). Length of stay did not increase one’s odds for mortality (OR 0.989, 95% CI: 0.965-1.014). Conclusions: Low utilization of palliative care and advanced care planning was seen widely in both populations. Previous hospitalization in the last 6 months was a predictor of mortality in this patient population.
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Hughes-McCormack, Laura Anne, Ruth McGowan, J. P. Pell, Daniel Mackay, Angela Henderson, Lisa O'Leary, and Sally-Ann Cooper. "Birth incidence, deaths and hospitalisations of children and young people with Down syndrome, 1990–2015: birth cohort study." BMJ Open 10, no. 4 (April 2020): e033770. http://dx.doi.org/10.1136/bmjopen-2019-033770.
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ObjectiveTo investigate current Down syndrome live birth and death rates, and childhood hospitalisations, compared with peers.SettingGeneral community.ParticipantsAll live births with Down syndrome, 1990–2015, identified via Scottish regional cytogenetic laboratories, each age–sex–neighbourhood deprivation matched with five non-Down syndrome controls. Record linkage to Scotland’s hospital admissions and death data.Primary outcomeHRs comparing risk of first hospitalisation (any and emergency), readmission for children with Down syndrome and matched controls were calculated using stratified Cox proportional hazards (PH) model, and length of hospital stay was calculated using a conditional log-linear regression model.Results689/1479 (46.6%) female and 769/1479 (51.9%) male children/young people with Down syndrome were identified (1.0/1000 births, with no reduction over time); 1235 were matched. 92/1235 (7.4%) died during the period, 18.5 times more than controls. More of the Down syndrome group had at least one admission (incidence rate ratio(IRR) 72.89 (68.72–77.32) vs 40.51 (39.15–41.92); adjusted HR=1.84 (1.68, 2.01)) and readmissions (IRR 54.85 (51.46–58.46) vs 15.06 (14.36–15.80); adjusted HR=2.56 (2.08, 3.14)). More of their admissions were emergencies (IRR 56.78 (53.13–60.72) vs 28.88 (27.73–30.07); first emergency admission adjusted HR=2.87 (2.61, 3.15)). Children with Down syndrome had 28% longer first admission after birth. Admission rate increased from 1990–2003 to 2004–2014 for the Down syndrome group (from 90.7% to 92.2%) and decreased for controls (from 63.3% to 44.8%).ConclusionsWe provide contemporaneous statistics on the live birth rate of babies with Down syndrome, and their childhood death rate. They require more hospital admissions, readmissions emergency admissions and longer lengths of stays than their peers, which has received scant research attention in the past. This demonstrates the importance of statutory planning as well as informal support to families to avoid added problems in child development and family bonding over and above that brought by the intellectual disabilities associated with Down syndrome.
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Wong, Aaron Kee Yee. "Addressing resource allocation for advance care planning discussions in hospital." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 16. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.16.
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16 Background: Advance care planning (ACP) is fundamental in quality palliative care. There is no data detailing the demand for ACP discussions in hospitals, nor any standard objective criteria to decide urgency of such discussions. This cross-sectional study addresses this by comparing the ability of two commonly used instruments to detect palliative patients, and to predict death in the current admission. Methods: All inpatients were censored from the largest tertiary hospital in the state on a single inpatient day. 475 patients were followed for 3 months or until discharge or death, whichever earlier. Quan-modified Charlson score (QCS) and the Palliative Prognostic Score (PaP) was identified for each patient. These instruments were chosen based on external validity and ease of scoring. Results: See Table. 134 patients were identified as palliative (using Gold Standards Framework Indicators). 40 patients died. Both instruments were highly specific in detecting palliative patients and deaths but not sensitive, meaning they predicted patients who were palliative or died that admission. PaP>5.6 was most sensitive test to detect death in current admission. Conclusions: Despite poor sensitivity, the most sensitive instrument (QCS) detected many patients requiring ACP discussion on a single day in hospital, highlighting the demand for ACP-trained staff. Secondly, streamlined usage of these instruments may assist in prioritising resource allocation. The QCS could identify patients needing ACP discussions (despite poor sensitivity, still identified many patients), whereas the PaP > 5.6 could refine the prioritisation of such discussions. This strategy could assist in reaching as many patients as possible using current staffing levels. [Table: see text]
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O’Grady, Stefan. "The impact of pre-task planning on speaking test performance for English-medium university admission." Language Testing 36, no. 4 (March 2019): 505–26. http://dx.doi.org/10.1177/0265532219826604.
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This study investigated the impact of different lengths of pre-task planning time on performance in a test of second language speaking ability for university admission. In the study, 47 Turkish-speaking learners of English took a test of English language speaking ability. The participants were divided into two groups according to their language proficiency, which was estimated through a paper-based English placement test. They each completed four monologue tasks: two picture-based narrative tasks and two description tasks. In a balanced design, each test taker was allowed a different length of planning time before responding to each of the four tasks. The four planning conditions were 30 seconds, 1 minute, 5 minutes, and 10 minutes. Trained raters awarded scores to the test takers using an analytic rating scale and a context-specific, binary-choice rating scale, designed specifically for the study. The results of the rater scores were analysed by using a multifaceted Rasch measurement. The impact of pre-task planning on test scores was found to be influenced by four variables: the rating scale; the task type that test takers completed; the length of planning time provided; and the test takers’ levels of proficiency in the second language. Increases in scores were larger on the picture-based narrative tasks than on the two description tasks. The results also revealed a relationship between proficiency and pre-task planning, whereby statistical significance was only reached for the increases in the scores of the lowest-level test takers. Regarding the amount of planning time, the 5-minute planning condition led to the largest overall increases in scores. The research findings offer contributions to the study of pre-task planning and will be of particular interest to institutions seeking to assess the speaking ability of prospective students in English-medium educational environments.
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Wiele, Andrew James, Trung Nguyen, Onyebuchi Ononogbu, Kristyn-Mae Russo, Phat Le, Tejal Amar Patel, Hilary Y. Ma, and Alyssa G. Rieber. "Reducing the wait time to initiate inpatient chemotherapy at Lyndon B. Johnson Hospital." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 210. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.210.
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210 Background: Delays in initiating inpatient (inpt) chemotherapy (chemo) for planned admissions can decrease patient (pt) satisfaction and increase length of stay and healthcare costs. Our center, a community public teaching hospital, lacked clear standard operating procedures for scheduled chemo admissions, resulting in significant delays. We developed a process improvement initiative to reduce the pt wait time from admission to chemo administration (time to chemo [TTC]). Methods: A multidisciplinary team was formed to clarify workflows and identify root causes prolonging wait times for pts admitted to the inpt chemo unit. We implemented two Plan-Do-Study-Act (PDSA) cycles over a 6-month period. First, in early March, we collaborated with pharmacy and nursing to standardize the inpt chemo operating procedures and extend pharmacy’s evening hours for chemo preparation (prep) from 7pm to 9pm. Second, in early June, we implemented a Pre-admission Checklist that was visibly displayed in clinic for fellows to review with faculty, and began discussing pts scheduled for admission during the daily, multidisciplinary huddle that already occurred on the inpt chemo unit. Using the electronic medical record and available time stamps, baseline data was collected from November-December 2019, post-intervention data for PDSA cycle 1 was collected from March-April 2020, and data collection for PDSA cycle 2 is ongoing. Results: Root cause analysis identified late afternoon admissions and PICC line placements as two main sources for TTC delays. Hospital procedures also limited inpt PICC line placement between 8am-4pm and inpt chemo prep between 7am-7pm. Baseline data revealed 77.4% (24/31) of pts were admitted between 3pm-10pm, the median TTC was 20.4 hrs, and 6.5% (2/31) of pts had chemotherapy initiated within 12 hrs of admission (TTC < 12). Additionally, 56.5% (26/46) of pts had PICC lines placed during their admission, but 69.2% (18/26) of the pts with PICC lines were eligible for outpatient port placement according to institutional intravenous (IV) access guidelines. After PDSA cycle 1, median TTC decreased by 10% to 18.4 hrs, and 33.3% (5/15) of pts had TTC < 12. Conclusions: After standardizing inpt chemo procedures and extending chemo prep times, PDSA cycle 1 resulted in a 10% reduction in TTC and a 26.8% increase in the rate of TTC < 12. Although admission times cannot be controlled at this time, the impact of improving pre-admission planning, and specifically addressing IV access, for PDSA cycle 2 is currently being evaluated and will be reported at the time of abstract presentation.
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Gedik, Ridvan, Shengfan Zhang, and Chase Rainwater. "Strategic level proton therapy patient admission planning: a Markov decision process modeling approach." Health Care Management Science 20, no. 2 (January 25, 2016): 286–302. http://dx.doi.org/10.1007/s10729-016-9354-6.
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