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Ramos, Joao Gabriel Rosa, Gabriel Machado Naus dos Santos, Marina Chetto Coutinho Bispo, et al. "Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study." American Journal of Critical Care 30, no. 5 (2021): 397–400. http://dx.doi.org/10.4037/ajcc2021453.
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This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.
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Gutierrez, Cristina, Yenny R. Cárdenas, Kristie Bratcher, et al. "Out-of-Hospital ICU Transfers to an Oncological Referral Center." Journal of Intensive Care Medicine 34, no. 1 (2016): 55–61. http://dx.doi.org/10.1177/0885066616686536.
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Objective: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. Design: Single-center cohort. Setting: A tertiary oncological center. Patients: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. Measurements and Main Results: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. Conclusion: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.
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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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Assareh, Hassan, Helen M. Achat, and Jean-Frederic Levesque. "Accuracy of inter-hospital transfer information in Australian hospital administrative databases." Health Informatics Journal 25, no. 3 (2017): 960–72. http://dx.doi.org/10.1177/1460458217730866.
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Inter-hospital transfers improve care delivery for which sending and receiving hospitals both accountable for patient outcomes. We aim to measure accuracy in recorded patient transfer information (indication of transfer and hospital identifier) over 2 years across 121 acute hospitals in New South Wales, Australia. Accuracy rate for 127,406 transfer-out separations was 87 per cent, with a low variability across hospitals (10% differences); it was 65 per cent for 151,978 transfer-in admissions with a greater inter-hospital variation (36% differences). Accuracy rate varied by departure and arrival pathways; at receiving hospitals, it was lower for transfer-in admission via emergency department (incidence rate ratio = 0.52, 95% confidence interval: 0.51–0.53) versus direct admission. Transfer-out data were more accurate for transfers to smaller hospitals (incidence rate ratio = 1.06, 95% confidence interval: 1.03–1.08) or re-transfers (incidence rate ratio > 1.08). Incorporation of transfer data from sending and receiving hospitals at patient level in administrative datasets and standardisation of documentation across hospitals would enhance accuracy and support improved attribution of hospital performance measures.
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Lim, GH, E. Seow, G. Koh, D. Tan, and HP Wong. "Study on the Discrepancies between the Admitting Diagnoses from the Emergency Department and the Discharge Diagnoses." Hong Kong Journal of Emergency Medicine 9, no. 2 (2002): 78–82. http://dx.doi.org/10.1177/102490790200900203.
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Objective To study the extent of diagnostic discrepancies at admission (diagnoses made by doctors in the Emergency Department) and discharge (final diagnoses at the ward) in our Emergency Department (ED) where the doctors have direct admitting rights; and how such discrepant diagnoses affected inter-departmental transfer of patients after their admission. Method A non-concurrent cohort study was performed on admissions through our ED between 24th to 30th April 1997. The admitting and discharge diagnoses and units were recorded. The reasons for the unmatched diagnoses and inter-departmental transfers were studied. The significance of transfers amongst patients who had matched and unmatched diagnoses was compared using the Chi-test at 95% confidence interval. Results Three hundred and sixty-one admissions were recorded during the study period. There were 314 (86.7%) and 47 (13.3%) admissions with matched and unmatched diagnoses respectively. Nine of the 47 admissions with unmatched diagnoses and 16 of the 314 admissions with matched diagnoses were transferred (p=0.001). Conclusion The ED doctors achieved a high level of diagnostic accuracy. The most common reason for unmatched diagnosis was because of the difficulty of diagnosing the patient's complex medical problem in the short contact time in the ED. The level of accuracy should increase with the advent of more diagnostic modalities and increased contact time with the patients in the ED.
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Howard, Robert, and Hans Foerstl. "Psychiatric referral letters from the 17th century." Psychiatric Bulletin 15, no. 5 (1991): 272–74. http://dx.doi.org/10.1192/pb.15.5.272.
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The 17th century saw the transfer of Bethlem from its original monastic site to more spacious accommodation at Moorfields in 1676, the development of an organised admissions system, and the establishment of an admissions register in 1683. The register contains often no more than the patients' names and the dates of their admission and discharge. Examinations of the admission register for the period 1684–1700 however, reveals 20 cases in which the entry is a copy of a warrant for admission in the form of a letter from the referring authority.
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Forsyth, René, Zhonghua Sun, Christopher Reid, and Rachael Moorin. "Rates and Patterns of First-Time Admissions for Acute Coronary Syndromes across Western Australia Using Linked Administrative Health Data 2007–2015." Journal of Clinical Medicine 10, no. 1 (2020): 49. http://dx.doi.org/10.3390/jcm10010049.
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Acute coronary syndrome (ACS) is globally recognised as a significant health burden, for which the reduction in total ischemic times by way of the most suitable reperfusion strategy has been the focus of national and international initiatives. In a setting such as Western Australia, characterised by 79% of the population dwelling in the greater capital region, transfers to hospitals capable of percutaneous coronary intervention (PCI) is often a necessary but time-consuming reality for outer-metropolitan and rural patients. Methods: Hospital separations, emergency department admissions and death registration data between 1 January 2007 and 31 December 2015 were linked by the Western Australian Data Linkage Unit, identifying patients with a confirmed first-time diagnosis of ACS, who were either a direct admission or experienced an inter-hospital transfer. Results: Although the presentation rates of ACS remained stable over the nine years evaluated, the rates of first-time admissions for ACS were more than double in the rural residential cohort, including higher rates of ST-segment elevation myocardial infarction, the most time-critical manifestation of ACS. Consequently, rural patients were more likely to undergo an inter-hospital transfer. However, 42% of metropolitan admissions for a first-time ACS also experienced a transfer. Conclusion: While the time burden of inter-hospital transfers for rural patients is a reality in health care systems where it is not feasible to have advanced facilities and workforce skills outside of large population centres, there is a concerning trend of inter-hospital transfers within the metropolitan region highlighting the need for further initiatives to streamline pre-hospital triage to ensure patients with symptoms indicative of ACS present to PCI-equipped hospitals.
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Fassmer, Alexander Maximilian, Alexandra Pulst, Guido Schmiemann, and Falk Hoffmann. "Sex-Specific Differences in Hospital Transfers of Nursing Home Residents: Results from the HOspitalizations and eMERgency Department Visits of Nursing Home Residents (HOMERN) Project." International Journal of Environmental Research and Public Health 17, no. 11 (2020): 3915. http://dx.doi.org/10.3390/ijerph17113915.
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Nursing home (NH) residents are often transferred to hospital (emergency department (ED) visits or hospital admissions) and this occurs more frequently in males. However, respective reasons are rather unclear. We conducted a multicenter prospective study in 14 northwest German NHs with 802 residents in which NH staff recorded anonymized data between March 2018 and July 2019 for each hospital transfer. Measures were analyzed using descriptive statistics and compared between sexes via univariate logistic regression analyses using mixed models with random effects. Eighty-eight planned transfers (53.5% hospital admissions, 46.5% ED visits) occurred as well as 535 unplanned transfers (63.1% hospital admissions, 36.9% ED visits). The two most common causes for unplanned transfers were deteriorations of health status (35.1%) and falls/accidents/injuries (33.5%). Male transferred residents were younger, more often married; their advance directives were more commonly not considered correctly and the NH staff identified more males nearing the end of life than females (52.9% vs. 38.2%). Only 9.2% of transfers were rated avoidable. For advance directive availability and NH staff’s perceptions on transfer conditions, we found marked inter-facility differences. There might be sociocultural factors influencing hospital transfer decisions of male and female nursing home residents and facility characteristics that may affect transfer policy.
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Rosenthal, Jennifer, James Marcin, Monica Lieng, and Patrick Romano. "2082 Profile of pediatric potentially avoidable transfers." Journal of Clinical and Translational Science 2, S1 (2018): 86–87. http://dx.doi.org/10.1017/cts.2018.301.
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OBJECTIVES/SPECIFIC AIMS: While hospital-hospital transfers of pediatric patients is often necessary, some pediatric transfers are potentially avoidable. Pediatric potentially avoidable transfers (PAT) represent a process with high costs and safety risks but few, if any, benefits. To better understand this issue, we described pediatric inter-facility transfers with early discharges. METHODS/STUDY POPULATION: We conducted a descriptive study using electronic medical record data at a single-center over a 12-month period to examine characteristics of pediatric patients with a transfer admission source and early discharge. Among patients with early discharges, we performed descriptive statistics for PAT defined as patient transfers with a discharge home within 24 hours without receiving any specialized tests, interventions, consultations, or diagnoses. RESULTS/ANTICIPATED RESULTS: Of the 2414 pediatric transfers 31.2% were discharged home within 24 hours. Among transferred patients with early discharges, 348 patients (14.4% of total patient transfers) received no specialized tests, interventions, consultations, or diagnoses. Direct admissions were categorized as PAT 2.2-fold more frequently than transfers arriving to the emergency department. Among transferred direct admissions, PAT proportions to the neonatal intensive care unit (ICU), pediatric ICU, and non-ICU were 5.8%, 17.4%, and 27.3%, respectively. Respiratory infections, asthma, and fractures were the most common PAT diagnoses. DISCUSSION/SIGNIFICANCE OF IMPACT: Early discharges and PAT are relatively common among transferred pediatric patients. Further studies are needed to identify the etiologies and clinical impacts of PAT, with a focus on direct admissions given the high frequency of PAT among direct admissions to both the pediatric ICU and non-ICU.
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Plate, Joost D. J., Linda M. Peelen, Luke P. H. Leenen, and Falco Hietbrink. "Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach." Trauma Surgery & Acute Care Open 3, no. 1 (2018): e000228. http://dx.doi.org/10.1136/tsaco-2018-000228.
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BackgroundThe aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU).MethodsThis cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the general intensive care unit (ICU), stand-alone neuro(surgical) IMCU, and stand-alone (trauma) surgical IMCU. Trauma mechanism, Abbreviated Injury Scale score and Injury Severity Score (ISS), vital signs, laboratory parameters, admission duration, intubation duration, ICU transfer, and in-hospital mortality were prospectively collected. Hypothetical cost savings were calculated using the fixed cost price per IMCU (US$1500) and ICU (US$2500) admission day.ResultsA total of 1320 admissions were included, 675 (51.1%) at the IMCU and 645 (48.9%) at the ICU. Patients admitted at the IMCU had a median ISS of 17 (11, 22). Their median duration of admission was 32.8 hours (18.8, 62.5). At the IMCU, one patient died due to aneurogenic shock. A subsequent ICU transfer was required in 38 (5.6%) IMCU admissions. Of these transfers, four patients died due to neurological deterioration. At the ICU, the median ISS was 22 (14, 30). Nearly all (n=620, 96.3%) ICU trauma patients required mechanical ventilation. Expected total cost savings due to the presence of the IMCU were US$1 772 785.DiscussionA substantial amount of trauma patients in need of critical care can safely be admitted at the IMCU, without the need for further mechanical ventilation. Thereby, the IMCU could fulfill an essential cost-saving role in the management of severely injured trauma patients.Level of evidenceLevel IV.
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Roberts, Christine, and Charles Algert. "Antenatal transfer of rural women: the NSW Inpatient Statistics Collection compare with an audit of hospital records?" Australian Health Review 23, no. 3 (2000): 78. http://dx.doi.org/10.1071/ah000078.
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The aim of this study was to determine whether the NSW Inpatient Statistics Collection (ISC), a census of hospitaladmissions, could be used to estimate the magnitude of, and reasons for, antenatal transfer of rural women. Data fromthe ISC were compared with results of a clinical audit of all antenatal admissions of rural women to perinatal centresin NSW during 1997-1998. While the overall number of perinatal centre admissions identified by the ISC and theaudit were similar, the ISC identified only about 70% of antenatal transfers. Rural hospitals identified 12% ofwomen as indigenous compared with 9% at perinatal centres. The ISC showed 28% of rural women admissions and42% of transfers were for threatened preterm labour compared with 21% and 30% respectively from the audit.
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Ali, Ambreen Fatima, Aaron Thomas Gerds, Anjali S. Advani, et al. "Admissions for neutropenic fever in myelodysplastic syndromes (MDS)." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18548-e18548. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18548.
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e18548 Background: MDS are associated with a risk of severe infections due to disease course, patient (pt) age, co-morbidities and treatment. While infection rates have been reported for MDS patients enrolled in clinical trials, the real-world incidence of infections that require hospitalization, and how disease related factors (e.g. genetic mutations) affect the likelihood of infection remain unclear. Methods: Clinical data for MDS pts (per 2016 WHO criteria) diagnosed between 1/2010-12/2016, and treated at the Cleveland Clinic were included. TET2 mutation data obtained by NGS (in the context of genomic panel) was also included. Results: Our dataset included 214 pts of median age 70 years (range 13-99), with 33%, 54%, and 12% having low, intermediate, and high risk MDS according to IPSS-R. Overall, 100 admissions for neutropenic fever were recorded with a median length of stay of 5 days per admission; 63 (29%) pts required at least one admission, and of these 9 (14%) pts required 3 or more (up to 6) admissions. Blood cultures were positive in 17 (27%) pts with common organisms including Staphylococcus (38%), Enterococcus (35%), and Pseudomonas (12%). Urine cultures were positive in 6 (10%) pts, with organisms including E. Coli (50%), Pseudomonas (17%) and Klebsiella (17%). Fungal work up was sent in 18 (29%) pts and was positive in 3 (17%) pts. 13 (21%) pts required ICU transfer, and of those 7 (51%) pts required vasopressor support, and 10 (77%) pts required mechanical ventilation. Median ICU length of stay was 3 days (range 1-26). 13 (21%) pts were discharged on IV antibiotics. Median OS for the entire cohort was 18 months (95% CI 7.9 – 34.7), and median OS for admitted patients was not significantly shorter at 48 or 65 months. The number of admissions for neutropenic fever, length of stay, IPSS-R risk category, TET2 mutation, and ICU transfer did not impact survival. Conclusions: The risk of admission for neutropenic fever was 29% with blood cultures positive in 27% of pts. TET2 mutation status and IPSS-R risk did not impact admission rate, length of stay or ICU transfer.
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Grimshaw, Kelly S., Kitty Fan, Alyssa Mullins, and Janet Parkosewich. "Using Quality Improvement Methods to Understand Incidence, Timing, and Factors Associated With Unplanned Intensive Care Unit Transfers of Patients With End-Stage Liver Disease." Progress in Transplantation 29, no. 4 (2019): 361–63. http://dx.doi.org/10.1177/1526924819888132.
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Introduction: Patients with end-stage liver disease are at risk for clinical deterioration, often requiring hospital admissions while awaiting transplantation. Nurses observed that many patients were or became unstable soon after arrival, requiring transfers to the medical intensive care unit. Objective: To explore the incidence, timing, and factors associated with unplanned intensive care transfers. Design: We conducted a quality improvement project using plan-do-study-act methods to explore administrative data from adult patients admitted to the hepatology service’s medical–surgical unit. Chi-square and t-tests were used to examine associations between demographic, clinical, and temporal factors and unplanned transfers. Data were analyzed at the hospital encounter level. Results: Unplanned transfers occurred in 8.6% of 1418 encounters. The number of transfers during these encounters ranged from 1 to 6. Most unplanned transfers (65.9%) occurred during the evening shift. On average, there was a 4.2-hour delay to the transfer. Fifty-one percent of these encounters required support from clinicians outside the unit while waiting for a bed. Factors associated with unplanned intensive care unit transfer were male sex ( P = .02), self-referral to the emergency department ( P < .001), and lower initial mean Rothman Index ( P < .001). Discussion: Results validated nurses’ concerns about the patients’ severity of illnesses at the time of admission and frequent need for transfer to intensive care soon after admission. We now have actionable data that are being used by leaders to assess unit admission criteria and develop operating budgets for human and material resources needed to care for this challenging population.
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Wee, Christopher, Leticia Varella, Lisa A. Rybicki, and James Stevenson. "Risk factors for adverse outcomes in solid tumor interhospital transfer patients." Journal of Clinical Oncology 35, no. 8_suppl (2017): 191. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.191.
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191 Background: We previously reported that inter-hospital transfer patients to our institution’s oncology service experienced higher mortality and increased length of stay (LOS) compared to other origins of admission. We sought to identify risk factors for adverse outcomes in this hospital transfer population. Methods: We reviewed all inter-hospital transfers from Jan-June 2016 to the Cleveland Clinic’s solid tumor oncology service. Patient characteristics, including age, albumin, and case severity indices (mortality and severity risk scores and AP-DRG), as well as encounter characteristics, including admitting provider (house staff or hospitalist), admission time (8AM-5PM or evening), admission day (weekday or weekend), and time between transfer acceptance and admission were recorded. Adverse events examined included activation of adult medical emergency team (AMET), ICU transfer, LOS, in-hospital mortality, and 30-day readmission. Associations of patient and encounter characteristics with adverse events were assessed using Wilcoxon and Fisher’s exact tests. Results: Fifty-three transfer admissions were identified. Patients had a median age of 67 years and 58.5% were male. House staff admitted the majority of patients (81.1%) and most occurred after hours (62.3%). Age, admission time and day, and type of admitting physician were not associated with adverse events. There was a significant association between higher AP-DRG and mortality/severity risk scores with ICU transfers, AMET activations, and mortality. Patients who experienced any adverse events on average had a lower mean albumin than those who did not (2.3 vs 3.0 g/dL p=0.006). LOS and readmission were not significantly associated with any patient or encounter characteristics. Conclusions: Burden of disease as measured by mortality/severity risk and AP-DRG as well as lower albumin levels are associated with adverse events in solid tumor inter-hospital transfer patients, while encounter characteristics do not predict for poorer outcomes. This population should be targeted for improvements in communication and handoffs at the time of transfer, as well as early involvement of palliative care providers.
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Hoare, Sarah, Michael P. Kelly, Larissa Prothero, and Stephen Barclay. "Ambulance staff and end-of-life hospital admissions: A qualitative interview study." Palliative Medicine 32, no. 9 (2018): 1465–73. http://dx.doi.org/10.1177/0269216318779238.
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Background: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. Aim: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. Design: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. Participants/setting: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. Results: Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care. Conclusion: Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.
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Boyle, Tehnaz P., Charles G. Macias, Susan Wu, et al. "Characterizing Avoidable Transfer Admissions in Infants Hospitalized for Bronchiolitis." Hospital Pediatrics 10, no. 5 (2020): 415–23. http://dx.doi.org/10.1542/hpeds.2019-0226.
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Reese, J., S. J. Deakyne, A. Blanchard, and L. Bajaj. "Rate of Preventable Early Unplanned Intensive Care Unit Transfer for Direct Admissions and Emergency Department Admissions." Hospital Pediatrics 5, no. 1 (2015): 27–34. http://dx.doi.org/10.1542/hpeds.2013-0102.
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Nguyen, Phuong T. K., Hoang T. Tran, Dominic A. Fitzgerald, Thach S. Tran, Stephen M. Graham, and Ben J. Marais. "Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study." European Respiratory Journal 54, no. 1 (2019): 1802256. http://dx.doi.org/10.1183/13993003.02256-2018.
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Pneumonia is the most common reason for paediatric hospital admission in Vietnam. The potential value of using the World Health Organization (WHO) case management approach in Vietnam has not been documented.We performed a prospective descriptive study of all children (2–59 months) admitted with “pneumonia” (as assessed by the admitting clinician) to the Da Nang Hospital for Women and Children to characterise their disease profiles and assess risk factors for an adverse outcome. The disease profile was classified using WHO pneumonia criteria, with tachypnoea or chest indrawing as defining clinical signs. Adverse outcome was defined as death, intensive care unit admission, tertiary care transfer or hospital stay >10 days.Of 4206 admissions, 1758 (41.8%) were classified as “no pneumonia” using WHO criteria and only 252 (6.0%) met revised criteria for “severe pneumonia”. The inpatient death rate was low (0.4% of admissions) with most deaths (11 out of 16; 68.8%) occurring in the “severe pneumonia” group. An adverse outcome was recorded in 18.7% of all admissions and 60.7% of the “severe pneumonia” group. Children were hospitalised for a median of 7 days at an average cost of 253 USD per admission. Risk factors for adverse outcome included WHO-classified “severe pneumonia”, age <1 year, low birth weight, previous recent admission with an acute respiratory infection and recent tuberculosis exposure. Breastfeeding, day-care attendance and pre-admission antibiotic use were associated with reduced risk.Few hospital admissions met WHO criteria for “severe pneumonia”, suggesting potential unnecessary hospitalisation and use of intravenous antibiotics. Better characterisation of the underlying diagnosis requires careful consideration.
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Lyons, Patrick G., Jeff Klaus, Colleen A. McEvoy, Peter Westervelt, Brian F. Gage, and Marin H. Kollef. "Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital." Journal of Oncology Practice 15, no. 8 (2019): e652-e665. http://dx.doi.org/10.1200/jop.18.00765.
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PURPOSE: Patients hospitalized outside the intensive care unit (ICU) frequently experience clinical deterioration. Little has been done to describe the landscape of clinical deterioration among inpatients with cancer. We aimed to describe the frequency of clinical deterioration among patients with cancer hospitalized on the wards at a major academic hospital and to identify independent risk factors for clinical deterioration among these patients. METHODS: This was a retrospective cohort study at a 1,300-bed urban academic hospital with a 138-bed inpatient cancer center. We included consecutive admissions to the oncology wards between January 1, 2014, and June 30, 2017. We defined clinical deterioration as the composite of ward death and transfer to the ICU. RESULTS: We evaluated 21,219 admissions from 9,058 patients. The composite outcome occurred during 1,945 admissions (9.2%): 1,365 (6.4%) had at least one ICU transfer, and 580 (2.7%) involved ward death. Logistic regression identified several independent risk factors for clinical deterioration, including the following: age (odds ratio [OR], 1.33 per decade; 95% CI, 1.07 to 1.67), male sex (OR, 1.15; 95% CI, 1.05 to 1.33), comorbidities, illness severity (OR, 1.11; 95% CI, 1.10 to 1.13), emergency admission (OR, 1.45; 95% CI, 1.26 to 1.67), hospitalization on particular wards (OR, 1.525; 95% CI, 1.326 to 1.67), bacteremia (OR, 1.24; 95% CI, 1.01 to 1.52), fungemia (OR, 3.76; 95% CI, 1.90 to 7.41), tumor lysis syndrome (OR, 3.01; 95% CI, 2.41 to 3.76), and receipt of antimicrobials (OR, 2.04; 95% CI, 1.72 to 2.42) and transfusions (OR, 1.65; 95% CI, 1.42 to 1.92). CONCLUSION: Clinical deterioration was common; it occurred in more than 9% of admissions. Factors independently associated with deterioration included comorbidities, admission source, infections, and blood product transfusion.
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Sun, Jianxia, Alan J. Girling, Cassie Aldridge, et al. "Sicker patients account for the weekend mortality effect among adult emergency admissions to a large hospital trust." BMJ Quality & Safety 28, no. 3 (2018): 223–30. http://dx.doi.org/10.1136/bmjqs-2018-008219.
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ObjectiveTo determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.DesignRetrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England.Outcome measures30-day postadmission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score (NEWS)), routes of admission to hospital, transfer to the intensive care unit (ICU) and demographics.ResultsDespite similar emergency department daily attendance rates, fewer patients were admitted on weekends (mean admission rate 91/day vs 120/day) because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24 hours (4.2% vs 3.0%), spent longer in hospital (median 3 days vs 2 days) and less likely to experience same-day discharge (17.2% vs 21.9%) (all p values <0.001).The crude 30-day postadmission mortality ratio for weekend admission (OR=1.13; 95% CI 1.08 to 1.19) was attenuated using standard adjustment (OR=1.11; 95% CI 1.05 to 1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; 95% CI 1.01 to 1.13) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect (OR=1.02; 0.96–1.08).NEWS completion rates were higher on weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.ConclusionsPatients admitted to hospital on weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.
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Gowhari, Michel, Tiesa Hughes-Dillard, Catherine Ryan, and Alexia Johnson. "Managing Sickle Cell Disease Patients with Acute Pain Crisis in the Most Appropriate Setting." Blood 134, Supplement_1 (2019): 2169. http://dx.doi.org/10.1182/blood-2019-131102.
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Introduction: Pain is the top concern of individuals with sickle cell disease (SCD). Acute painful vaso-occlusive episodes in SCD are the leading cause of emergency department (ED) encounters and frequent hospital admissions. Well-documented disparities include significant delay and under treatment of SCD patients with acute pain crisis in the ED. An acute care observation unit (ACOU) staffed with SCD specialists can help to address these disparities. SCD patients treated in a dedicated ACOU have a 40% lower admission rate than patients treated in the ED. An expedited transfer and treatment program at our dedicated sickle ACOU at the University of Illinois Hospital (UIH) was implemented with the goal of improving overall care and decreasing the hospital admission rate for SCD patients. Method: This is an outcome study of individuals with SCD >16 years of age who presented with an acute painful episode to UIH. A quality improvement project used the Plan-Do-Study-Act translation method. The following key areas were identified for intervention: 1) established criteria for direct ACOU admission, 2) expedited transfer to the ACOU from the ED, 3) addition of a third provider to expand hours, and 4) establishing a consistent but individualized pain treatment plan across the ED and ACOU. The number of admissions to hospital of patients with SCD was examined from September 2018 through August 2019. Applying the Donabedian triad of Structure, Process, and Outcomes, we demonstrated improved outcome and decrease hospitalization. Results: There were 877 admissions to the ACOU from January to July of 2019, which is an increase of 37% compared to the same period in 2018. Of the 877 admissions, 793 were discharged home (90.4%) as compared to 88.6 % in 2018. The average time to first dose of opioids in the ACOU in 2019 was 55 minutes with and average decrease in the pain score of 2.62 during an average length of stay of 4:18 hours. Conclusions: Expedited care and treatment with a focus on improving quality and improving access resulted in increased volume of patients treated and decreased rate of admission to the hospital. Allocating resources to a dedicated sickle acute care observation unit can significantly decrease inpatient hospitalizations. Table. Disclosures No relevant conflicts of interest to declare.
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Richardson, J. David, Tracy Cross, David Lee, et al. "Impact of Level III Verification on Trauma Admissions and Transfer." Journal of Trauma: Injury, Infection, and Critical Care 42, no. 3 (1997): 498–503. http://dx.doi.org/10.1097/00005373-199703000-00018.
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Isenberg, Sarina, Chunhua Lu, John P. McQuade, Thomas J. Smith, and A. Rab Razzak. "Estimating the cost-savings of a comprehensive hospital-based palliative care program." Journal of Clinical Oncology 34, no. 7_suppl (2016): 3. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.3.
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2 Background: In FY 2012, Johns Hopkins Medicine (JHM) established a palliative care inpatient unit (PCU). The PCU received patients as transfers and direct admissions. PCUs can improve care (Roza K, et al. JPM 2015) and lower per diem costs compared to usual care (Smith TJ, et al. JPM 2003; Goldstein J, et al. JPSM 2015). This project studied the financial impact of the PCU and PC program on JHM. Methods: Using one fiscal year of admissions, the team calculated the per day variable cost of pre-transfer in to palliative care (from ED) and palliative care transfer. These fees were multiplied by the number of patients transferred to the PCU (153) and by the average length of stay in the PCU (5.11 days). These variable costs were added together to reach the combined savings. Consultation savings were estimated using established methods (Morrison RS, et al. Arch Int Med 2008; adjusted to 2014 dollars). Results: The PCU operated at 54% occupancy in the first year. The daily loss pre-transfer of $1,672 was reduced 59% to $785 post-transer. Over 60% of transfers came from the ICU, freeing beds. The PCU saved JHM $367,751 in direct costs; additional cost savings for PC consultation were estimated at $4.3M (1,335 live discharges × $2,374, 165 decedent discharges × $6,872) and $370,000 was collected in professional fees, for a total contribution of approximately $5M. Conclusions: The PCU and PC program had a favorable impact on the health system. As JH moves to an acountable care organization model being both provider and insurer, such improved quality, cost savings, and increased ICU availability are desirable.
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Acharya, Samita, and Yogendra Amatya. "Duration of stay in emergency department and outcomes of admitted patients." Journal of Patan Academy of Health Sciences 2, no. 1 (2015): 7–11. http://dx.doi.org/10.3126/jpahs.v2i1.20333.
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Introductions: Duration of stay in Emergency Department (ED) is associated with negative outcomes, from increased mortality to increased duration of length of stay as inpatient. This study evaluates the length of duration of stay in ED after admission and the outcomes.Methods: This was a cross sectional observational study conducted at Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health Sciences. All the patients presenting to ED and getting admitted from 21st July to 4th August 2014 were enrolled in the study. Primary outcomes were hospital mortality, length of hospital stays (days) and secondary outcome was rate of transfer of inpatient to ICU or step down for higher care.Results: There were total 178 admissions form ED during the study period. Length of hospital stay increased with the increased duration spent in ED (p=0.004). The mortality group also had increased duration of stay in ED with mean duration of 23.23 hours. Increased duration of stay in ED after admission was also directly related to increased inpatient higher care transfers and thus prolonged hospital length of stay.Conclusions: Increased duration of stay in ED after admission was associated with increased hospital stay, increased mortality and increased inpatient transfer for higher care.Journal of Patan Academy of Health Sciences, Vol. 2, No. 1, 2015. page: 7-11
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Moreno-García, Estela, Verónica Rico, Laia Albiach, et al. "Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection." Revista Española de Quimioterapia 34, no. 3 (2021): 238–44. http://dx.doi.org/10.37201/req/037.2021.
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Objectives. In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods. A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results. A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions. Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
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Sato, T., and E. Yeung. "Handover practice in acute surgical admissions." Bulletin of the Royal College of Surgeons of England 96, no. 5 (2014): 150–52. http://dx.doi.org/10.1308/rcsbull.2014.96.5.150.
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Handover is defined as ‘the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis’. 1 Following the introduction of the European Working Time Regulations (EWTR) in 2003, the number of hours for doctors in training reduced steadily to 48 hours per week from August 2009. 2 This has increased both the number of handovers required each day and the number of doctors involved in those handovers. It is therefore vital that accurate information is passed from one team to another to ensure continuity of care and patient safety. 1,2
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Atmore, Carol, Susan Dovey, Robin Gauld, Andrew R. Gray, and Tim Stokes. "Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study." BMJ Open 11, no. 5 (2021): e046207. http://dx.doi.org/10.1136/bmjopen-2020-046207.
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ObjectiveLittle is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients’ rural or urban location using general practice data.DesignSecondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.SettingNew Zealand (NZ) general practice clinical records including hospital discharge data.ParticipantsRandomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.OutcomesAdmission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.ResultsOf 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location was not associated with increased hospital harm risk (aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95% CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).ConclusionsRural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.
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Fatima, Samar, Sara Shamim, Amna Subhan Butt, Safia Awan, Simra Riffat, and Muhammad Tariq. "The discrepancy between admission and discharge diagnoses: Underlying factors and potential clinical outcomes in a low socioeconomic country." PLOS ONE 16, no. 6 (2021): e0253316. http://dx.doi.org/10.1371/journal.pone.0253316.
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Objective The discrepancy between admission and discharge diagnosis can lead to possible adverse patient outcomes. There are gaps in integrated studies, and less is understood about its characteristics and effects. Therefore, this study was conducted to determine the frequency, characteristics, and outcomes of diagnostic discrepancies at admission and discharge. Design and data sources This retrospective study reviewed the admitting and discharge diagnoses of adult patients admitted at Aga Khan University Hospital (AKUH), Internal Medicine Department between October 2018 and February 2019. The frequency and outcomes of discrepancies in patient diagnoses were noted among Emergency Department (ED) physician versus admitting physician, admitting physician versus discharge physician, and ED physician versus discharge physician for the full match, partial match, and mismatch diagnoses. The studied outcomes included interdepartmental transfer, Intensive Care Unit (ICU) transfer, in-hospital mortality, readmission within 30 days, and the length of stay. For simplicity, we only analyzed the factors for the discrepancy among ED physicians and discharge physicians. Results Out of 537 admissions, there were 25.3–27.2% admissions with full match diagnoses while 18.6–19.4% and 45.3–47.9% had mismatch and partial match diagnoses respectively. The discrepancy resulted in an increased number of interdepartmental transfers (5–5.8%), ICU transfers (5.6–8.7%), in-hospital mortality (8–11%), and readmissions within 30 days in ED (14.4%-16.7%). A statistically significant difference was observed for the ward’s length of stay with the most prolonged stay in partially matched diagnoses (6.3 ± 5.4 days). Among all the factors that were evaluated for the diagnostic discrepancy, older age, multi-morbidities, level of trainee clerking the patient, review by ED faculty, incomplete history, and delay in investigations at ED were associated with significant discrepant diagnoses. Conclusions Diagnostic discrepancies are a relevant and significant healthcare problem. Fixed patient or physician characteristics do not readily predict diagnostic discrepancies. To reduce the diagnostic discrepancy, emphasis should be given to good history taking and thorough physical examination. Patients with older age and multi-morbidity should receive significant consideration.
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Boncea, Emanuela Estera, Paul Expert, Kate Honeyford, et al. "Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case–control study in a UK hospital network." BMJ Quality & Safety 30, no. 6 (2021): 457–66. http://dx.doi.org/10.1136/bmjqs-2020-012124.
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BackgroundIntrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals.ObjectiveThis study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI).MethodsA retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination.ResultsOf the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13).ConclusionIntrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
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Hope, Joan. "Boost transfer student yield with collaboration between admissions, registrar, financial aid." Successful Registrar 16, no. 6 (2016): 1–5. http://dx.doi.org/10.1002/tsr.30205.
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Hope, Joan. "Boost transfer student yield with collaboration between admissions, registrar, financial aid." Enrollment Management Report 20, no. 5 (2016): 1–7. http://dx.doi.org/10.1002/emt.30200.
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O’Neil, Bernadette, and Jason Kane. "1261: COST REDUCTION OPPORTUNITIES IN INTERFACILITY TRANSFER ADMISSIONS TO THE PICU." Critical Care Medicine 48, no. 1 (2020): 607. http://dx.doi.org/10.1097/01.ccm.0000644960.64963.eb.
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Singh, Sunny R. K., Sindhu Malapati, Rohit Kumar, Olekdandra Lupak, and Philip Kuriakose. "Predictors of Transfer to Different Facility at Discharge in Patients Admitted with Hematologic Malignancy: A Nationwide Inpatient Sample (NIS) Database Analysis." Blood 134, Supplement_1 (2019): 2132. http://dx.doi.org/10.1182/blood-2019-127604.
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Background: Improvement in cancer treatment has led to an increase in prevalence of hematological malignancies with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer to another non-acute facility (including nursing home, subacute rehab and other institutional care) at the time of discharge. Methods: This is a retrospective cohort analysis of NIS database from 2014. Inclusion criteria was any admission of adults (≥18 years) with hematological malignancy (identified by ICD-9-CM diagnosis codes). We identified subgroups of hematological malignancies as follows: multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute myeloid and lymphoid leukemia, chronic myeloid and lymphoid leukemias. Patients transferred in from a different acute care hospital or another type of health facility were excluded. Aggressive inpatient care was defined by use of mechanical ventilation, vasopressors, hemodialysis (end stage renal disease excluded) or cardiopulmonary resuscitation. Primary outcome was transfer upon discharge to a different facility excluding acute care hospital (transfer out). Factors associated with this outcome were analyzed using multivariate logistic regression analysis. Statistical analysis was done using STATA. Results: There were 505,230 admissions of patients with hematological malignancy in the year 2014. Of the entire study population, 15.5% (n= 78,390) were transferred out at discharge and the most common primary diagnosis at admission for them was unspecified septicemia. Among those who were transferred out, mean age was 75.4 years (compared to 63.3 years for those not transferred out), mean length of stay was 9.7 days (compared to 6.7 days for those not transferred out) and 75.1% had Charlson Comorbidity Index (CCI) ≥3 (compared to 55.9% for those not transferred out). Also, among those who were transferred out, admission was elective in only 12.6% (compared to 24.9% for those not transferred out), aggressive inpatient care was utilized in 7.8% (compared to 2.1% for those not transferred out) and inpatient chemotherapy was given in 7.2% admissions (compared to 23.3% for those not transferred out). Breakdown of type of insurance for the two cohorts is shown in table 1. Result of multivariate logistic regression analysis for factors associated with primary outcome (transfer out) are summarized in table 2. We adjusted for the factors listed in the table and others such race, mean income quartile of patient's zip-code, hospital factors (urban or rural location, teaching status, geographical region and bed-size) and day of admission (weekend or weekday). Conclusion: Among admissions of patients with hematological malignancies, older age, female gender, presence of co-morbidities, longer length of stay, diagnosis of myeloma and chronic leukemias were associated with higher odds of transfer to a different non-acute facility at discharge. Whereas, elective admission, insurance type other than medicare, diagnosis of acute leukemias and those receiving inpatient chemotherapy had lower odds of being transferred to a different non-acute facility at discharge. A future area of exploration is development of a scoring system using the most clinically relevant and strongly associated factors to predict risk of transfer to a different non-acute facility at discharge. This will allow early decision making and mobilization of resources by healthcare systems for these patients with complex healthcare needs. Disclosures Kuriakose: Alexion: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy.
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Albright, DA, and M. Indeck. "Comparison of complication and mortality rate between direct trauma admissions and transfer trauma admissions to a rural trauma center." Annals of Emergency Medicine 18, no. 4 (1989): 450–51. http://dx.doi.org/10.1016/s0196-0644(89)80685-7.
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Bazhenov, A. V., G. M. Galstyan, E. N. Parovichnikova, et al. "Role of the intensive care in treatment of patients with acute myeloid leukemia." Terapevticheskii arkhiv 91, no. 7 (2019): 14–24. http://dx.doi.org/10.26442/00403660.2019.07.000321.
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Aim. Remission induction can be associate, with the life threatening complications and transfer to ICU of de novo acute myeloid leukemia (AML) patients (pts). We evaluate influence of transfer to ICU and life threatening complication on early mortality and long - tram survival of de novo AML pts. Materials and methods. Retrospective study. All de novo AML pts younger than 60 years old admitted in the National Research Center for Hematology from 2013 to 2016 years were enrolled in the study. Patients were divided into 2 groups: pts who were required ICU admission during remission induction (ICU-pts) and pts who did not require ICU admission and received chemotherapy only in hematology ward (non-ICU pts). The reasons for ICU admissions and results of life support were analyzed. Overall survival (OS) were assessed by the Kaplan-Meier method, long rank value p
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Wee, Christopher E., Lindsey M. Goodman, Leticia Varella, et al. "Analysis of Origins of Admission for Solid Tumor Oncology Inpatients: Disease Severity and Outcomes." Journal of Oncology Practice 13, no. 7 (2017): e666-e672. http://dx.doi.org/10.1200/jop.2016.016543.
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Purpose: Hospital transfers may affect clinical outcomes. Evaluation of admission by source of transfer, time of admission, and provider type may identify opportunities to improve inpatient outcomes. Methods: We reviewed charts of patients admitted to the solid tumor oncology service between July and December 2014 from the Cleveland Clinic Foundation (CCF) Main Campus emergency department (ED), CCF Regional EDs, outside hospital (OSH) ED, OSH inpatient services, and CCF outpatient clinics. Data collected included time of admission, mortality and severity risk scores, and provider type. Risk factors were assessed for clinical outcomes, including activations of the Adult Medical Emergency Team, intensive care unit transfers, in-hospital mortality, and length of stay (LOS). Results: Five hundred admissions were included. OSH inpatient transfers had significantly higher disease severity compared with all other origins of admission. OSH inpatient transfers demonstrated significantly longer LOS compared with all other origins of admission, and higher mortality rates compared with the outpatient direct admits and CCF Main Campus ED admits. After adjusting for disease severity and risk of mortality, OSH ED patients remained at higher risk for Adult Medical Emergency Team activation, OSH inpatient transfers had the longest LOS, and CCF Main Campus ED patients had the lowest risk of mortality. Time of admission and provider type were not associated with any of the outcomes. Conclusion: Oncology inpatients transferred from an outside health care facility are at higher risk for adverse outcomes. The magnitude of difference is lessened, but still significant, after adjustment for disease severity and risk of mortality.
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Arul, GS, J. Reynolds, S. DiRusso, et al. "Paediatric admissions to the British military hospital at Camp Bastion, Afghanistan." Annals of The Royal College of Surgeons of England 94, no. 1 (2012): 52–57. http://dx.doi.org/10.1308/003588412x13171221499027.
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INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice.
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Hines, David. "Admissions Criteria for Ranking Master's-Level Applicants to Clinical Doctoral Programs." Teaching of Psychology 13, no. 2 (1986): 64–67. http://dx.doi.org/10.1207/s15328023top1302_3.
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All APA-approved doctoral programs in clinical psychology were surveyed to determine their admissions and credit transfer policies for students from master's-level programs. The results indicated that Graduate Record Examination (GRE) scores, recommendations, and research involvement were consistently rated as most important in ranking applicants for admission. The doctoral programs varied in the weights assigned to graduate versus undergraduate grade point averages (GPAs). Most programs indicated that students with a master's degree could reduce the time needed to complete their doctoral requirements by about a year. However, about one third of the schools indicated that little or no reduction in time was possible.
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Hotvedt, Ragnar, Just Thoner, Arne W. Wilskow, and Olav H. Førde. "HOW URGENT ARE EMERGENCY ADMISSIONS?" International Journal of Technology Assessment in Health Care 15, no. 4 (1999): 699–708. http://dx.doi.org/10.1017/s0266462399015494.
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Objectives: To assess necessary treatment and degree of urgency for patients admitted to emergency rooms, and potential health consequences of transfer to nearest alternative hospital.Methods: During 1 month, we included all 1,300 emergently admitted patients in all seven general hospitals in a Norwegian county with a population of 236,921 inhabitants. The number of patients in need of surgical and/or intensive medical treatment, the urgency of the necessary treatment, and the risk to each patient of adverse permanent health consequences of further transport to nearest alternative hospital were assessed by a multidisciplinary expert panel.Results: Ninety-four patients (7.2% of 1300 patients) were considered in need of either surgical (n = 22) or intensive medical treatment (n = 70) or both (n = 2) within 8 hours of arrival in hospital. Medical treatment had the greatest urgency, while surgery most often could be postponed. In cases where the patients were initially to be given only stabilizing treatment and then transported (assisted by qualified personnel) to another hospital, the panel estimated the risk of losing health benefit to be high for 14 patients. In six of these cases the risk was linked to delay of thrombolytic treatment.Conclusions: Fewer than 10% of the patients who are admitted as emergency cases to general hospitals in Norway need surgical or intensive medical treatment within 8 hours of their arrival. The medical consequences of transport of patients to the nearest alternative hospital are generally small and can often be further reduced by simple means.
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Sileo, Deseray, Frank Walch, Brooke M. French, et al. "Admission to the Regular Ward is Safe Following Uncomplicated Craniosynostosis Surgery: A Retrospective Study." FACE 2, no. 3 (2021): 208–18. http://dx.doi.org/10.1177/27325016211027962.
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Background: At our craniofacial center patients are routinely admitted to a regular ward, or floor, rather an intensive care unit (ICU) after uncomplicated craniosynostosis surgery. In this study, we review the safety of our postoperative placement policy, examining the rate of transfer from floor to ICU. Methods: The charts of patients who underwent craniosynostosis surgery from 2009 through 2017 at a single children’s hospital were reviewed. Postoperative hospital courses were characterized as preoperatively-planned ICU admission, perioperatively-planned ICU admission, or primary floor admission. The primary outcome was transfer from floor to ICU. Secondary outcomes included duration of hospitalization. Results: Chart review yielded 420 patients. Three hundred sixty-eight (88%) were admitted directly to the floor and 52 (12.0%) directly to an ICU. Of patients admitted to the floor, 2 (0.5%) were transferred to an ICU. Twenty-four patients with syndromic and 20 patients with multisutural craniosynostosis were admitted to the floor. Only 1 patient from each group (the same patient; 4.2% and 5.0%, respectively), was transferred to an ICU. Thirty-two ICU admissions were preoperatively planned and 20 were perioperatively planned. Reasons for preoperatively planned ICU admission included significant comorbidities and type of surgery. Reasons for perioperatively planned ICU admissions included significant intraoperative adverse events, excessive blood loss, and failure of clearance from the post-anesthesia care unit (PACU). Patients admitted to the ICU had a statistically significant longer mean length of hospitalization (4.8 days vs 2.7 days) than did patients admitted to the floor. Conclusions: Most postoperative craniosynostosis surgery patients—including patients with syndromic and/or multisutural synostosis—are managed safely on the floor at our center. Some patients still need postoperative ICU admission, but are easily identified preoperatively, intraoperatively, or in the PACU. Our findings should be applicable to other large craniofacial centers.
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Wambuguh, Oscar, Monika Eckfield, and Lynn Van Hofwegen. "Examining the Importance of Admissions Criteria in Predicting Nursing Program Success." International Journal of Nursing Education Scholarship 13, no. 1 (2016): 87–96. http://dx.doi.org/10.1515/ijnes-2015-0088.
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AbstractBaccalaureate nursing programs select students likely to graduate, become licensed, and contribute to a diverse workforce, and admissions criteria need to support those goals. This study assessed five criteria: pre-admit science GPA; TEAS score; healthcare experience; previous baccalaureate degree; and pre-admission university enrollment vs. college transfer as predictors of three desired outcomes: graduation; nursing program GPA; and passing NCLEX-RN. Results found TEAS and pre-admit science GPA predicted nursing program outcomes. Students with TEAS≥82 had 8 % greater probability of graduating, 13 % greater probability of a GPA≥3.25, and 9 % greater probability of passing NCLEX-RN, compared to students with TEAS < 82. Students with pre-admit science GPAs≥3.8 had 11 % greater probability of passing NCLEX-RN and 14 % greater probability of a GPA≥3.25 compared to students with pre-admit science GPAs < 3.8. Further discussions regarding factors important for training a diverse nursing workforce and effective ways to implement non-academic admission criteria are warranted.
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Nielsen, Katie R., Russ Migita, Maneesh Batra, Jane L. Di Gennaro, Joan S. Roberts, and Noel S. Weiss. "Identifying High-Risk Children in the Emergency Department." Journal of Intensive Care Medicine 31, no. 10 (2016): 660–66. http://dx.doi.org/10.1177/0885066615571893.
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Purpose: Early warning scores (EWS) identify high-risk hospitalized patients prior to clinical deterioration; however, their ability to identify high-risk pediatric patients in the emergency department (ED) has not been adequately evaluated. We sought to determine the association between modified pediatric EWS (MPEWS) in the ED and inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission. Methods: This is a case–control study of 597 pediatric ED patients admitted to the inpatient ward at Seattle Children’s Hospital between July 1, 2010, and December 31, 2011. Cases were children subsequently transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi-square analysis. Results: Fifty children experienced ward-to-PICU transfer within 24 hours of admission. The area under the receiver–operator characteristic curve was 0.691. Children with MPEWS > 7 in the ED were more likely to experience ward-to-PICU transfer (odds ratio 8.36, 95% confidence interval 2.98-22.08); however, the sensitivity was only 18.0% with a specificity of 97.4%. Using MPEWS >7 for direct PICU admission would have led to 167 unnecessary PICU admissions and identified only 9 of 50 patients who required PICU care. Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS threshold of 7 is not sufficient to identify more than a small proportion of ward-admitted children with subsequent clinical deterioration.
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Perry, Melissa EO, Kitenge Kalenga, Louise Francois Watkins, et al. "HIV-related mortality at a district hospital in Botswana." International Journal of STD & AIDS 28, no. 3 (2016): 277–83. http://dx.doi.org/10.1177/0956462416646492.
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We reviewed mortality data among medical inpatients at a tertiary hospital in Botswana to identify risk factors for adverse inpatient outcomes. This review was a prospective analysis of inpatient admissions. All medical admissions to male and female medical wards were recorded over a six-month period between 1 November 2011 and 30 April 2012. Data collected included patient demographics, HIV status (positive, negative, unknown), HIV testing history, HIV related treatment and serological history, admission and discharge diagnoses, and mortality status at final discharge or transfer. Of 972 patients admitted during the surveillance period, 427 (43.9%) were known to be HIV-positive on admission, 144 (14.8%) were known to be HIV-negative, and 401 (41.3%) had an unknown HIV status. Of those with unknown status, 131 (32.7%) were tested for HIV during admission and among these 35 (27.5%) were HIV-positive. Including patients with known mortality status following transfer, 172 (17.9%) patients died during the hospitalization. Death occurred in 105 (23%) of known HIV-positive patients, compared with 31 (13%) of known HIV-negative patients (p = 0.002, HR = 1.56 in adjusted analyses). Among HIV-positive patients who died, a low CD4 cell count (<200 cells/mm3) was associated with death. Overall, patients who died had significantly more neurological and respiratory-related presenting complaints than patients who survived. In conclusion, we identified higher overall mortality among HIV-positive patients at a tertiary hospital in Botswana, and low rates of in-hospital HIV testing and antiretroviral therapy initiation. These data demonstrate that despite available antiretroviral therapy in the population for over a decade, HIV continues to add excess burden to the hospital system and adds to inpatient mortality in Botswana.
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Williams, Emma E., Rebecca Lee, Nia Williams, et al. "The impact of transfers from neonatal intensive care to paediatric intensive care." Journal of Perinatal Medicine 49, no. 5 (2021): 630–31. http://dx.doi.org/10.1515/jpm-2021-0022.
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Abstract Objectives Infants receiving care from neonatal intensive care unit (NICU) can develop chronic problems and be transferred to a paediatric intensive care unit (PICU) for on-going care. There is concern that such infants may take up a large amount of PICU resource, but this is not evidence based. We determined the impact of such transfers. Methods We reviewed 10 years of NICU admissions to two tertiary PICUs, which had approximately 12,000 admissions during that period. Results Sixty-seven infants, gestational age at birth 34.7 (IQR 27.1–38.8) weeks and postnatal age on transfer 81 (IQR 9–144) days were admitted from NICUs. The median (IQR) length of stay was 12 (4–41) days. The 19 infants born <28 weeks of gestation had a greater median length of stay (32, range IQR 10–93 days) than more mature born infants (7.5, IQR 4–26 days) (p=0.003). The median cost of PICU stay for NICU transfers was £23,800 (range 1,205–1,034,000) per baby. The total cost of care for infants transferred from NICUs was £6,457,955. Conclusions Infants transferred from NICUs were a small proportion of PICU admissions but, particularly those born <28 weeks of gestation, had prolonged stays which needs to be considered when determining bed capacity.
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Christopher, Wee, Lindsey Martin Goodman, Lisa A. Rybicki, et al. "Effects of admission (adm) source, time, and provider on inpatient (inpt) oncology (onc) outcomes at the Cleveland Clinic Foundation (CCF)." Journal of Clinical Oncology 34, no. 7_suppl (2016): 140. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.140.
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140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. Methods: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics. Pts were excluded if the adm was planned or if admitted from the CCF Main Campus ED. Data collected included pt and encounter characteristics and provider type (house-staff or nocturnal hospitalist). Clinical outcomes, including activation of the adult medical emergency team (AMET), ICU transfers, length of stay (LOS), and in-hospital mortality were compared using chi-squared test; ECOG PS and LOS with the Kruskal-Wallis tests and Wilcoxon rank sum test. Results: A total of 413 unique pt admissions were reviewed. 213 were included after exclusion criteria were applied. The probability of AMET activation, mortality, and LOS differed by origin of transfer. Pts admitted from CCF regional EDs had the lowest median LOS and no deaths. OSH int transfers demonstrated significantly higher mortality vs other origins of transfer. Pts whose first orders were placed after 5pm had no significant differences in AMET activation, ICU transfers, LOS, or mortality vs daytime adm. There were no differences in adverse outcomes by the type of admitting provider. Conclusions: Onc inpts transferred from an outside healthcare setting were at highest risk for adverse outcomes (AMETs, increased LOS, and mortality) include those originating from OSH inpt services. Process and communication interventions focused on transfers from outside inpt facilities may improve safety and outcomes in this population. [Table: see text]
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Shenoy, Erica S., Hang Lee, Taige Hou, et al. "The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations." Infection Control & Hospital Epidemiology 37, no. 7 (2016): 782–90. http://dx.doi.org/10.1017/ice.2016.54.
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OBJECTIVETo determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes.DESIGNRetrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011.METHODSOperational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination.RESULTSOverall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39–9.88] vs 8.60 hours [95% CI, 8.47–8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13–1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82–7.24] vs 5.27 days [95% CI, 5.15–5.38]) than patients with no MRSA/VRE flag.CONCLUSIONSMRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow.Infect Control Hosp Epidemiol 2016;37:782–790
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Al-Bazz, Dalal, Fareeba Anwar, and Qaiser Javed. "Utilisation of mental health transfer checklist proforma from acute physical health hospitals (Liverpool University Hospitals NHS Foundation Trust) to mental health hospitals (Mersey Care NHS Foundation Trust)." BJPsych Open 7, S1 (2021): S307. http://dx.doi.org/10.1192/bjo.2021.812.
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AimsTesting the compliance and completion rate of a transfer checklist (proforma) created in accordance with local hospital policies.BackgroundThe proforma was developed following serious incidents where medically unstable patients were inappropriately discharged to mental health hospitals, requiring readmission to acute medical hospitals. Frequently these events reported an inadequate handover from medical to mental health teams and patients were often prematurely deemed medically fit with evidence to the contrary.Although parity of esteem between mental and physical health has been a high profile political issue in the UK since 2011, evidence indicates that parity is far from being achieved. This first ever checklist was designed to improve safety of patient transfer from acute physical health hospitals to mental health hospitals by ensuring patients are medically fit and better communication between the two trusts.MethodData were collected retrospectively over a six-month period between August 2018 and January 2019 and retrieved from patient notes available at relevant trusts. Electronic notes were obtained from medical wards, accident and emergency and Mersey Care electronic systems. Notes were specifically scrutinised for presence of the proforma, quality of completion and, number and reasons for readmission from mental health hospitals to acute physical health hospitals following their medical optimization. Readmissions were considered as admissions to physical health hospitals up to one month following discharge with evidence of ongoing concerns.Result6597 referrals were made to liaison services from Liverpool University Hospitals, of which 5–6 % were admitted to inpatient mental health units. 31% of admissions from Liverpool University Hospitals were readmitted to a physical health hospital within one month of discharge indicating inappropriate and unsafe discharges. Of all those readmitted, 10% had ongoing acute medical concerns prior to admission to a mental health hospital. The proforma was filled in 13% of admissions from Liverpool University Hospitals. None of the forms were fully complete.Conclusion10% of patient admissions to mental health hospitals were identified as inappropriate due to ongoing acute medical concerns. The proforma served as structured guidance and evidence of medical fitness at time of transfer. However poor compliance was observed, which could be secondary to lack of awareness of the proforma and inadequate dissemination of the policy. Findings were shared and discussed with the appropriate teams both in acute physical health and mental health hospitals and steps will be taken to raise awareness of the proforma before completing a second audit.
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Evans, Ron L., and Richard T. Connis. "Risk Screening for Adverse Outcomes in Subacute Care." Psychological Reports 78, no. 3 (1996): 1043–48. http://dx.doi.org/10.2466/pr0.1996.78.3.1043.
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Purpose of this study was to identify variables near hospital admission that could identify patients at risk for placement, death, or readmission. The goals were to assess sensitivity and specificity of screening strategies in predicting adverse outcomes that deter or affect home health care. We evaluated whether generic screens might efficiently identify type of outcome. Criteria reported in the literature were used to predict outcomes for 1,332 admissions. Factors that discriminated type of outcome included comorbidity, mental status, living arrangement, transfer to special care, prior admission, iatrogenic trauma, and pending litigation. We conclude risk scores can accurately predict outcome of hospital treatment, which may be useful in targeting patients for intervention. Using billing data, although rather insensitive, was the most cost-effective strategy.
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Gaur, Nimish. "Profile of ICU Admissions of Obstetric Patients, Indications for Transfer to a Tertiary Care Centre and Maternal Outcomes: A Single Centre Experience." Journal of Medical Science And clinical Research 05, no. 06 (2017): 23587–89. http://dx.doi.org/10.18535/jmscr/v5i6.129.
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Singh, Sunny R. K., Sindhu Janarthanam Malapati, Rohit Kumar, Kannan Thanikachalam, and Yaser Alkhatib. "Predictors of transfer to different facility at discharge in patients admitted with metastatic solid malignancy: Five-year National Inpatient Sample (NIS) database analysis." Journal of Clinical Oncology 37, no. 31_suppl (2019): 38. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.38.
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38 Background: Improvement in cancer treatment has led to an increase in prevalence of metastatic malignancy (met-Ca) with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer at discharge to another non-acute facility, such as nursing home and sub-acute rehab. Methods: This is a retrospective cohort analysis of NIS database (from years 2010 to 2014.) Inclusion criteria was any admission of adults (≥18 years) with met-Ca (identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.) Patients transferred in from a different acute care hospital or another type of health facility were excluded. Primary outcome was transfer upon discharge to a different facility (transfer out) excluding acute care hospital. Statistical analysis was done using STATA. Results: There were 3,204,631 admissions with met-Ca, 15.3% (n= 490,735) had transfer out. Of these, 50.6% were females, 69.6% Caucasians and mean age was 70.9 years. On multivariate regression analysis, African Americans had higher odds for transfer out versus Caucasians (OR 1.06 p <0.005). Admission type- weekend vs weekday and elective vs non elective were also associated with this outcome (OR 1.08 p<0.005 and OR 0.56 p<0.005). Odds ratio for other predictors are shown below (p value <0.005 for all). Conclusions: Age, race, increased length of stay, cancer type, hospital size and teaching status, admission type and insurance type had a significant predictive value for transfer out after discharge in patients with met-Ca. A future area of exploration is the development of a scoring system to predict risk of transfer to a different facility at discharge- this will allow early mobilization of resources for these patients with complex healthcare needs. [Table: see text]