Improved length of stay and cost savings result from increases in clinical nutrition patient care staffing

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

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144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning

Age and Ageing ◽

10.1093/ageing/afz102.30 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

Mary Randles ◽

Sylvia Hickey ◽

Susanne Cotter ◽

Carmel Walsh ◽

Kieran O'Connor ◽

...

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Multidisciplinary Team ◽

Older Persons ◽

Patient Flow ◽

Geriatric Medicine ◽

City Centre ◽

Nurse Specialist ◽

Complex Care ◽

Clinical Nurse

Abstract Background Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital. Methods The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications. Results There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days). Conclusion Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.

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Effect of online literature searching on length of stay and patient care costs

Academic Medicine ◽

10.1097/00001888-199406000-00017 ◽

1994 ◽

Vol 69 (6) ◽

pp. 489-95 ◽

Cited By ~ 72

Author(s):

M S Klein ◽

F V Ross ◽

D L Adams ◽

C M Gilbert

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Literature Searching ◽

Care Costs

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Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

PEDIATRICS ◽

10.1542/peds.111.se1.e461 ◽

2003 ◽

Vol 111 (Supplement_E1) ◽

pp. e461-e470

Author(s):

Barbara Kuzma-O’Reilly ◽

Maria L. Duenas ◽

Coleen Greecher ◽

Lois Kimberlin ◽

Dennis Mujsce ◽

...

Keyword(s):

Length Of Stay ◽

Neonatal Intensive Care ◽

Outcome Measure ◽

Implementation Strategies ◽

Cost Savings ◽

Nutrition Support ◽

Evidence Based ◽

Published Evidence ◽

Support Practices ◽

Neonatal Population

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

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Clinical Pharmacists’ Intervention Documentation in Germany with DokuPIK

Pharmacoinformatics and Drug Discovery Technologies - Advances in Bioinformatics and Biomedical Engineering ◽

10.4018/978-1-4666-0309-7.ch010 ◽

2012 ◽

pp. 178-186

Author(s):

Claudia Langebrake ◽

Heike Hilgarth

Keyword(s):

Length Of Stay ◽

Adverse Effects ◽

Indirect Cost ◽

Direct Cost ◽

Cost Savings ◽

Economic Effects ◽

Rational Use ◽

Rational Use Of Medicines ◽

Clinical Pharmacists ◽

Reduction Of Costs

The next challenge will be the creation of a tool to determine the economic effects of pharmacists’ interventions. Up to now, there is the possibility to enter direct cost savings that can be generated through the rational use of medicines. The calculation of indirect cost savings (for example reduction of the length of stay, reduction of costs arising from inappropriate dosage, adverse effects or interactions, decrease of morbidity and/or mortality) is much more difficult, and therefore has not yet been included into DokuPIK.

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Patient-Care Team Contact Patterns Impact Treatment Length of Stay in the Emergency Department

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) ◽

10.1109/embc.2019.8857803 ◽

2019 ◽

Cited By ~ 3

Author(s):

Shivaram P. Arunachalam ◽

Onur Asan ◽

David M. Nestler ◽

Heather A. Heaton ◽

Thomas R. Hellmich ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Patient Care ◽

Patient Care Team ◽

Care Team ◽

Treatment Length ◽

Contact Patterns

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Implementation of an Acute Care Surgery Service in a Community Hospital: Impact on Hospital Efficiency and Patient Outcomes

The American Surgeon ◽

10.1177/000313481608200128 ◽

2016 ◽

Vol 82 (1) ◽

pp. 79-84 ◽

Cited By ~ 6

Author(s):

Michael Kalina

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Acute Care ◽

Patient Outcomes ◽

Community Hospital ◽

Hospital Efficiency ◽

Hospital Charges ◽

Acute Care Surgery ◽

Health Evaluation ◽

Care Surgery

A service led by acute care surgeons managing trauma, critically ill surgical, and emergency general surgery patients via an acute care surgery model of patient care improves hospital efficiency and patient outcomes at university-affiliated hospitals and American College of Surgeons–verified trauma centers. Our goal was to determine whether an acute care surgeon led service, entitled the Surgical Trauma and Acute Resuscitative Service (STARS) that implemented an acute care surgery model of patient care, could improve hospital efficiency and patient outcomes at a community hospital. A total of 492 patient charts were reviewed, which included 230 before the implementation of the STARS [pre-STARS (control)] and 262 after the implementation of the STARS [post-STARS (study)]. Demographics included age, gender, Acute Physiology and Chronic Health Evaluation 2 score, and medical comorbidities. Efficiency data included length of stay in emergency department (ED-LOS), length of stay in surgical intensive care unit (SICU-LOS), and length of stay in hospital (H-LOS), and total in hospital charges. Average age was 64.1 + 16.4 years, 255 males (51.83%) and 237 females (48.17%). Average Acute Physiology and Chronic Health Evaluation 2 score was 11.9 + 5.8. No significant differences in demographics were observed. Average decreases in ED-LOS (9.7 + 9.6 hours, pre-STARS versus 6.6 + 4.5 hours, post-STARS), SICU-LOS (5.3 + 9.6 days, pre-STARS versus 3.5 + 4.8 days, post-STARS), H-LOS (12.4 + 12.7 days, pre-STARS versus 11.4 + 11.3 days, post-STARS), and total in hospital charges ($419,602.6 + $519,523.0 pre-STARS to $374,816.7 + $411,935.8 post-STARS) post-STARS. Regression analysis revealed decreased ED-LOS—2.9 hours [ P = 0.17; 95% confidence interval (CI): -7.0, 1.2], SICU-LOS—6.3 days ( P < 0.001; 95% CI: -9.3, -3.2), H-LOS—7.6 days ( P = 0.001; 95% CI: -12.1, -3.1), and 3.4 times greater odds of survival ( P = 0.04; 95% CI: 1.1, 10.7) post-STARS. In conclusion, implementation of the STARS improved hospital efficiency and patient outcomes at a community hospital.

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Comparison of Fixed-Dose Inhaled Epoprostenol and Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome in Critically Ill Adults

Journal of Intensive Care Medicine ◽

10.1177/0885066620906800 ◽

2020 ◽

pp. 088506662090680 ◽

Cited By ~ 2

Author(s):

Mitchell S. Buckley ◽

Sumit K. Agarwal ◽

Roxanne Garcia-Orr ◽

Rajeev Saggar ◽

Robert MacLaren

Keyword(s):

Nitric Oxide ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Length Of Stay ◽

Respiratory Distress Syndrome ◽

Clinical Outcomes ◽

Distress Syndrome ◽

Cost Savings ◽

Fixed Dose ◽

The Mean

Purpose: Several reports have demonstrated similar effects on oxygenation between inhaled epoprostenol (iEPO) compared to inhaled nitric oxide (iNO) for acute respiratory distress syndrome (ARDS). Previous studies directly comparing oxygenation and clinical outcomes between iEPO and iNO exclusively in an adult ARDS patient population utilized a weight-based dosing strategy. The purpose of this study was to compare the clinical and economic impact between iNO and fixed-dosed iEPO for ARDS in adult intensive care unit (ICU) patients. Methods: This retrospective cohort study was conducted at a major academic medical center between January 1, 2014, and October 31, 2018. Patients ≥18 years of age with moderate-to-severe ARDS were included. The primary end point was to compare the mean change in partial arterial oxygen pressure to fraction of inspired oxygen (Pao 2: Fio 2) at 4 hours from baseline between iEPO and iNO. Other secondary aims were total acquisition drug costs, in-hospital mortality, ICU and hospital length of stay, and duration of mechanical ventilation. Results: A total of 239 patients were included with 139 (58.2%) and 100 (41.8%) in the iEPO and iNO groups, respectively. The mean change in Pao 2: Fio 2 at 4 hours from baseline in the iEPO and iNO groups were 31.4 ± 54.6 and 32.4 ± 42.7 mm Hg, respectively ( P = .88). The responder rate at 4 hours was similar between iEPO and iNO groups (64.7% and 66.0%, respectively, P = .84). Clinical outcomes including mortality, overall hospital and ICU length of stay, and mechanical ventilation duration were similar between iEPO and iNO groups. Estimated annual cost-savings realized with iEPO was USD1 074 433. Conclusion: Fixed-dose iEPO was comparable to iNO in patients with moderate-to-severe ARDS for oxygenation and ventilation parameters as well as clinical outcomes. Significant cost-savings were realized with iEPO use.

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