The Impact of a Perinatal Palliative Care on Length of Stay, ICU Days and Invasive Procedures (FR419D)

Aim: To investigate the association between a hospital palliative care unit assessment and hospital outcome. Methods: This was a prospective cohort study. Data were assessed from all patients treated and followed by the hospital palliative care team (HPCT) from November 2016 until December 2017. Results: The mean age of the 588 patients was 73.15±13.6 years. All of the patients included in the study were referred to palliative care. A large proportion of patients were affected by cancer, 69.7% (410), while 30.3% (178) were affected by an advanced chronic illness. The three most frequent cancers were: gastrointestinal (n=81, 19.8%), gynaecological (n=66, 16.1%) and lung (n=63, 15.4%); the three most frequent chronic advanced diseases were: advanced dementia (n=45, 25.3%), severe ischaemic/haemorrhagic stroke (n=36, 20.2%) and severe heart failure (n=25, 15.3%). The majority of patients were in clinical wards (n=476, 81.0%) and the average length of stay was 22.9 days. Hospital outcome trends were evaluated in terms of length of stay and number of deaths that occurred in the hospital. In particular, length of stay decreased from 25.8 days to 18.1 days, hospital death from 13 to 0 during the time that the HPCT assessed patients for an appropriate discharge. Conclusion: The HPCT is an effective means of managing patients affected by severe illness, reducing the number of deaths that occur within the hospital, long periods of hospitalisation and instances of readmission. However, further studies are required to fully assess the impact of an HPCT on hospital outcomes.

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The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136722 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6722

Author(s):

Daniel Adrian Lungu ◽

Elisa Foresi ◽

Paolo Belardi ◽

Sabina Nuti ◽

Andrea Giannini ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Geographical Variation ◽

Average Length ◽

Surgical Techniques ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Invasive Approach ◽

Average Length Of Stay ◽

The Impact

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.

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Evaluating the impact of timing of initiation of community-based palliative care on use and cost of unplanned acute care services at the end of life: A study using linked hospital and community based provider service data

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.682 ◽

2018 ◽

Vol 3 (4) ◽

Cited By ~ 1

Author(s):

Rachael Moorin ◽

Cameron Wright ◽

David Youens

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Data Collection ◽

Length Of Stay ◽

End Of Life ◽

Acute Care ◽

Community Based ◽

Timing Of Initiation ◽

The Impact ◽

Care Costs

IntroductionExpected time to death is often used to determine eligibility to publicly funded community-based palliative care (CPC) because most acute care costs in the end-of-life period are incurred immediately prior death. We know CPC use reduces acute care costs but the impact of timing of initiation is unknown. Objectives and ApproachWe explored the association between timing of CPC initiation and unplanned hospital use, over the final year of life for Western Australian cancer decedents who died between 1/1/2001 and 31/12/2011 using linked Cancer Registry, Mortality System, Hospital Morbidity Data Collection, Emergency Department (ED) Data Collection and CPC records. The relationship between first-time use of CPC and unplanned hospitalisations and ED presentations was evaluated using multivariable negative binomial regression and Cragg-hurdle models. The exposure was month of CPC initiation (adjusted for intensity of use); outcomes were the rate, length of stay and cost of unplanned hospitalisations and emergency department presentations. ResultsOf the 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the last three months of life. Initiation of CPC prior to the last six months of life was associated with a lower mean number of unplanned hospitalisations in the last six months of life (1.4 versus 1.7 for initiation within six months of death); associated average costs were also lower ((AU$, 2012) 12,976 versus $13,959). While patients initiating CPC earlier showed a trend toward fewer hospital admissions, earlier initiation was associated with a higher cumulative and average length of stay. Indirect adjustment for admission complexity suggests that this may be due to more complicated indications. Conclusion/ImplicationsThis study provides more detail to guide policy around timing of access to CPC. Our results argue against restricting access to the final few months of life, as earlier initiation may result in fewer and lower the cost of unplanned hospitalisations and ED presentations at the very end of life.

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The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients

Palliative & Supportive Care ◽

10.1017/s147895151100040x ◽

2011 ◽

Vol 9 (4) ◽

pp. 387-392 ◽

Cited By ~ 15

Author(s):

Glen Digwood ◽

Dana Lustbader ◽

Renee Pekmezaris ◽

Martin L. Lesser ◽

Rajni Walia ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Medical Intensive Care Unit ◽

Terminally Ill ◽

Terminally Ill Patients ◽

Medical Intensive Care ◽

The Impact

AbstractObjective: This study evaluates the impact of a 10-bed inpatient palliative care unit (PCU) on medical intensive care unit (MICU) mortality and length of stay (LOS) for terminally ill patients following the opening of an inpatient PCU. We hypothesized that MICU mortality and LOS would be reduced through the creation of a more appropriate location of care for critically ill MICU patients who were dying.Method: We performed a retrospective electronic database review of all MICU discharges from January 1, 2006 through December 31, 2009 (5,035 cases). Data collected included MICU mortality, MICU LOS, and mean age. The PCU opened on January 1, 2008. We compared location of death for MICU patients during the 2-year period before and the 2-year period after the opening of the PCU.Results: Our data showed that the mean MICU mortality and MICU LOS both significantly decreased following the opening of the PCU, from 21 to 15.8% (p = 0.003), and from 4.6 to 4.0 days (p = 0.014), respectively.Significance of results: The creation of an inpatient PCU resulted in a statistically significant reduction in both MICU mortality rate and MICU LOS, as terminally ill patients were transitioned out of the MICU to the PCU for end-of-life care. Our data support the hypothesis that a dedicated inpatient PCU, capable of providing care to patients requiring mechanical ventilation or vasoactive agents, can protect terminally ill patients from an ICU death, while providing more appropriate care to dying patients and their loved ones.

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The Impact of Palliative Care Consultation in the ICU on Length of Stay

Journal of Intensive Care Medicine ◽

10.1177/0885066616664329 ◽

2016 ◽

Vol 33 (6) ◽

pp. 346-353 ◽

Cited By ~ 18

Author(s):

Kwadwo Kyeremanteng ◽

Louis-Philippe Gagnon ◽

Kednapa Thavorn ◽

Daren Heyland ◽

Gianni D’Egidio

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Small Sample ◽

Cochrane Library ◽

Palliative Care Consultation ◽

Multicenter Rct ◽

Retrospective Cohort Studies ◽

Small Sample Sizes ◽

The Cochrane Library ◽

The Impact

Introduction: The intensive care unit (ICU) consumes 20% of hospital expenditures and 1% of gross domestic product. Many strategies have been attempted to reduce ICU costs. A systematic review was conducted to evaluate the effect of palliative care (PC) consultations in the ICU on length of stay (LOS) and costs. Methods: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs), prospective, and retrospective cohort studies looking at PC consultations in adult ICUs published between January 2000 and February 2016 were selected. Independent reviewers assessed the eligibility of studies, extracted data on ICU, hospital LOS, and mortality, and rated each study’s quality. The cost was derived from an existing model in the literature; the primary outcome was ICU LOS and the secondary outcomes were direct variable costs, mortality, and hospital LOS. Results: We reviewed 814 abstracts, but only 8 studies met inclusion criteria and were included. The patients with a PC consultation in the ICU, when compared to those who did not, showed a trend toward reduced LOS. This reduction was statistically significant in the higher quality studies. Mortality was similar in both groups. Palliative care consultations also lead to a reduction in costs in 5 of the 8 eligible trials. On average, ICU costs were USD7533 and USD6406 (control vs PC, P < .05) and hospital direct variable costs were USD9518 and USD8971 ( P < .05) per admission. Due to interstudy heterogeneity, all outcomes were described narratively. Conclusion: This review demonstrates a trend that PC consultations reduce LOS and costs without impacting mortality. However, due to the small sample sizes and varying degrees of quality of evidence, many questions remain. A large multicenter RCT and formal economic evaluation would be needed for more definitive results.

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Neonatal and perinatal palliative care pathway: a tertiary neonatal unit approach

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000820 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000820

Author(s):

Abena N Akyempon ◽

Narendra Aladangady

Keyword(s):

Palliative Care ◽

Care Pathway ◽

Perinatal Care ◽

Neonatal Unit ◽

Bereavement Support ◽

Perinatal Palliative Care ◽

The Impact

A lack of well-structured guideline or care pathway results in inadequate, inconsistent and fragmented palliative care (PC) for babies and their families. The impact on the families could be emotionally and psychologically distressing. Not all neonatal units have specialist PC clinicians or teams, and such units will benefit from a well-planned perinatal PC pathway. In this article, we discuss a tertiary neonatal unit perinatal care pathway which provides guidance from the point of diagnosis and establishment of eligibility of a baby for PC through to care after death and bereavement support for families. Planning PC with families which encourages family-centred and individualised approach is also discussed.

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The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

Journal of Neurosurgery Spine ◽

10.3171/2020.5.spine20457 ◽

2020 ◽

Vol 33 (6) ◽

pp. 812-821

Author(s):

Scott L. Zuckerman ◽

Clinton J. Devin ◽

Vincent Rossi ◽

Silky Chotai ◽

E. Hunter Dyer ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Discharge Planning ◽

Lumbar Fusion ◽

Nonparametric Tests ◽

Learning System ◽

Design Quality ◽

Implementation Phase ◽

Healthcare Improvement ◽

The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

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11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.016 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S13-S14

Author(s):

Sarah Zavala ◽

Kate Pape ◽

Todd A Walroth ◽

Melissa A Reger ◽

Katelyn Garner ◽

...

Keyword(s):

Vitamin D ◽

Length Of Stay ◽

Vitamin D Deficiency ◽

Burn Injury ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Hospital Length Of Stay ◽

Burn Patients ◽

Comfort Care ◽

The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

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