Predictors of Hospital Length of Stay and 30-Day Readmission in Cervical Spondylotic Myelopathy Patients: An Analysis of 3057 Patients Using the ACS-NSQIP Database

2018 ◽  
Vol 110 ◽  
pp. e450-e458 ◽  
Author(s):  
Peter G. Passias ◽  
Cyrus M. Jalai ◽  
Nancy Worley ◽  
Shaleen Vira ◽  
Saqib Hasan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cervical Spondylotic Myelopathy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acs Nsqip ◽  
Acs Nsqip Database

scholarly journals Development and Validation of a web-based Postoperative Clostridioides difficile infection risk prediction model

2020 ◽  
Author(s):  
Sang H. Woo ◽  
Bryan Hess ◽  
Lily Ackermann ◽  
Scott W. Cowan ◽  
Jennifer Valentine
Keyword(s):  
Length Of Stay ◽  
Prediction Model ◽  
Risk Prediction ◽  
Infection Risk ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Training Cohort ◽  
Acs Nsqip ◽  
Clostridioides Difficile

AbstractBackgroundClostridioides difficile infection is associated with significant morbidity, mortality and increased costs. Assessment of the postoperative C. difficile infection risk is necessary to improve the outcome of surgical patients.ObjectiveTo develop and validate a risk prediction tool for C. difficile infection after surgery.MethodsIn this retrospective cohort study, 2,451,169 surgical patients from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS-NSQIP) over 2015-2017 were included. Nine predictors were selected for the model: age, preoperative leukocytosis (>12 ×109/L), hematocrit (≤30%), chronic dialysis, insulin dependent diabetes, weight loss, steroid use, presence of preoperative sepsis, and surgery type. A second model included hospital length of stay as a predictor. A predictive model was developed using ACS-NSQIP 2015-2016 training cohort (n=1,435,157) and tested using 2017 validation cohort (n=1,016,012). Multivariate logistic regression was used for the model.Main outcomeThe primary outcome was postoperative 30-day C. difficile infection (CDI).Results0.39% of the patients (n=9,675) developed CDI and 42.3% (n=4,091) of CDI occurred post-discharge. The Clostridioides difficile risk prediction model had excellent AUC (area under the receiver operating characteristic curve) for postoperative C. difficile infection (training cohort=0.804, test cohort= 0.803). The model that includes hospital length of stay has a high AUC (training cohort=0.841, test cohort=0.838).ConclusionThe C. difficile prediction model provides a robust predictive tool for postoperative C. difficile infection.

scholarly journals Using the ACS-NSQIP to Identify Factors Affecting Hospital Length of Stay After Elective Posterior Lumbar Fusion

Spine ◽  
2014 ◽  
Vol 39 (6) ◽  
pp. 497-502 ◽  
Author(s):  
Bryce A. Basques ◽  
Michael C. Fu ◽  
Rafael A. Buerba ◽  
Daniel D. Bohl ◽  
Nicholas S. Golinvaux ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Factors Affecting ◽  
Posterior Lumbar Fusion ◽  
Acs Nsqip

scholarly journals Development and Validation of Postoperative Venous Thromboembolism risk prediction model

2020 ◽  
Author(s):  
Sang H. Woo ◽  
Ruben Rhoades ◽  
Lily Ackermann ◽  
Scott W. Cowan ◽  
Jillian Zavodnick ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Prediction Model ◽  
Risk Prediction ◽  
Hospital Length ◽  
Risk Prediction Model ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Using Data

AbstractBackgroundVTE is a serious postoperative complication after surgery with resultant higher morbidity and mortality. Despite years of experience with current risk models, rates continue to be high and more information is needed on individual patient risk in the prophylaxis era.Research QuestionsCan we assess the individualized risk of postoperative venous thromboembolism (VTE) for broad categories of surgery?MethodsThis study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database. Patient data (n=2,875,190) from 2015-2017 were used for study analysis. Eight predictors were selected for the model: age, preoperative platelet count≥450 (×109/L), disseminated cancer, corticosteroid use, serum albumin ≤2.5 g/dL, preoperative sepsis, hospital length of stay and surgery type. The second model included 7 predictors without hospital length of stay. A predictive model was trained using ACS-NSQIP data from 2015-2016 (n=1,859,227) and tested using data from 2017 (n= 1,015,963). Primary outcomes are postoperative 30-day VTE, including deep vein thrombosis (DVT) and/or pulmonary embolism (PE).ResultsVTE occurred in 23,249 patients (0.81%) and 49.9% of VTE occurred after discharge from index hospitalization. The risk prediction model had high AUC (area under the receiver operating characteristic curve) for postoperative VTE of 0.78 (training cohort) and 0.78 (test cohort).InterpretationThis clinical prediction model is a validated, practical and easy-to-use tool to identify surgical patients at the highest risk of postoperative VTE and provide an individualized assessment of risk based on clinical factors and type of surgery. This prediction model may be used as a tool to assess individualized risk of postoperative VTE and promote broader discussion and awareness of the VTE risk during the perioperative period.

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

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