PP233-SUN THE IMPACT OF MALNUTRITION AND DECREASED FOOD INTAKE ON LENGTH OF STAY, READMISSION, AND MORTALITY IN ACUTE CARE PATIENTS

Abstract Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

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Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

Annals of Pharmacotherapy ◽

10.1177/1060028018815064 ◽

2018 ◽

Vol 53 (5) ◽

pp. 471-477 ◽

Cited By ~ 2

Author(s):

Mary-Haston Leary ◽

Kathryn Morbitzer ◽

Bobbi Jo Walston ◽

Stephen Clark ◽

Jenna Kaplan ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Positive Impact ◽

Pharmacy Practice ◽

Care Practice ◽

Readmission Rates ◽

A Value ◽

Pharmacist Interventions ◽

Semistructured Interviews ◽

The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

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The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

The American Surgeon ◽

10.1177/000313481508100916 ◽

2015 ◽

Vol 81 (9) ◽

pp. 854-858 ◽

Cited By ~ 5

Author(s):

Rudy J. Judhan ◽

Raquel Silhy ◽

Kristen Statler ◽

Mija Khan ◽

Benjamin Dyer ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Tertiary Care ◽

Disease Process ◽

Pediatric Care ◽

Care Hospital ◽

Late Night ◽

General Surgeons ◽

The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

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The Impact of Introducing a Physical Medicine and Rehabilitation Consultation Service to an Academic Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/irz079 ◽

2019 ◽

Vol 40 (5) ◽

pp. 648-651

Author(s):

Lawrence R Robinson ◽

Matthew Godleski ◽

Sarah Rehou ◽

Marc Jeschke

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Trauma Patients ◽

Physical Medicine ◽

Consultation Service ◽

Physical Medicine And Rehabilitation ◽

The Impact

Abstract Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS.

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Predictors of Nonroutine Discharge Among Patients Undergoing Surgery for Grade I Spondylolisthesis: Insights From the Quality Outcomes Database (QOD)

Neurosurgery ◽

10.1093/neuros/nyz310_612 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Praveen V Mummaneni ◽

Mohamad Bydon ◽

John Knightly ◽

Mohammed Ali Alvi ◽

Anshit Goyal ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Degenerative Spondylolisthesis ◽

Care Facility ◽

Quality Outcomes ◽

Acute Care Facility ◽

Factors Associated ◽

Discharge Disposition ◽

Patient Reported ◽

The Impact

Abstract INTRODUCTION Discharge to an in-patient rehabilitation facility or another acute care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to health-care costs. In the era of changing dynamics of healthcare payment models where the risk of cost over-runs are being increasingly shifted to surgeons and hospitals, it is important to understand better outcomes such as discharge disposition. In the current manuscript, we sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis. METHODS We queried the Quality Outcomes Database for patients with grade 1 lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multiside study investigating the impact of fusion on clinical and Patient Reported Outcomes (PROs) among patients with grade 1 spondylolisthesis were evaluated. Nonroutine discharge was defined as those that were discharged to postacute or nonacute care setting in the same hospital or transferred to another acute care facility. RESULTS Of the 605 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to an inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute care facility). On multivariable logistic regression, after adjusting for an array of demographic, socioeconomic, clinical, and operative variables, factors found to be independently associated with higher odds of nonroutine discharge included higher age (OR 10.53, 95% CI 3.8-29.2, P < .001), higher BMI (OR 2.42, 95% CI 1.45-4.05, P < .001), depression (OR 4.97, 95% CI 2.10-11.77, P < .001), and length of stay (OR 3.4, 95% CI 2.3-4.9, P < .001). CONCLUSION In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included higher age, higher BMI, presence of depression, and higher length of stay.

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Hospital-acquired infections in Belgian acute-care hospitals: an estimation of their global impact on mortality, length of stay and healthcare costs

Epidemiology and Infection ◽

10.1017/s0950268811000100 ◽

2011 ◽

Vol 140 (1) ◽

pp. 126-136 ◽

Cited By ~ 23

Author(s):

F. VRIJENS ◽

F. HULSTAERT ◽

S. DEVRIESE ◽

S. VAN DE SANDE

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Excess Mortality ◽

National Level ◽

Acute Care Hospitals ◽

Public Healthcare ◽

Hospital Acquired Infections ◽

Number Of Patients ◽

Hospital Acquired ◽

The Impact

SUMMARYAssessing the overall burden of disease which can be attributed to hospital-acquired infections (HAIs) remains a challenge. A matched cohort study was performed to estimate excess mortality, length of stay and costs attributable to HAIs in Belgian acute-care hospitals, using six matching factors (hospital, diagnosis-related group, age, ward, Charlson score, estimated length of stay prior to infection). Information was combined from different sources on the epidemiology and burden of HAIs to estimate the impact at national level. The total number of patients affected by a HAI each year was 125 000 (per 10·9 million inhabitants). The excess mortality was 2·8% and excess length of stay was 7·3 days, corresponding to a public healthcare cost of €290 million. A large burden was observed outside the intensive-care unit setting (87% of patients infected and extra costs, 73% of excess deaths).

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PP163-SUN THE IMPACT OF LENGTH OF STAY ON THE NUTRITIONAL STATUS OF LONG-TERM PATIENTS IN THE ACUTE CARE SETTING

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(11)70217-4 ◽

2011 ◽

Vol 6 (1) ◽

pp. 85-86

Author(s):

J. Bauer ◽

K. Hiscocks ◽

R. Fichera ◽

P. Horsley ◽

J. Martineau ◽

...

Keyword(s):

Length Of Stay ◽

Nutritional Status ◽

Acute Care ◽

Care Setting ◽

Acute Care Setting ◽

The Impact

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The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit–A Multicenter Prospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10112389 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2389

Author(s):

Davinder Ramsingh ◽

Sumit Singh ◽

Cecilia Canales ◽

Elyse Guran ◽

Zach Taylor ◽

...

Keyword(s):

Length Of Stay ◽

Observational Study ◽

Acute Care ◽

Prospective Observational Study ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Arterial Blood ◽

Evaluation Point ◽

Significant Difference ◽

The Impact

Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. Methods: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. Conclusions: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.

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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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