scholarly journals MP023: Reasons for referral and hospitalization among emergency department patients with syncope

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S74-S74
Author(s):  
O. Cook ◽  
M.A. Mukarram ◽  
M. Rahman ◽  
S. Kim ◽  
K. Arcot ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Improve Patient Safety ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cardiac Monitoring ◽  
Inpatient Cost ◽  
Monitoring Strategy ◽  
Potential Cost ◽  
Cardiac Syncope ◽  
Number Of Patients

Introduction: Syncope can be caused by serious life-threatening conditions not obvious during the initial ED assessment leading to wide variations in management. We aimed to identify the reasons for consultations and hospitalizations, outcomes, and the potential cost savings if an outpatient cardiac monitoring strategy were developed. Methods: We conducted a prospective cohort study of adult syncope patients at 5 academic EDs over 41 months. We collected baseline characteristics, reasons for consultation and hospitalization, hospital length of stay and average total inpatient cost. Adjudicated 30-day serious adverse events (SAEs) included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage and procedural intervention. We used descriptive statistics with 95% CI. Results: Of the 4,064 patients enrolled (mean age 53.1 years, 55.9% female), 3,255 (80.1%) were discharged from the ED, 209 (5.2%) had a SAE identified in the ED, 600 (14.8%) with no SAE were referred for consultation in the ED and 299 (7.4%) were hospitalized: 55.5% of referrals and 55.2% of hospitalizations were for suspected cardiac syncope (46.5% admitted for cardiac monitoring of whom 71.2% had no cause identified). SAE among groups were 9.7% in total; 2.5% discharged by ED physician; 3.4% discharged by consultant from ED; 21.7% as inpatient and 4.8% following discharge from hospital. The mean hospital length of stay for cardiac syncope was 6.7 (95%CI 5.8, 7.7) days with total estimated costs of $7,925 per patient (95% CI: 7434, 8417). Conclusion: Suspected cardiac syncope, particularly arrhythmia, was the major reason for ED referral and hospitalization. The majority of patients hospitalized for cardiac monitoring had no identified cause. An important number of patients suffered SAE, particularly arrhythmias outside the hospital. These findings highlight the need to develop a robust syncope prediction tool and a remote cardiac monitoring strategy to improve patient safety while saving substantial health care resources.

scholarly journals Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications

2020 ◽  
Vol 5 (1) ◽  
pp. e000483 ◽  
Author(s):  
Abid D Khan ◽  
Anna J Elseth ◽  
Jacqueline A Brosius ◽  
Eliza Moskowitz ◽  
Sean C Liebscher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Brain Injury ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Injury Severity ◽  
Improve Patient Safety ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Ct ◽  
The Brain

BackgroundThe Brain Injury Guidelines provide an algorithm fortreating patients with traumatic brain injury (TBI) and intracranial hemorrhage(ICH) that does not mandate hospital admission, repeat head CT, orneurosurgical consult for all patients. The purposes of this study are toreview the guidelines’ safety, to assess resource utilization, and to proposeguideline modifications that improve patient safety and widespreadreproducibility.MethodsA multi-institutional review of TBI patients was conducted. Patients with ICH on CT were classified as BIG 1, 2, or 3 based on the guidelines. BIG 3 patients were excluded. Variables collected included demographics, Injury Severity Score (ISS), hospital length of stay (LOS), intensive care unit LOS, number of head CTs, type of injury, progression of injury, and neurosurgical interventions performed.Results269 patients met inclusion criteria. 98 were classifiedas BIG 1 and 171 as BIG 2. The median length of stay (LOS) was 2 (2,4)days and the ICU LOS was 1 (0,2) days. Most patients had a neurosurgeryconsultation (95.9%) and all patients included had a repeat head CT. 370repeat head CT scans were performed, representing 1.38 repeat scans perpatient. 11.2% of BIG 1 and 11.1% of BIG 2 patients demonstratedworsening on repeat head CT. Patients who progressed exhibited a higherISS (14 vs. 10, p=0.040), and had a longer length of stay (4 vs. 2 days;p=0.015). After adjusting for other variables, the presence of epiduralhematoma (EDH) and intraparenchymal hematoma were independent predictors ofprogression. Two BIG 2 patients with EDH had clinical deteriorationrequiring intervention.DiscussionThe Brain Injury Guidelines may improve resourceallocation if utilized, but alterations are required to ensure patientsafety. The modified Brain Injury Guidelines refine the originalguidelines to enhance reproducibility and patient safety while continuing toprovide improved resource utilization in TBI management.

scholarly journals Epidemiology of burn patients admitted in the Netherlands: a nationwide registry study investigating incidence rates and hospital admission from 2014 to 2018

2021 ◽  
Author(s):  
Daan T. Van Yperen ◽  
Esther M. M. Van Lieshout ◽  
Michael H. J. Verhofstad ◽  
Cornelis H. Van der Vlies
Keyword(s):  
Length Of Stay ◽  
Incidence Rate ◽  
Hospital Length ◽  
Entire Population ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Annual Number ◽  
Burn Patients ◽  
Burn Center ◽  
Number Of Patients

Abstract Purpose The aim of this study was to gain insight into the epidemiology of burn patients admitted to a hospital without a burn center or referred to a burn center. Methods This retrospective, nationwide, cohort study included patients with burns or inhalation trauma, admitted between 2014 and 2018, from a national trauma registry. The primary outcome measure was admission to a hospital with or without a burn center. Secondary outcome measures were patient and injury characteristics, Intensive Care Unit (ICU) admission and length of stay, and hospital length of stay (HLOS). Results Of the 5524 included patients, 2787 (50.4%) were treated at a non-burn center, 1745 (31.6%) were subsequently transferred to a burn center, and 992 (18.0%) were primarily presented and treated at a burn center. The annual number of patients decreased from 1199 to 1055 (− 12.4%). At all admission locations, a clear incidence peak was observed in children ≤ 4 years and in patients of ≥ 80 years. The number of ICU admissions for the entire population increased from 201 to 233 (33.0%). The mean HLOS for the entire population was 8 (SD 14) days per patient. This number remained stable over the years in all groups. Conclusion Half of all burn patients were admitted in a non-burn center and the other half in a burn center. The number and incidence rate of patients admitted with burns or inhalation trauma decreased over time. An increased incidence rate was found in children and elderly. The number of patients admitted to the ICU increased, whereas mean hospital length of stay remained stable.

scholarly journals CPAP Use in Covid-19 Patients: A Retrospective Observational Study in the Emergency Department.

2020 ◽  
Author(s):  
Nicolo Capsoni ◽  
Daniele Privitera ◽  
Annamaria Mazzone ◽  
Chiara Airoldi ◽  
Laura Angaroni ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Observational Study ◽  
Positive Pressure ◽  
Number Of Patients ◽  
Mechanical Ventilation Time ◽  
Medical Wards

Abstract BackgroundDuring COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Study design and MethodsA retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. ResultsA total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16-37] vs 15 days [IQR 9-17] (p=0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p=0.003) and respiratory rate (RR) (p=0.059).ConclusionsA short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s SpO2 improvement and RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery

2020 ◽  
pp. postgradmedj-2020-138650
Author(s):  
Jun Han Tang ◽  
Bei Wang ◽  
Jie Ling Jaclyn Chow ◽  
Priscilla M Joseph ◽  
Jia Ying Chan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Intervention ◽  
Early Mobilisation ◽  
Potential Cost ◽  
Improvement Project ◽  
Pareto Chart

BackgroundEarly mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives.ObjectivesThe primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months.MethodsWe report a multidisciplinary team clinical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan–Do–Study–Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay.ResultsMobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay.ConclusionMultidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underwent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings.

scholarly journals CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

2020 ◽  
Author(s):  
Nicolò Capsoni ◽  
Daniele Privitera ◽  
Annamaria Mazzone ◽  
Chiara Airoldi ◽  
Valentina Albertini ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Observational Study ◽  
Positive Pressure ◽  
Number Of Patients ◽  
Mechanical Ventilation Time ◽  
Medical Wards

Abstract Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

scholarly journals 751. Impact of Changing from a Three-step to Two-step Testing Algorithm for the Diagnosis of Clostridioides difficile

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S473-S473
Author(s):  
Jonathan Lapin ◽  
Vasilios Athans ◽  
Shawn Binkley ◽  
Tiffany Lee ◽  
Sonal Patel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Primary Outcome ◽  
Hospital Length ◽  
Control Measures ◽  
Nucleic Acid Amplification ◽  
Targeted Treatment ◽  
Hospital Length Of Stay ◽  
Prior History ◽  
Clostridioides Difficile ◽  
Number Of Patients

Abstract Background The optimal method for laboratory diagnosis of Clostridioides difficile infection (CDI) remains undefined and national guidelines do not make a recommendation for a preferred diagnostic algorithm. Aiming to improve infection control measures, the Hospital of the University of Pennsylvania changed its testing process for the diagnosis of CDI from a 3-step to a 2-step algorithm (Figure 1) in September 2018. Starting an algorithm with nucleic acid amplification testing (NAAT) has been hypothesized to lead to potential diagnostic uncertainty if the result is positive by NAAT alone, as this test cannot distinguish between active infection and colonization. Three-Step and Two-Step Diagnostic Testing Algorithms Methods This retrospective, single-center, quasi-experimental study included patients ≥ 18 years of age that tested positive for C. difficile between May 1st, 2018 and January 31st, 2019. The study period encompassed 4 months prior to the algorithm change, a 1-month washout immediately following the change, and the subsequent 4 months. The primary outcome was proportion of patients who tested positive for C. difficile and received targeted treatment for CDI. Secondary outcomes included total number of patients who tested positive for C. difficile and received targeted treatment for CDI, duration of treatment for CDI, and hospital length of stay. Results Sixty-nine patients in the pre-group (3-step) and 75 patients in the post-group (2-step) tested positive for C. difficile. A higher proportion of patients in the post-group tested positive by NAAT alone (59.4% vs. 73.3%). CDI severity and prior history of CDI were similar between groups. The primary outcome occurred in 89.9% of patients in the pre-group and 83.8% in the post-group (p=0.213). Sixty-two patients in each group received targeted treatment for CDI (p=0.213), median treatment duration was 15 (IQR 11.25-25.75) and 14 (IQR 11-25) days (p=0.505), and median hospital length of stay was 9 (IQR 3-15) and 6 (IQR 3-20) days (p=0.690) in the pre-group and post-group, respectively. Conclusion Although there was a higher percentage of patients in the post-group that tested positive for C. difficile by NAAT alone, there was no difference in the proportion or total number of patients who received targeted CDI treatment between time periods. Disclosures All Authors: No reported disclosures

Initial Suction Evacuation of Traumatic Hemothoraces: A Novel Approach to Decreasing Chest Tube Duration and Complications

2012 ◽  
Vol 78 (8) ◽  
pp. 883-887 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Suction Catheter ◽  
Trauma Patients ◽  
Surgical Drainage ◽  
High Resource ◽  
Number Of Patients

Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. However, the high resource and expertise requirement may limit the widespread applicability of surgical drainage. We present the results of a relatively simple and novel intervention for traumatic hemothoraces undertaken by our faculty to shorten chest tube duration and prevent empyema formation. At our Level I trauma center, 10 trauma patients underwent initial suction evacuation of their traumatic hemothoraces using a sterile suction catheter before chest tube placement. Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.

scholarly journals Experiencia inicial en Buenos Aires con la cirugía transoral robótica (TORS)

2020 ◽  
Vol 112 (2) ◽  
pp. 141-156
Author(s):  
Eduardo Busto ◽  
◽  
Marta Patrucco
Keyword(s):  
Robotic Surgery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Benign Tumors ◽  
Endoscopic Evaluation ◽  
Swallowing Function ◽  
Invasive Approach ◽  
Surgical Tool ◽  
Number Of Patients

Background: robotic surgery is an alternative to open surgery, CO2 laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.

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