Factors Affecting Hospital Length of Stay in Geriatric Patients with a Surgically Treated Fragility Ankle Fracture

BackgroundThe efficacy of prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for reversal of oral anticoagulants has not been investigated in geriatric patients suffering intracranial hemorrhage (ICH) due to a ground-level fall (GLF).MethodsPatients 65 years and older who were treated at Santa Barbara Cottage Hospital between January 2011 and March 2018 with ICH after a GLF while taking warfarin were reviewed. Patients were reversed with either FFP (n=25) or PCC (n=27) and patient outcomes were compared. Separate analyses were conducted for patients who received adjuvant vitamin K administration and those who did not.ResultsMortality rates, hospital length of stay, intensive care unit admission and length of stay were similar for both FFP and PCC intervention. There was no difference in radiological progression of hemorrhage within the first 24 hours of admission (FFP: 36%, PCC: 43%, p=0.365). In patients who had international normalized ratio (INR) values measured prior to intervention, 81% (17 out of 21) of the PCC group reached an INR value below 1.5 within an 8-hour period, whereas only 29% (4 out of 14) of the FFP group did (p=0.002). Vitamin K was concomitantly given to 28% of the patients receiving FFP, and 81% of those patients receiving PCC. No significant differences in outcomes were found whether adjunctive vitamin K was administered or not, in either FFP or PCC group. However, when vitamin K was not administered, the PCC group had a higher rate of INR reversal (80% vs. 10% for FFP, p=0.006).ConclusionAdministration of PCC is as effective in short-term outcomes as FFP in treating geriatric patients on warfarin sustaining an ICH after a GLF. INR reversal was more successful, significantly faster, and required lower infusion volumes in patients receiving PCC.Level of evidenceLevel III.

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Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia

International Psychogeriatrics ◽

10.1017/s1041610214002002 ◽

2014 ◽

Vol 27 (2) ◽

pp. 313-321 ◽

Cited By ~ 6

Author(s):

Zahinoor Ismail ◽

Tamara Arenovich ◽

Robert Granger ◽

Charlotte Grieve ◽

Peggie Willett ◽

...

Keyword(s):

Mental Health ◽

Length Of Stay ◽

Geriatric Patients ◽

Hospital Length ◽

Geriatric Psychiatry ◽

Assessment Instrument ◽

Hospital Length Of Stay ◽

Psychotic Symptoms ◽

Discharge Data ◽

Use Of Resources

ABSTRACTBackground:Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds.Methods:Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models.Results:A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS – a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS.Conclusions:Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.

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Predicting Hospital Length of Stay for Geriatric Patients with Mood Disorders

The Canadian Journal of Psychiatry ◽

10.1177/070674371205701107 ◽

2012 ◽

Vol 57 (11) ◽

pp. 696-703 ◽

Cited By ~ 13

Author(s):

Zahinoor Ismail ◽

Tamara Arenovich ◽

Charlotte Grieve ◽

Peggie Willett ◽

Gautam Sajeev ◽

...

Keyword(s):

Mental Health ◽

Length Of Stay ◽

Mood Disorder ◽

Mood Disorders ◽

Geriatric Patients ◽

Hospital Length ◽

Assessment Instrument ◽

Hospital Length Of Stay ◽

Discharge Data ◽

Use Of Resources

Objective: To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds. Method: Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument—Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models. Results: Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living. Conclusions: Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.

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