scholarly journals Expanding emergency department capacity: a multisite study

2014 ◽  
Vol 38 (3) ◽  
pp. 278 ◽  
Author(s):  
Julia L. Crilly ◽  
Gerben B. Keijzers ◽  
Vivienne C. Tippett ◽  
John A. O'Dwyer ◽  
Marianne C. Wallis ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Delay Time ◽  
Service Outcomes ◽  
Before And After ◽  
Related Service ◽  
Comparative Cohort Study ◽  
Public Emergency ◽  
Admission Requirement ◽  
Offload Delay ◽  
Respiratory Conditions

Objectives The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area. Methods The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission. Results Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1–3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses. Conclusions Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered.

scholarly journals Chest Mobility Exercise with Staked Breathing Versus Chest Mobility Exercises with Incentive Spirometery On Chest Expansion with Pleural Effusion Patient: A Comparative Study

2021 ◽  
Vol 9 (4) ◽  
pp. 3949-3953
Author(s):  
Minhaj Tahir ◽  
◽  
Tahzeeb Fatima ◽  
Devendra Trivedi ◽  
Manjit Kumar ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Pleural Effusion ◽  
P Value ◽  
Chest Expansion ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Pleura Effusion ◽  
Respiratory Conditions ◽  
Incentive Spirometry

Background: Pleural effusion is one of the commonly seen respiratory conditions in India with approximately 1 million people being diagnosed each year. Twenty to forty percent of hospitalized patients with bacterial pneumonia develop pleural effusion. In India unlike western countries, tuberculosis pleura effusion is common. The pleural cavity is involved in approximately 5% of all patients with tuberculosis. Since there was no literature regarding the effectiveness chest mobility exercise with staked breathing or chest mobility exercises with incentive spirometery in pleural effusion. There was a need to find out as to which approach are the best ones to implement. Objective: To compare the efficacy of chest mobility exercise with stacked breathing versus chest mobility exercise with incentive spirometery on chest expansion in patients with pleural effusion. Materials and Method: 20 patients with pleural effusion were selected by easy sampling and randomly assigned into two groups (10 patients each groups). Group A received chest mobility exercises and intensive spirometery and group B received chest mobility exercises and stacked breathing. Both groups were instructed to perform the intervention 3 time per day, 8 to 10 time per session for one week. Chest expansion was measured by thoracic flow cytometry before and after one week of intervention. Result: In group A chest expansion increase from 2.68 to 2.87 which was statistically significant (P value < 0.0023). In Group B the chest expansion increases from 2.94 to 3.09 which was not statistically significant (P value < 0.216). Conclusion: It was concluded from the result that both chest mobility exercises with intensive spirometery and chest mobility exercise with stacked breathing are equally effective in improving the chest expansion in subject with pleural effusion. KEY WORDS: Pleural effusion, Chest mobility exercises, Incentive Spirometry, Stacked breathing, Thoracic flow cytometry.

scholarly journals Respiratory Complications Before and After Liver Transplant

2018 ◽  
Vol 34 (5) ◽  
pp. 355-363
Author(s):  
Filipe S. Cardoso ◽  
Constantine J. Karvellas
Keyword(s):  
Critical Care ◽  
Liver Transplant ◽  
Patient Outcomes ◽  
Negative Impact ◽  
Perioperative Period ◽  
Therapeutic Approaches ◽  
Respiratory Complications ◽  
Before And After ◽  
Respiratory Conditions

Respiratory complications before and after liver transplant are common, diverse, and potentially have a negative impact on patient outcomes. In this review, we discuss the most frequent respiratory conditions that patients may develop in the perioperative period. Their prevention and/or treatment may help to maximize the benefit these patients may derive from liver transplant. This review examines diagnostic and therapeutic approaches to these complications for hepatologists, surgeons, and critical care physicians.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Paulo David Scatena Gonçales ◽  
Joyce Assis Polessi ◽  
Lital Moro Bass ◽  
Gisele de Paula Dias Santos ◽  
Paula Kiyomi Onaga Yokota ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
High Complexity ◽  
Rapid Response Teams ◽  
Cardiorespiratory Arrest ◽  
Reduced Frequency ◽  
Before And After ◽  
Response Team ◽  
The Impact

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

scholarly journals Standardised mortality ratios as a user-friendly performance metric and trigger for quality improvement in a Flemish hospital network: multicentre retrospective study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029857
Author(s):  
Wim Tambeur ◽  
Pieter Stijnen ◽  
Guy Vanden Boer ◽  
Pieter Maertens ◽  
Caroline Weltens ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Mortality ◽  
Web Application ◽  
Hospital Admissions ◽  
Diagnosis Related Groups ◽  
Medical Officer ◽  
Custom Made ◽  
Before And After ◽  
R Shiny ◽  
Concomitant Reduction

ObjectiveTo illustrate the development and use of standardised mortality rates (SMRs) as a trigger for quality improvement in a network of 27 hospitals.DesignThis research was a retrospective observational study. The primary outcome was in-hospital mortality. SMRs were calculated for All Patient Refined—Diagnosis-Related Groups (APR-DRGs) that reflect 80% of the Flemish hospital network mortality. Hospital mortality was modelled using logistic regression. The metrics were communicated to the member hospitals using a custom-made R-Shiny web application showing results at the level of the hospital, patient groups and individual patients. Experiences with the metric and strategies for improvement were shared in chief medical officer meetings organised by the Flemish hospital network.Setting27 Belgian hospitals.Participants1 198 717 hospital admissions for registration years 2009–2016.ResultsPatient gender, age, comorbidity as well as admission source and type were important predictors of mortality. Altogether the SMR models had a C-statistic of 88%, indicating good discriminatory capability. Seven out of ten APR-DRGs with the highest percentage of hospitals statistically significantly deviating from the benchmark involved malignancy. The custom-built web application and the trusted environment of the Flemish hospital network created an interoperable strategy to get to work with SMR findings. Use of the web application increased over time, with peaks before and after key discussion meetings within the Flemish hospital network. A concomitant reduction in crude mortality for the selected APR-DRGs from 6.7% in 2009 to 5.9% in 2016 was observed.ConclusionsThis study reported on the phased approach for introducing SMR reporting to trigger quality improvement. Prerequisites for the successful use of quality metrics in hospital benchmarks are a collaborative approach based on trust among the participants and a reporting platform that allows stakeholders to interpret and analyse the results at multiple levels.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

2021 ◽  
Author(s):  
Neima Briggs ◽  
Michael V Gormally ◽  
Fangyong Li ◽  
Sabrina L Browning ◽  
Miriam M Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research Question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study Design and Methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P=0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P=0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P=0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P=0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

scholarly journals Functional assessment of muscle response in lower limbs of tumbling gymnasts through tensiomyography

2016 ◽  
Vol 64 (3) ◽  
pp. 505
Author(s):  
Nicolás Rojas-Barrionuevo ◽  
Mercedes Vernetta-Santana ◽  
Jesús López-Bedoya
Keyword(s):  
Delay Time ◽  
High Performance ◽  
Vastus Lateralis ◽  
Rectus Femoris ◽  
Response Speed ◽  
Biceps Femoris ◽  
Lower Limbs ◽  
Muscle Response ◽  
Antagonist Muscles ◽  
Before And After

Introduction: Jumping capacity, a distinctive technical skill of tumbling gymnasts, is associated to a successful performance in training and competition; hence the need for an individualized, precise and localized assessment of the most demanded muscle structures.Objective: To assess muscle response of the flexo-extension structure in the knee joint and the extension of the ankle joint in a sample of 12 high-performance male gymnasts.Materials and methods: An acrobatic training protocol including sets of forward somersault in tumbling track was conducted. The contraction time, delay time and deformation of muscle belly were evaluated, and the muscular response speed was calculated using tensiomyography before and after the training intervention in different periods of time.Results: Significant differences were found (p<0.05) according to the muscle group involved, where rectus femoris and biceps femoris presented greater enhancement and shortening of the contraction and delay time. Major differences appeared between agonist-antagonist muscles (vastus lateralis-biceps femoris) (p<0.05) due to a decrease in the contraction and delay speed in vastus medialis (p<0.001).Conclusions: Tensiomyography allows estimating the states of activation-enhancing of the musculature responsible of jumping in tumblers, as well as planning the training based on the state of muscle fatigue.

scholarly journals Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ibrahim Soliman ◽  
Waleed Tharwat Aletreby ◽  
Fahad Faqihi ◽  
Nasir Nasim Mahmood ◽  
Omar E. Ramadan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Discharge ◽  
Neurocritical Care ◽  
Middle Eastern ◽  
Icu Length Of Stay ◽  
Icu Discharge ◽  
Before And After ◽  
Group 2 ◽  
Injured Patients ◽  
Group 1

Background. Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim. This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods. A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions. Results. Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p<0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p<0.05). Conclusion. Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.

Abstract 11056: Hospitals Accepting Greater Proportions of High Risk Transfer-In STEMI Patients Do Not Have Higher Risk-Adjusted Hospital Mortality: A Report From the AHA Mission: Lifeline Program

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael C Kontos ◽  
Tracy Y Wang ◽  
Anita Y Chen ◽  
Laine Thomas ◽  
Eric Bates ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mortality Risk ◽  
Risk Adjustment ◽  
Risk Model ◽  
Risk Transfer ◽  
Before And After

Background: Mortality is an important quality measure for acute MI hospital care. There is concern that, despite risk adjustment, PCI receiving hospitals receiving a disproportionate volume of high risk STEMI transfers may have their reported mortality adversely affected. Methods: All STEMI patients from April 2011 to December 2013 in the ACTION Registry®-GWTG™ were included. High risk was defined as pts with either cardiogenic shock or cardiac arrest on admission. Hospitals were divided into tertiles based on the proportion of high risk STEMI patients who were transferred relative to the total number of STEMI patients treated. Adjusting for covariates in the ACTION mortality risk model, the differences in risk-adjusted in-hospital mortality in each tertile were determined before and after excluding high risk STEMI transfer pts. Results: Among 119,680 STEMI pts treated at 539 primary PCI hospitals, 37,028 (31%) pts were transfers, of whom 4,500 (4%) were high risk. The proportion of high risk STEMI transfers ranged from 0-12% across hospitals. Times from initial hospital presentation to PCI were similar across tertiles: Low 107 min; Middle, 100 min; High 106 min. The ACTION mortality risk model, which includes cardiogenic shock but not cardiac arrest, slightly underestimated mortality for high-risk STEMI transfer pts (observed in-hospital mortality rate: 26%, predicted mortality rate: 24%). While differences in observed hospital mortality were present among hospitals with a greater proportion of high-risk transfers, risk-adjusted mortality was unaffected by the inclusion or exclusion of high-risk transfer patients across all tertiles (TABLE). Conclusions: Receiving PCI hospitals accepting greater proportions of high risk STEMI transfer pts did not have a higher risk-adjusted in-hospital mortality when a clinical mortality risk model was used for risk adjustment.

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