scholarly journals 108 A Multidisciplinary Team Initiative to End PJ Paralysis Was Successful in Achieving Cultural Change on An Acute Geriatric Ward

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
J Butler ◽  
T Welford
Keyword(s):  
Cultural Change ◽  
The Elderly ◽  
Recovery Phase ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Service Development ◽  
Steady Increase ◽  
Geriatric Ward ◽  
Additional Equipment ◽  
Acute Geriatric Ward

Abstract Introduction Prolonged bedrest amongst the elderly causes deconditioning leading to; increased hospital length of stay, additional social costs and decreased quality of life. An audit on an acute geriatric ward in November 2018, found that over a third of patients medically fit (PMF) to sit out remained in bed all day. Therefore, a service development initiative was undertaken, addressing the misconception that keeping elderly patients in bed is safe, when in fact, unintentional harm results. Method In a root cause analysis, four main reasons for bedrest were identified: risk aversion, unknown function, widespread “bed is safe” culture and lack of equipment. The project tasked getting PMF out of bed each day and was audited daily from November 2018 to present, involving all members of the multi-disciplinary team (MDT) and using a “plan, do, study, act” approach. Results Initially, the project showed an increase in percentage of PMF sitting out each day, but this subsequently decreased with winter pressures. However, for a whole year (February 2019–February 2020) a sustained and significant improvement was achieved (64.3%–89.7%). The pre-COVID19 period (February–March 2020) saw fluctuations in PMF sitting out. Data collection halted during the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19 recovery phase) which showed a steady increase in PMF out of bed, with recent figures surpassing pre-COVID19 levels (97.8%). Conclusion Cultural change takes time to embed and needs persistent reviewing by a dedicated and engaged MDT. Improvements were made through more accessible doctor’s advice, better MDT education and communication, daily feedback of data and sourcing additional equipment. Disruption to working patterns over the COVID19 period made this unachievable and the project lost impetus. In the COVID19 recovery phase, the specialized MDT reformed and worked successfully to restore the cultural change as evidenced by audited data.

scholarly journals High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

2020 ◽  
Author(s):  
Yang Tao ◽  
Panke Cheng ◽  
Wen Chen ◽  
Peng Wan ◽  
Yaokai Chen ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Medical Center ◽  
Age Groups ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asymptomatic Patients ◽  
Imported Cases ◽  
History Of ◽  
Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

In the Wake of Hurricane Isabel: A Prospective Study of Postevent Trauma and Injury Control Strategies

2005 ◽  
Vol 71 (3) ◽  
pp. 194-197 ◽  
Author(s):  
E.B. Gagnon ◽  
M.B. Aboutanos ◽  
A.K. Malhotra ◽  
D. Dompkowski ◽  
T.M. Duane ◽  
...  
Keyword(s):  
Injury Severity ◽  
Control Strategies ◽  
Recovery Phase ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Urban City ◽  
Upper And Lower Extremities ◽  
Hurricane Isabel ◽  
A Prospective Study

Preventing hurricane-related injuries (HRI) has historically centered on the pre-event and event phases of the disaster. To date, no study has focused on injuries occurring during the postevent phase. We examined HRI that occurred after Hurricane Isabel struck a U.S. urban city. HRI presenting 1 week prior to the hurricane were collected from emergency department electronic records. HRI that presented to our level 1 trauma center were prospectively collected for 1 week after the hurricane. Nine hundred seventy-eight patients with possible HRI were identified. Fifty-one patients with trauma directly attributed to the hurricane were used for analysis. The number of HRI occurring before, during, and after the hurricane were 7 (14%), 3 (6%), and 41 (80%), respectively. The majority of HRI (37%) occurred on posthurricane day 1. Head, chest, upper and lower extremities accounted for 9 (18%), 8 (16%), 13 (26%), and 14 (28%) of HRI. More than one third of HRI patients were admitted to the hospital, and 12 (24%) underwent an operation. The average hospital length of stay was 4.7 days. Of our trauma alerts, 75 per cent had an Injury Severity Score (ISS) >8, and 20 per cent had an ISS >15. Tree-related injuries (TRI) accounted for 59 per cent of HRI. Males, ages 50–60, had the highest incidence of injury (63%). Significant injuries occur in the wake of a hurricane. Optimization of disaster preparation must include prevention strategies targeted to the postevent recovery phase of disasters.

EARLY TRACHEOSTOMY IN THE ELDERLY SURGICAL ICU (SICU) PATIENT IS ASSOCIATED WITH DECREASED ICU AND HOSPITAL LENGTH OF STAY.

2006 ◽  
Vol 34 ◽  
pp. A124 ◽  
Author(s):  
Richard H Savel ◽  
Evan Goldstein ◽  
Deborah Riedinger ◽  
Herbert E Lehman ◽  
Yizhak Kupfer
Keyword(s):  
Length Of Stay ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Early Tracheostomy ◽  
Surgical Icu

scholarly journals High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

2020 ◽  
Author(s):  
Yang Tao ◽  
Panke Cheng ◽  
Wen Chen ◽  
Peng Wan ◽  
Yaokai Chen ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Medical Center ◽  
Age Groups ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asymptomatic Patients ◽  
Imported Cases ◽  
History Of ◽  
Epidemiological Characteristics

Abstract Background SARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. Methods In this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed. Findings 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days). Conclusion The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

scholarly journals Clinical Features of Cardio-Renal Syndrome in a Cohort of Consecutive Patients Admitted to an Internal Medicine Ward

2011 ◽  
Vol 5 (1) ◽  
pp. 220-225 ◽  
Author(s):  
F Fabbian ◽  
M Pala ◽  
A De Giorgi ◽  
A Scalone ◽  
C Molino ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Clinical Features ◽  
Cardiorenal Syndrome ◽  
The Elderly ◽  
Arterial Disease ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Internal Medicine Ward ◽  
Type 3

Introduction: Cardiorenal syndrome (CRS) is a disorder of the heart and kidney whereby interactions between the 2 organs can occur. We recorded the clinical features of CRS in patients consecutively admitted to an Internal Medicine ward. Patients and Methods: We retrospectively analyzed the anthropometric, history, clinical, biochemical and treatment characteristics in 438 out of 2,998 subjects (14.6%) admitted to our unit (from June 2007 to December 2009), diagnosed with CRS, according to Acute Dialysis Quality Initiative (ADQI) recommendations. Estimated glomerular filtration (eGFR) was calculated using several equations: MDRD (Modification of Diet in Renal Disease; 2 variations GFRMDRD186, GFRMDRD175), Mayo, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockroft-Gault. Results: Mean age was 80±8 years, 222 (50.6%) were males, 321 (73.2%) were smokers, 229 (52.2%) were diabetic, 207 (47.2%) had a history of acute myocardial infarction, 167 (38.1%) had angina, 135 (30.8%) were affected by cerebrovascular disease, 339 (77.3%) had peripheral arterial disease. CRS was type 1 in 211 cases (48.2%), type 2 in 96 (21.9%), type 3 in 88 (20.1%), type 4 in 29 (6.6%) and type 5 in 14 (3.2%). eGFR, calculated by different formulae, ranged between 31 and 36 ml/min/1.73 m2. GFR was lower in CRS type 3 than in the other types, and the values ranged between 24 and 27 ml/min/1.73 m2. Mean hospital length-of-stay (LOS) was 9.8±6.3 days. Diuretics were the most prescribed medication (78.7%); only 5 patients underwent haemodialysis. Conclusions: CRS is common, especially in the elderly. CRS Type 1 was the prevalent subset and patients had stage 3-4 renal insufficiency. Results obtained from the GFR equations were similar although the Mayo equation tended to overestimate the eGFR.

scholarly journals Restoration of Colorectal Services in the Recovery Phase of the COVID-19 Pandemic: A view from Oxford

2020 ◽  
Author(s):  
Trevor Yeung ◽  
Julia Merchant ◽  
Patrick Chen ◽  
Corinne Smart ◽  
Hamira Ghafoor ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Recovery Period ◽  
Information Management System ◽  
Recovery Phase ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Major Surgery ◽  
Record System ◽  
Patient Pathways ◽  
The Impact

Abstract BackgroundThe coronavirus pandemic has significantly disrupted the way we deliver healthcare worldwide. We have been flexible and creative in order to continue providing elective colorectal cancer operations and to restart services for benign cases during the recovery period of the pandemic. In this paper, we describe the impact of coronavirus on our elective services and how we have implemented new patient pathways to allow us to continue providing patient care.MethodsData on major colorectal elective resections was prospectively collected in an Enhanced Recovery After Surgery (ERAS) database. Data on the number of proctology cases and telemed appointments were collected from the hospital theatre information management system and electronic patient record system respectively. ResultsDuring the pandemic, there was a complete shift towards cancer cases, with benign services and proctology cases being placed on hold. Hospital length of stay was reduced. We implemented earlier hospital discharge and more intense telephone follow up after elective major surgery. This has not resulted in an increase in post-operative complications, nor any increase in readmission into hospital. During the recovery phase, we have introduced a higher proportion of telemed consultations, including one-stop telemed proctology clinics, resulting in straight to tests or investigations.ConclusionsWe have created a streamlined multi-disciplinary pathway to reinstate our elective colorectal services as soon as possible and to minimise potential harm caused to patients whose treatment have been delayed. We anticipate many of these changes will be permanently incorporated into our clinical practice once the pandemic is over.

scholarly journals Where are we with improving outcome guidance? An update on pelvic urological services in the NHS

2017 ◽  
Vol 10 (1_suppl) ◽  
pp. 29-33 ◽  
Author(s):  
Samer Jallad ◽  
Luke Hounsome ◽  
Julia Verne ◽  
Erik Mayer
Keyword(s):  
Multidisciplinary Approach ◽  
Postoperative Mortality ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Pelvic Surgery ◽  
Steady Increase ◽  
Case Volume ◽  
Outcome Relationship ◽  
Catchment Areas ◽  
Volume Outcome

Background: The volume–outcome relationship in surgery has been a focus of interest for over a decade. The National Institute for Health and Care Excellence (NICE) published their improving outcome guidance in 2002, which encouraged a regionalised multidisciplinary approach in managing urological cancer cases and recommended centralisation of urological pelvic surgery. The current study offers an updated view on the urological pelvic services in England with regard to radical cystectomy (RC) and radical prostatectomy (RP) and adherence to improving outcome guidance guidelines and patterns of services provision since its introduction in 2002. Methods: The data for inpatient elective RC and RP were taken from hospital episodes statistics for 2003–2013. The RC and RP cases were calculated separately per year for every trust to calculate the annual rates and then combined for every trust. The catchment areas for RC and RP were calculated using the proportionate-flow method. Results: The number of trusts performing RC and RP reduced significantly over the 10 years, while in the same period, the numbers of RC and RP performed increased significantly ( P<0.05). There has been a steady increase in the cases referred to another trust for their RC or RP surgery ( P<0.05). Overall, there has been a significant increase in the number of trusts achieving the improving outcome guidance recommended minimal case volume of 50 or more (RC + RP combined) over the 10-year analysis ( P=0.0006). Conclusion: There has been a shift in urological pelvic surgery provision in England since the publication of improving outcome guidance by NICE in 2002, with over 95% of cases being performed in improving outcome guidance compliant centres achieving 50 cases or more per year. Simultaneously, a significant reduction in postoperative mortality and the hospital length of stay has been seen over this period.

Retrospective Data Review Comparing Complication Rates and Hospital Length of Stay in the Elderly

2016 ◽  
Vol 12 (7) ◽  
pp. S134-S135
Author(s):  
Van Leavitt ◽  
David Podkameni ◽  
Joseph Heller ◽  
Albert Chen ◽  
Flavia Soto ◽  
...  
Keyword(s):  
Length Of Stay ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Retrospective Data
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