scholarly journals 449 Burden of Epistaxis - Room for Improvement?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Ash ◽  
M Faoury ◽  
N Eze
Keyword(s):  
Length Of Stay ◽  
Significant Proportion ◽  
Self Care ◽  
Tertiary Hospital ◽  
Inpatient Admission ◽  
Haematological Disorder ◽  
Admission Rates ◽  
Written Information ◽  
Retrospective Audit

Abstract Aim We conducted an audit at a large tertiary hospital of the measures and information given to patients admitted with Epistaxis. The aim of this audit was to identify factors for prolonged inpatient admissions and elucidate the extent of patient suitable information provided. Method A retrospective audit was conducted collecting data over two months on all patients admitted with epistaxis. Data was collected on demographics, co-morbidities, length of stay, discussions with other specialities and the extent (verbal/written) of information given to patients with regard to management of epistaxis in the community and how to reduce the risk of further episodes of epistaxis. Results Sixty patients were identified with an average age of 68 years. The patients were inpatients for an average of 41 hours. 10% had a form of haematological disorder, 40% were on warfarin/DOAC and 45% had hypertension. 40% had neither verbal nor written information given about either management or reducing risk. 10% had written information about both. 8% were re-admitted within 30 days of discharge and 17% had previously been admitted with epistaxis in the last 6 months. Conclusions Epistaxis is a common inpatient admission in ENT with a significant bed burden on the department. A significant proportion of patients are co-morbid and thus easily understandable trust guidelines on management of epistaxis on warfarin/doac should be available to reduce length of stay. The low proportion of patients provided with information to help self-care is significant and is likely to play an important role in the re-admission rates.

Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments

2018 ◽  
Vol 42 (3) ◽  
pp. 321 ◽  
Author(s):  
James M. Sayer ◽  
Rita M. Kinsella ◽  
Belinda A. Cary ◽  
Angela T. Burge ◽  
Lara A. Kimmel ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Length Of Stay ◽  
Nurse Practitioners ◽  
Wait Time ◽  
Low Back ◽  
Admission Rates ◽  
Acute Low Back Pain ◽  
Retrospective Audit

Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners). Methods A retrospective audit (October 2012–September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED. Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32 min; P < 0.001) and ED length of stay (median 141 vs 175 min; P < 0.001). Significantly fewer patients seen by the AMP were admitted (P < 0.001), and this difference remained after accounting for the difference in triage code between the groups. Conclusions Improved ED metrics were demonstrated in patients with low back pain when managed by an AMP compared with patients seen by doctors and nurse practitioners. What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain. What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time. What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of increased readmissions, compared with their medical and nursing colleagues. Support for the role of the AMP within the ED setting is strengthened by these results.

scholarly journals 272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Sharrock ◽  
A Nugur ◽  
S Hossain
Keyword(s):  
Morbid Obesity ◽  
Length Of Stay ◽  
Lower Limb ◽  
Average Length ◽  
Perioperative Complications ◽  
Joint Infection ◽  
Admission Rate ◽  
Tendon Injury ◽  
Morbidly Obese ◽  
Admission Rates

Abstract Introduction There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty. Method We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI &gt;40). Results 285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury. For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications. Conclusions Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.

scholarly journals Hartmann’s procedure, reversal and rate of stoma-free survival

2018 ◽  
Vol 100 (4) ◽  
pp. 301-307 ◽  
Author(s):  
S Hallam ◽  
BS Mothe ◽  
RMR Tirumulaju
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Retrospective Audit ◽  
Audit Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Hartmann’s procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann’s is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann’s procedure between 2008 and 2014. Reversal of Hartmann’s rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien–Dindo) including 30-day mortality were recorded. Results Hartmann’s procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann’s rate was 47% (n = 108). Median age of patients was 58 years (range 21–84 years), American Society of Anesthesiologists grade 2 (range 1–4), length of stay was eight days (range 2–42 days). Median time to reversal of Hartmann’s was 11 months (range 4–96 months). The overall complication rate from reversal of Hartmann’s was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann’s procedure was 7% (n = 15). Where Hartmann’s procedure wass not reversed, for 30% (n = 31) this was the patient’s choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann’s procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann’s procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann’s procedure in this study.

To screen or not to screen? Vitamin D deficiency in chronic mental illness

2017 ◽  
Vol 26 (1) ◽  
pp. 56-59
Author(s):  
Ivana Goluza ◽  
Jay Borchard ◽  
Nalin Wijesinghe ◽  
Kishan Wijesinghe ◽  
Nagesh Pai
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
P Value ◽  
Hydroxyvitamin D ◽  
Psychiatric Setting ◽  
Retrospective Audit ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
25 Hydroxyvitamin D ◽  
The Mean

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

scholarly journals Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

2018 ◽  
Vol 15 (11) ◽  
pp. 2532 ◽  
Author(s):  
Richard Ofori-Asenso ◽  
Ella Zomer ◽  
Ken Chin ◽  
Si Si ◽  
Peter Markey ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Acute Stroke ◽  
Charlson Comorbidity Index ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Comorbidity Index

The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0–1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan–Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.

Abstract WMP118: In Safe Hands: Implementation on the Stroke Unit. Does it Improve Patient Care and Ward Efficiency?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sheila M Jala ◽  
Sarah Giaccari ◽  
Melissa Passer ◽  
Carin Bertmar ◽  
Susan Day ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Stroke Unit ◽  
Oral Intake ◽  
Improve Patient Care ◽  
Tertiary Hospital ◽  
Study Data ◽  
Acute Hospital ◽  
Staff Satisfaction ◽  
Number Of Patients ◽  
Significant Difference

The ‘In Safe Hands” (ISH) is a structured interdisciplinary bedside round developed to increase patients participation in their care in acute hospital wards. This has shown to improve quality of care by reducing communication errors and complications, enhancing a culture of safety in an acute hospital. The purpose of this study was to assess the effect of ISH on length of stay (LOS), in-hospital complications and assess whether the ISH enhances patient and staff satisfaction in a stroke unit of a tertiary hospital in Sydney, Australia. This was a longitudinal study pre and post implementation. A total of 200 patients participated in the study. Data on the length of stay, incidence rate relating to patient safety and patient and staff satisfaction surveys using Patient Experience Tracker (PET) devices were collected pre and post implementation. ISH increased the number of patients with at least 72hours in stroke unit care by 80 percent (P < 0.001). Fever and hyperglycaemia were treated in all patients following ISH implementation vs only 50% and 64% respectively of patients pre ISH implementation. Swallow screen was completed in all patients prior oral intake compared to 92% of patients of the pre ISH group (P = 0.03). There was no significant difference in the LOS and complications. All stroke patients received stroke education and there were no readmissions post implementation. There was no significant difference in the patient and staff satisfaction. In conclusion, although ISH did not improve the primary endpoints of LOS, complications and satisfaction it did improve protocol adherence.

scholarly journals Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

2019 ◽  
Vol 24 (03) ◽  
pp. e313-e318
Author(s):  
Sidhartha Sinha ◽  
Matthew Fok ◽  
Ijaz Ahmad ◽  
Mustafa Al-Sheikh ◽  
Christopher Backhouse
Keyword(s):  
Patient Education ◽  
Length Of Stay ◽  
District General Hospital ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Retrospective Audit ◽  
Parathyroid Adenomas ◽  
Biochemical Cure ◽  
Postoperative Length ◽  
Preoperative Patient

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

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