Modification of Blood Test Draw Order to Reduce Blood Culture Contamination: A Randomized Clinical Trial

2019 ◽  
Vol 71 (5) ◽  
pp. 1215-1220 ◽  
Author(s):  
Frederic S Zimmerman ◽  
Hani Karameh ◽  
Eli Ben-Chetrit ◽  
Todd Zalut ◽  
Marc Assous ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Medical Patients ◽  
Demographic Differences ◽  
Post Hoc Analysis ◽  
Post Hoc

Abstract Background Blood culture contamination leads to unnecessary interventions and costs. It may be caused by bacteria in deep skin structures unsusceptible to surface decontamination. This study was designed to test whether diversion of blood obtained at venipuncture into a lithium heparin tube prior to aspiration of blood culture reduces contamination. Methods The order of blood draws for biochemistry and blood cultures was randomized. Following standard disinfection and venipuncture, blood was either aspirated into a sterile lithium heparin tube before blood culture bottles (diversion group) or blood cultures first and then lithium heparin tube (control group). All study personnel were blinded with the exception of the phlebotomist. Results After exclusions, 970 blood culture/biochemistry sets were analyzed. Contamination occurred in 24 of 480 (5.0%) control vs 10 of 490 (2.0%) diversion group cultures (P = .01). True pathogens were identified in 26 of 480 (5.4%) control vs 18 of 490 (3.7%) diversion cultures (P = .22). Despite randomization, demographic differences were apparent between the 2 groups. A post hoc analysis of 637 cultures from 610 medical patients admitted from home neutralized demographic differences. Culture contamination remained more frequent in the control vs diversion group (17/312 [5%] vs 7/325 [2%]; P = .03). Fewer diversion group patients were admitted to hospital (control: 200/299 [66.9%] vs diversion: 182/311 [58.5%]; P = .03), and length of stay was shorter (control: 30 hours [interquartile range {IQR}, 6–122] vs diversion: 22 [IQR, 5–97]; P = .02). Conclusions Use of lithium heparin tubes for diversion prior to obtaining blood cultures led to a 60% decrease in contamination. This technique is easy and inexpensive and might decrease overall hospital length of stay. Clinical Trials Registration NCT03966534.

scholarly journals 558. Evaluating Length of Stay Data for Use in Targeting Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S265-S265
Author(s):  
Katryna Gouin ◽  
Kelly M Hatfield ◽  
Sarah H Yi ◽  
Sujan Reddy ◽  
Hannah Wolford ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Blood Culture ◽  
Large Fraction ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Birth Date ◽  
Post Discharge

Abstract Background Evidence suggests that interventions such as MRSA decolonization are useful in the prevention of MRSA bloodstream infections (BSI) both during hospitalization and post-discharge. However, decolonization may be costly and have diminishing effectiveness when used on all inpatients. Hospital length of stay (LOS) is a known risk factor for MRSA BSI. To determine whether LOS could be useful in prioritizing patients for intervention, we aimed to evaluate (i) distribution of time from admission to hospital-onset (HO) MRSA BSI, and (ii) frequency and LOS of hospitalizations that preceded community-onset (CO) MRSA BSI. Methods MRSA-positive blood cultures among adults admitted to New York hospitals from 2013 to 20s16 were identified in the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). We linked these data to admissions in New York’s hospital discharge dataset, the Statewide Planning and Research Cooperative System (SPARCS), where the NHSN blood culture collection date was between a patient’s SPARCS admission and discharge dates and there was an exact match for birth date, gender and facility. Time to MRSA BSI was defined as the number of days from admission (day 1) to collection of a blood culture positive for MRSA. We defined positive blood cultures collected on days 1–3 as CO, and those collected ≥day 4 as HO. Results We linked 10,425 (79%) MRSA BSIs from NHSN to SPARCS. 78% (8,147) of MRSA BSIs were CO and 22% (2,278) were HO. The median time to HO MRSA BSI was 10 days (IQR 6–21) (Figure 1), in contrast to the median LOS for all hospitalizations of 4 days (IQR 3–7). By definition, 35% of all hospitalizations were never at risk of HO MRSA BSI because their LOS was < 4 days. Among CO MRSA BSI, 48% were discharged from a hospital in the 90 days preceding their BSI (Figure 2). The median LOS of these prior hospitalizations was 8 days (IQR 5–14), and 87% were at least 4 days in length. Conclusion Over half of HO MRSA BSI occur on or after day 10 of hospitalization and a large fraction of CO MRSA BSI had a lengthy hospitalization shortly before their BSI diagnosis. Our results suggest that patients likely to have a long LOS could be evaluated as potential targets for prevention strategies (e.g., decolonization) to reduce both HO and CO MRSA BSI. Disclosures All authors: No reported disclosures.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

2021 ◽  
Author(s):  
Wesam Sourour ◽  
Valeria Sanchez ◽  
Michel Sourour ◽  
Jordan Burdine ◽  
Elizabeth Rodriguez Lien ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Multivariate Linear Regression Analysis ◽  
Negative Blood Culture ◽  
Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

scholarly journals Multimodal Analgesia in Lumbar Fusion Surgery: Impact Amidst the Opioid Epidemic

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yi Lu ◽  
Erica Bertoncini
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
P Value ◽  
Standard Group ◽  
Fusion Surgery ◽  
Hospital Stays

Abstract INTRODUCTION Spine surgery traditionally relies on opioid analgesics for postoperative pain management. Opioids are associated with prolonged hospital stays and opioid use disorders. Opioid-focused prescribing habits in surgery have partially contributed to the opioid epidemic. METHODS A retrospective analysis was performed comparing patients receiving a multimodal analgesia regimen after lumbar fusion surgery vs control group receiving standard analgesia regimen. The multimodal regimen consisted of Acetaminophen 975 mg TID, Toradol 7.5 mg Q6 hours for 24-ho followed by Celebrex 100 mg BID for 7-d, Robaxin 500 mg Q6 hours prn for muscle spasms, Gabapentin 300 mg/100 mg TID for 4-wk, and prn narcotic. The standard regimen consisted of Acetaminophen 975 mg TID, narcotic prn, and muscle relaxant prn. There were 12 patients in the multimodal group and 26 patients in the control group evaluated over 3-mo and 6-mo time periods respectively. Primary outcomes included hospital length-of-stay, total and IV narcotic requirements in Morphine Milligram Equivalent (MME), and VASS pain scores. RESULTS Study results demonstrate differences between patient populations when focusing on the opioid-naïve participants. Opioid-naïve patients in the multimodal group were found to have significantly lower IV narcotic requirement than the control (0.22+/−0.67 mg/d for multimodal vs 5.36+/−5.56 mg/d for standard group, P-value = .001). These patients also had shorter hospital stays than the control (2.78+/−0.83 d for multimodal vs 3.53+/−1.17 d for standard group) but the difference was just below our threshold for significance (P-value = .066). Including both opioid-naïve and opioid-tolerant patients, no significant differences were found in hospital length-of-stay, MME, IV narcotic requirement nor VASS score between the multimodal group and the control groups (P-values of .46, .81, .36, and .91, respectively). CONCLUSION Overall, the study favors using multimodal analgesia in those undergoing lumbar spinal fusion surgeries as evident by considerably reduced IV narcotic requirement and nearly significant shortened hospital length-of-stay in opioid-naïve patients compared to control.

scholarly journals Effects of Methylprednisolone on Ventilator-Free Days in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome and COVID-19

2021 ◽  
Author(s):  
Mohamed Badr ◽  
Bruno De Oliveira ◽  
Khaled Abdallah ◽  
Ashraf Nadeem ◽  
Yeldho Varghese ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Competing Risks ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone increases the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study Setting: Intensive care unit Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included Interventions: None Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) during the first 28 days, defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray&rsquo;s proportional subhazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg.kg-1 (IQR: 1-1.3 mg.kg-1) and median duration of 5 days (IQR:5-7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6-20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6-16.7) in patients who did not receive methylprednisolone (difference, 4.61; 95% CI, 1.10-8.12; P = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95%CI: 0.02-0.45; p=0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p=0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR:15-41 days] vs. 37 days [IQR:23-52 days], p=0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p=0.052). However, 91% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

Abstract 12794: Hospital Length of Stay and Readmissions Post Heart Failure Hospitalization in the EVEREST Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hassan Khan ◽  
Andreas P Kalogeropoulos ◽  
Andrew P Ambrosy ◽  
Aldo P Maggioni ◽  
Faiez Zannad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Western Europe ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Research Strategies ◽  
Geographical Regions ◽  
America South ◽  
Post Hoc ◽  
The Relationship

Background: Previous reports have provided conflicting data regarding the relationship between length of stay (LOS) and subsequent readmissions risk among patients hospitalized for heart failure (HF). Methods: We performed a post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial to evaluate the differences in LOS overall and between geographical regions (North America, South America, Western Europe, and Eastern Europe) in association with all-cause and cause specific (HF, cardiovascular [CV] non-HF and non-CV) readmissions within 30 days of discharge after HF hospitalization. Results: The median (IQR) LOS among the 4,133 patients enrolled from 20 countries across 359 sites was 8 (4-11) days. The 30-day readmissions rates were 15.6% (95% confidence intervals [CI] 14.6-16.8) for all-cause; 5.5% (95%CI 4.9-6.3) for HF; 4.4% (95%CI 3.8-5.1) for CV non-HF and 5.8% (95%CI 5.1-6.6) for non-CV readmissions. Overall there was a positive correlation between LOS and all cause readmissions (r=0.09; 95%CI 0.06-0.12). The adjusted odds ratio for the top (>14 days) versus the bottom (<3 days) quintile for LOS was 1.39 (95%CI 0. 92-2.11) for all-cause; 0.43 (95%CI 0.24-0.79) for HF; 2.99 (95%CI 1.49-6.02) for CV non-HF and 1.72 (95%CI 1.05-2.81) for non-CV readmissions, Figure 1. These findings remained consistent in analyses within patient characteristic subgroups and also largely within regions. Conclusions: Longer hospital LOS was associated with a higher risk for all-cause, CV non-HF, and non-CV readmissions, and with a lower risk of HF readmissions. These results may have important bearing in developing clinical and research strategies to reduce readmissions.

scholarly journals Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

2011 ◽  
Vol 114 (4) ◽  
pp. 882-890 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
Jeffery S. Vender ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P &lt; 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P &lt; 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P &lt; 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay

2010 ◽  
Vol 34 (3) ◽  
pp. 334 ◽  
Author(s):  
Caroline A. Brand ◽  
Marcus P. Kennedy ◽  
Bellinda L. King-Kallimanis ◽  
Ged Williams ◽  
Christopher A. Bain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Models Of Care ◽  
Hospital Length ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Medical Patients ◽  
Medical Assessment ◽  
Planning Unit ◽  
The Impact

Objective.The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and ‘front end loading’ approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay. Methods.A pre-post study design was used. Cases were defined as all general medical patients admitted to the RMH between 1 August 2003 and 31 January 2004. MAPU patients were defined as general medical patients who had been discharged from RMH MAPU unit as part of their RMH inpatient admission. Historical controls were defined as all general medical patients admitted to the RMH between 1 August 2002 and 31 January 2003. Results.There was a reduction in median length of stay that did not reach statistical significance. During the study period, median emergency department length of stay for MAPU patients was 10.3 h compared with 13.2 h for non-MAPU patients who were admitted directly to general wards. Conclusions.The reductions in length of stay are likely to be of clinical significance at the emergency department (ED) level. The MAPU model also contributes to providing care appropriate care for older admitted patients. What is known about the topic?There is increasing interest in models of acute medical management in public hospitals in Australia. One of the key factors driving interest in these models has been the need to improve patient flow to improve hospital efficiency and contribute to reducing bed access block. There are very little published data pertaining to the effectiveness of these models of care. What does the paper add?The paper reports non-statistical, but probably important clinical reductions in hospital and ED length of stay using a before and after cohort analysis. It highlights the difficulties evaluating these models of care in the absence of well designed controlled studies and suggests evaluation of length of stay needs to be powered to detect small changes in ED efficiency rather than overall hospital length of stay. What are the implications for practitioners?Practitioners in the area can draw on the results of this paper to design an acute medical planning unit and develop an evaluation framework.

scholarly journals Individualized Fluid Management Using the Pleth Variability Index

2020 ◽  
Vol 133 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Marc-Olivier Fischer ◽  
Sandrine Lemoine ◽  
Benoît Tavernier ◽  
Chems-Eddine Bouchakour ◽  
Vincent Colas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Orthopedic Surgery ◽  
Hospital Length ◽  
Fluid Administration ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Intermediate Risk ◽  
Variability Index ◽  
Plethysmographic Variability Index

Background The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery. Methods This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient. Results In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively. Conclusions Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jason Talevski ◽  
Viviana Guerrero-Cedeño ◽  
Oddom Demontiero ◽  
Pushpa Suriyaarachchi ◽  
Derek Boersma ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Outcome Measures ◽  
Care Pathway ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Care Pathways ◽  
Discharge Location

Abstract Background Care pathways are generally paper-based and can cause communication failures between multidisciplinary teams, potentially compromising the safety of the patient. Computerized care pathways may facilitate better communication between clinical teams. This study aimed to investigate whether an electronic care pathway (e-pathway) reduces delays in surgery and hospital length of stay compared to a traditional paper-based care pathway (control) in hip fracture patients. Methods A single-centre evaluation with a retrospective control group was conducted in the Orthogeriatric Ward, Nepean Hospital, New South Wales, Australia. We enrolled patients aged > 65 years that were hospitalized for a hip fracture in 2008 (control group) and 2012 (e-pathway group). The e-pathway provided the essential steps in the care of patients with hip fracture, including examinations and treatment to be carried out. Main outcome measures were delay in surgery and hospital length of stay; secondary outcomes were in-hospital mortality and discharge location. Results A total of 181 patients were enrolled in the study (129 control; 54 e-pathway group). There was a significant reduction in delay to surgery in the e-pathway group compared to control group in unadjusted (OR = 0.19; CI 0.09–0.39; p < 0.001) and adjusted (OR = 0.22; CI 0.10–0.49; p < 0.001) models. There were no significant differences between groups for length of stay (median 11 vs 12 days; p = 0.567), in-hospital mortality (1 vs 7 participants; p = 0.206) or discharge location (p = 0.206). Conclusions This pilot study suggests that, compared to a paper-based care pathway, implementation of an e-pathway for hip fracture patients results in a reduction in total number of delays to surgery, but not hospital length of stay. Further evaluation is warranted using a larger cohort investigating both clinical and patient-reported outcome measures.

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