scholarly journals 65 & Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 594-595
Author(s):  
Tracey Vien ◽  
Stella Bobroff ◽  
Ricardo de Ocampo
Keyword(s):  
Los Angeles ◽  
Length Of Stay ◽  
Average Length ◽  
The United States ◽  
Holistic Care ◽  
Kaiser Permanente ◽  
Average Length Of Stay ◽  
Telemetry Unit ◽  
Management Staff

Abstract Data indicates that older persons will increase in numbers along with having an increase of life expectancy in the United States. Kaiser Permanente Los Angeles Medical Center’s Utilization Department developed “65 & Thrive”—an age-specialized initiative to provide holistic care that preserves independence, quality of life, prevents functional and cognitive decline, and promotes both patients and their families to continue thriving. The initiative’s focus is guided by the 5 M’s model on mobility, medication, mentation, multi-morbidity, and what matters. Case management staff were given age-sensitivity trainings, improved workflows and made assessments that identified, addressed, and secured resources for patients throughout their hospitalization. Silver Angel volunteers were specially trained to prevent physical and mental decline and focused on activities to prevent delirium, depression and falls. The volunteers visited with patients daily for these interactions. The initiative was piloted in April 2020 on a stroke telemetry unit and since then the hospital has seen a significant decrease in the overall annual readmission rates by 3.1% when compared to 2019. The average length of stay for older adult patients; however, increased from 4.05 to 4.83 days unfortunately due to COVID-19. This initiative demonstrates the necessity to expand “65 & Thrive” throughout the hospital and ultimately to other Kaiser Permanente medical centers to best provide holistic care to older adults.

scholarly journals The efficient of beds used based on graphic Barber Johnson at Semen Padang Hospital in 2017

2019 ◽  
Vol 6 (12) ◽  
pp. 5071
Author(s):  
Sayati Mandia
Keyword(s):  
Statistical Analysis ◽  
Length Of Stay ◽  
Medical Record ◽  
Medical Records ◽  
Average Length ◽  
Sampling Technique ◽  
Occupancy Rate ◽  
Bed Occupancy ◽  
Average Length Of Stay

Background: Quality of hospital services can be seen from the bed usage. Statistical analysis of efficiency bed usage can be mesured based on inpatient medical records. To determine the efficiency requires four parameters namely bed occupancy rate (BOR), average length of stay (ALoS), turnover interval (TI), and bed turnover (BTR). parameters can be presented using Graphic Barber Johnson. This study aims to determine the efficiency of bed usage at Semen Padang Hospital in 2017.Methods: This research was conducted at Semen Padang Hospital, West Sumatera, Indonesia from January to December 2017. The study used a descriptive method with a qualitative approach. The data was collected from medical records department. The population is all abstraction data of in-patient medical record in 2017, 9796 medical record used total sampling technique. Data analysis was performed by calculating the values of ALoS, BOR, BTR, and TI. Data will be presented based on graphic Barber Johnson. Excel 2010 and graphic Barber Johnson method were applied for data analysis.Results: Number of daily inpatient censuses in 2017 are 31227 and number of service days are 31362. Number of beds 144. Statistical analysis results obtained total BOR 60%, BTR 67 times, TI 2 days and ALoS 3 days. The highest value of bed occupancy rate is 66% on August.Conclusions: Based on statistical, value of bed occupancy rate (60%) and turnover interval (2 days) are efficient at Semen Padang Hospital in 2017. Average length of stay (3 days) and bed turnover rate (67 times) are not efficient.

Is a Diagnosis-Based Classification System Appropriate for Funding Psychiatric Care in Alberta?

1995 ◽  
Vol 40 (9) ◽  
pp. 507-513 ◽  
Author(s):  
Chantelle M Wellock
Keyword(s):  
Length Of Stay ◽  
Classification System ◽  
Negative Impact ◽  
Average Length ◽  
The United States ◽  
Classification Systems ◽  
Short Stay ◽  
Average Length Of Stay ◽  
Variation Explained ◽  
Better Than

Objective This study evaluated the appropriateness of the Refined Group Number (RGN) classification system for funding psychiatric discharges in Alberta. Method Multiple regression was used to calculate the amount of variation explained (R2) in length of stay by RGNs for psychiatric discharges. The distribution of short-stay cases (less than 5 days) was also reviewed. Results The R2 value was higher than those from American studies (0.284 versus less than 0.10) for psychiatric discharges. The length of stay distribution by RGN indicated that the mean was not representative of typical cases. Short-stay cases made up the majority of cases from rural hospitals and had a negative impact on the average length of stay. Conclusions The RGN methodology performed better than diagnosis-based classification systems in the United States. However, there were significant weaknesses in the classification system which suggest that a funding system using the RGN grouper would result in inequitable funding for psychiatric discharges.

scholarly journals 1436. Overview of ESBL Enzyme Producing Infections and UTIs

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S800-S800
Author(s):  
Premalkumar M Patel ◽  
Aliya Rehman ◽  
Angel Porras ◽  
Samuel Rapaka ◽  
Claudio Tuda
Keyword(s):  
Data Analysis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Economic Burden ◽  
Average Length ◽  
The United States ◽  
Extended Spectrum Beta Lactamase ◽  
Average Length Of Stay ◽  
Hospitalization Costs ◽  
Tract Infections

Abstract Background Extended-spectrum beta lactamase (ESBL) enzymes are plasmid-mediated, rapidly emerging and complex thereby posing a major therapeutic challenge in the management of urinary tract infections (UTIs) in community and hospital settings. In 2017, there were an estimated 197,400 cases of ESBL-producing Enterobacterales among hospitalized patients and 9,100 estimated deaths in the United States. Methods We conducted a retrospective cohort study using a publicly accessible National Inpatient Sample (NIS) database from October 2015 to December 2017. Adult patients (age >/= 18 years old) with UTI as a principal diagnosis were included. SAS 9.4 was used for univariate and multivariate linear. Logistic regression statistical analyses were used to compare mean age at the time of admission, length of stay, in-hospital mortality, hospitalization costs, and Elixhauser comorbidity indices. Results Of the total 5,776,156 patients included in the study, 52,765 patients had ESBL-enzyme induced UTIs. 66% were females and 34% were males. 63.3% were Caucasian, 11.6% were African-American, 18.8% were Hispanic, and 4.4% were Asian or Pacific Islander. The most common comorbidities were renal failure (22.8%), diabetes mellitus with complications (20.8%), congestive heart failure (20.5%), chronic lung disease (20.0%), neurological diseases (17.8%), obesity (12.6%), paralysis (12.5%), and depression (11.5%). In-hospital mortality was 2.5% (p< 0.0001), which was most likely due to the underlying co-morbidities. In patients without ESBL-enzyme induced UTIs, average length of stay was 7.8±8.5 days, and economic burden was &16,166.8 ± &21,183.5 USD. In comparison, patients with ESBL-enzyme induced UTIs had in-hospital mortality of 3.9%, average length of stay of 7.0 ± 9.7 days, and economic burden of &15,793.3 ± &29,268.6 USD. ESBL and UTI data analysis image 1 ESBL and UTI data analysis image 2 Conclusion We found that ESBL-enzyme-producing UTIs have statistically significant prolonged length of stay and economic burden, though in hospital mortality rate is low. This could be due to judicious use of antimicrobial therapy. There is a need for further research, as well as increased antimicrobial stewardship for UTIs, a globally recognized major cause of nosocomial acquired infections. Disclosures All Authors: No reported disclosures

scholarly journals Stres dan Kualitas Tidur Caregiver dalam Merawat Pasien Skizofrenia di Poliklinik RSJ Bina Karsa Kota Medan

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Roxsana Devi Tumanggor ◽  
Yuli Marhamah
Keyword(s):  
Length Of Stay ◽  
Sleep Quality ◽  
Family Caregiver ◽  
Average Length ◽  
Poor Sleep ◽  
Mild Stress ◽  
Poor Sleep Quality ◽  
Average Length Of Stay ◽  
Good Sleep

Family caregiver is the primary care provider for family members with spesific illness. It is often the caregiver experiences stress and sleep disturbances during the caregiving process. This research is a descriptive study which aims to analyze the stress and sleep quality of caregivers in caring for schizophrenia patients at the Polyclinic of the Bina Karsa Psychiatric Hospital / RSJ Bina Karsa Kota Medan. The study population was 442 caregiver patients with schizophrenia who accompanied the patient routine control from April to May 2019.  40 samples were involved with purposive sampling technique.  The criteria of caregiver for schizophrenia patients were the family caregiver (father, mother, children, siblings, husband/wife etc.), provide care for 1-4 years, lived in Medan and patients is the recurrent patients. The instruments in this study were a demographic data questionnaire, a DASS 42 (Depression Anxiety Stress Scale) questionnaire and an SQQ (Sleep Quality Questionnary) questionnaire. The collected data were then analyzed by descriptive test, Annova test, and Kruskal Walis test. Based on the results of this study, the majority of respondents experienced mild stress 28 people (70%) with an average length of stay of 1 year and 3 months. For the quality of sleep experienced by the caregiver, data was obtained that 24 respondents (60%) experienced poor sleep quality and only 2 respondents (5%) experienced good sleep quality. In 2 respondents who had good sleep quality, the average length of stay was 3 years, 24 respondents had poor sleep quality, the average length of stay was 2 years 5 months, 14 respondents had adequate sleep quality, and the average length of stay was 1 year 10 months. The results of this study can be used as basic data for further assessment of caregivers who are often not a priority in health service policies.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

2020 ◽  
Vol 41 (S1) ◽  
pp. s403-s404
Author(s):  
Jonathan Edwards ◽  
Katherine Allen-Bridson ◽  
Daniel Pollock
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Average Length ◽  
Bloodstream Infections ◽  
Central Line ◽  
Significant Shift ◽  
Care Hospital ◽  
Average Length Of Stay ◽  
Period 2 ◽  
Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

scholarly journals Planning for the First and Last Mile: A Review of Practices at Selected Transit Agencies in the United States

2021 ◽  
Vol 13 (4) ◽  
pp. 2222
Author(s):  
Hossain Mohiuddin
Keyword(s):  
Los Angeles ◽  
Gap Analysis ◽  
The United States ◽  
Design Guidelines ◽  
Plan Implementation ◽  
Marginalized Communities ◽  
Transit Ridership ◽  
Last Mile ◽  
Transit Agencies

A transit trip involves travel to and from transit stops or stations. The quality of what are commonly known as first and last mile connections (regardless of their length) can have an important impact on transit ridership. Transit agencies throughout the world are developing innovative approaches to improving first and last mile connections, for example, by partnering with ride-hailing and other emerging mobility services. A small but growing number of transit agencies in the U.S. have adopted first and last mile (FLM) plans with the goal of increasing ridership. As this is a relatively new practice by transit agencies, a review of these plans can inform other transit agencies and assist them in preparing their own. Four FLM plans were selected from diverse geographic contexts for review: Los Angeles County Metropolitan Transportation Authority (LA Metro), Riverside (CA) Transit Agency (RTA), and Denver Regional Transit District (RTD), and City of Richmond, CA. Based on the literature, we developed a framework with an emphasis on transportation equity to examine these plans. We identified five common approaches to addressing the FLM issue: spatial gap analysis with a focus on socio-demographics and locational characteristics, incorporation of emerging mobility services, innovative funding approaches for plan implementation, equity and transportation remedies for marginalized communities, and development of pedestrian and bicycle infrastructures surrounding transit stations. Strategies in three of the plans are aligned with regional goals for emissions reductions. LA Metro and Riverside Transit incorporate detailed design guidelines for the improvement of transit stations. As these plans are still relatively new, it will take time to evaluate their impact on ridership and their communities’ overall transit experience.

scholarly journals Biased and unbiased estimation of the average length of stay in intensive care units in the Covid-19 pandemic

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nathanael Lapidus ◽  
Xianlong Zhou ◽  
Fabrice Carrat ◽  
Bruno Riou ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Parametric Method ◽  
Estimation Methods ◽  
Unbiased Estimation ◽  
Bed Occupancy ◽  
Average Length Of Stay ◽  
Discharged Patients ◽  
First Admission

Abstract Background The average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios. Methods Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n = 59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods' patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date. Results LOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95% CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series' true ICU_ALOS was greater than 21 days, well above reported estimates to date. Conclusions Discharges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models. Funding Support by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).

Sign in / Sign up

Export Citation Format

Share Document