scholarly journals 56. Ertapenem Utilization: “CRE”ating Solutions for Improving Hospital Stay and Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S49-S49
Author(s):  
Debra M Willner ◽  
Victoria Bengualid ◽  
Bismarck Bisono-Garcia ◽  
Judith Berger
Keyword(s):  
Length Of Stay ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acinetobacter Baumanii ◽  
Carbapenem Resistant ◽  
Days Of Therapy ◽  
Future Direction ◽  
Hospital Days

Abstract Background Ertapenem, a carbapenem offers advantages over other carbapenems. It is administered daily and can therefore facilitate home infusion discharges, it has a narrower spectrum of activity which could reduce resistance, and is more cost effective than meropenem. Our objectives were to determine whether ertapenem utilization decreased hospital length of stay and whether use had an impact on future meropenem resistance. Methods This was a retrospective chart review of ertapenem over 2 years for the following infections: urinary tract, skin and soft tissue (SSTI), and osteomyelitis. Evaluated pathogens, duration of inpatient therapy, discharged antimicrobials, length of discharged therapy, and positive cultures up to 90 days post treatment. Analyzed length of stay, and calculated the hospital days that were saved by discharging patients on ertapenem. Results 70 patients were analyzed, with indications and pathogens listed in Figure 1. Patients were initially placed on empiric therapies pending culture results. On average, patients received 2.9 days of empiric meropenem. Once cultures finalized, patients were switched to ertapenem. On average, patients received 6 days of inpatient ertapenem prior to discharge. 37 patients were discharged with ertapenem, totaling 937 days of discharged therapy. Of the 36 patients readmitted within 90 days, 20 had pathogens identified, of which 4 were meropenem-resistant (Figure 2). Infections, Pathogens, and Treatment Duration Conclusion In this pilot stewardship initiative, switching to and discharging patients on ertapenem saved 937 hospital days over the 2 years evaluated, with the greatest days of therapy saved in osteomyelitis and SSTIs. There were a total of 422 days of inpatient ertapenem, mostly in the SSTI and cystitis indications. Of the 20 pathogens identified on readmission, 4 (20%) were meropenem-resistant. All were Acinetobacter baumanii-often carbapenem-resistant; none of the cultures were the same pathogen as the originally identified, but this warrants further investigation. The indication associated with least days of therapy saved and the highest days of inpatient ertapenem was cystitis. 53% of the patients were discharged with ertapenem; future direction involved identifying barriers for speedy discharge across all indications. Disclosures All Authors: No reported disclosures

Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?

2013 ◽  
Vol 79 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Annabelle L. Fonseca ◽  
Kevin M. Schuster ◽  
Adrian A. Maung ◽  
Lewis J. Kaplan ◽  
Kimberly A. Davis
Keyword(s):  
Respiratory Failure ◽  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Nasogastric Decompression

Bowel rest, nasogastric (NG) decompression, and intravenous hydration are used to treat small bowel obstruction (SBO) conservatively; however, there are no data to support nasogastric tube (NGT) use in patients without active emesis. We aim to evaluate the use of nasogastric decompression in SBO and the safety of managing patients with SBO without the use of a NGT. A retrospective chart review was conducted of adult patients admitted to Yale New Haven Hospital over five years with the diagnosis of SBO. We compared patients who received NG decompression with those who did not. Outcome variables assessed were days to resolution, associated complications, hospital length of stay, and disposition. Of 290 patients who fit the criteria, 190 patients (65.52%) were managed conservatively. Fifty-five patients (18.97%) did not receive NGTs. Sixty-eight patients (23.45%) did not present with emesis; however, nearly 75 per cent of these patients received NGTs. Development of pneumonia and respiratory failure was significantly associated with NGT placement. Time to resolution and hospital length of stay were significantly higher in patients with NGTs. Patients with NG decompression had a significantly increased risk of pneumonia and respiratory failure as well as increased time to resolution and hospital length of stay.

Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 165-165
Author(s):  
Ali John Zarrabi ◽  
Karen Armstrong ◽  
Kimberly A. Curseen ◽  
Tammie E. Quest
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Commercial Insurance ◽  
Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

scholarly journals In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

2018 ◽  
Vol 15 (8) ◽  
pp. 1570 ◽  
Author(s):  
Monica Eneriz-Wiemer ◽  
Lee Sanders ◽  
Mary McIntyre ◽  
Fernando Mendoza ◽  
D. Do ◽  
...  
Keyword(s):  
Birth Weight ◽  
Length Of Stay ◽  
Low Birth Weight ◽  
Healthcare Providers ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Interpreter Use ◽  
Adjusted Incidence Rate ◽  
Hospital Days ◽  
Adjusted Incidence

To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

scholarly journals Differences in hospital length of stay between neonates exposed to buprenorphine versus methadone in utero: A retrospective chart review

2018 ◽  
Vol 24 (2) ◽  
pp. e104-e110
Author(s):  
Sarah Fernandez ◽  
Teresa Bruni ◽  
Lisa Bishop ◽  
Roxanne Turuba ◽  
Brieanne Olibris ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
In Utero ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Impact of early home psychotropic medication reinitiation on surrogate measures of intensive care unit delirium

2019 ◽  
Vol 9 (4) ◽  
pp. 263-268 ◽  
Author(s):  
Matthew Li ◽  
Mei H. Chang ◽  
Yeismel Miranda-Valdes ◽  
Kirsten Vest ◽  
Troy D. Kish
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
Icu Delirium

Abstract Introduction Intensive care unit (ICU) delirium is a major contributing factor to increased mortality, length of stay, and cost of care. Psychotropic medications may often require extensive tapering to prevent withdrawal symptoms; during ICU admission, home psychotropics are frequently held which may precipitate acute drug withdrawal and subsequent delirium. Methods This is a single-center, observational, retrospective chart review. The primary endpoint was the total number of new-start antipsychotics used to treat ICU delirium. Secondary endpoints included use of restraints, ICU length of stay, and hospital length of stay. Results A total of 2334 charts were reviewed for inclusion; 55 patients were categorized into each group. There was no statistically significant difference in the requirement for new-start antipsychotics (P = 1.0), restraint use (P = .057), or ICU length of stay (P = .71). There was a statistically significant decrease in hospital length of stay (P = .048). Discussion Early reinitiation was associated with a decrease in hospital length of stay but was not associated with a decrease in the number of new-start antipsychotics, use of restraints, or ICU length of stay.

scholarly journals Burden of illness in carbapenem-resistant Acinetobacter baumannii infections in US hospitals between 2014 and 2019

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jason M. Pogue ◽  
Yun Zhou ◽  
Hemanth Kanakamedala ◽  
Bin Cai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acinetobacter Baumannii ◽  
Burden Of Illness ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. Methods To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014–2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality. Results 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P < 0.01), whereas CS A. baumannii was more frequently associated with bloodstream infections (CS 16.7% and CR 8.6%, P < 0.01). Patients with CR A. baumannii infections had higher in-hospital (CR 16.4% vs CS 10.0%; P < 0.01) and 30-day (CR 32.2% vs CS 21.6%; P < 0.01) mortality compared to those with CS infections. After adjusting for age, sex, admission source, infection site, comorbidities, and treatment with in vitro active antibiotics within 72 h, carbapenem resistance was independently associated with increased mortality (adjusted odds ratio 1.42 [95% confidence interval 1.15; 1.75], P < 0.01). CR infections were also associated with increases in hospital length of stay (CR 11 days vs CS 9 days; P < 0.01), rate of intensive care unit utilization (CR 62.3% vs CS 45.1%; P < 0.01), rate of readmission with A. baumannii infections (CR 17.8% vs CS 4.0%; P < 0.01) and hospital charges. Conclusions These data suggest that the burden of illness is significantly greater for patients with CR A. baumannii infections and are at higher risk of mortality compared with CS infections in US hospitals.

scholarly journals Hemothorax following lung transplantation: incidence, risk factors, and effect on morbidity and mortality

2016 ◽  
Vol 11 ◽  
Author(s):  
Aria Hong ◽  
Christopher S. King ◽  
A. Whitney Walter Brown ◽  
Shahzad Ahmad ◽  
Oksana A. Shlobin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Lung Transplantation ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Term Survival ◽  
Ischemic Time ◽  
Incidence Risk

Background: Hemothorax after lung transplantation may result in increased post-operative morbidity and mortality. Risk factors for developing hemothorax and the outcomes of patients who develop hemothorax have not been well studied. Methods: A retrospective chart review was performed on all patients who underwent lung transplantation at a single center between March 2009 and July 2014. Comparison was made between patients with and without hemothorax post-transplant. Results: There were 132 lung transplantations performed during the study period. Hemothorax was a complication in 17 (12.9 %) patients, occurring an average of 9 days after transplant. No difference was found between the hemothorax and non-hemothorax groups with respect to age, preoperative anticoagulation, lung allocation score, prior thoracotomy, coagulation profile, use of cardiopulmonary bypass, ischemic time, or postoperative P/F ratio. There was a trend towards a higher incidence of hemothorax in patients with underlying sarcoidosis and re-transplantation (p = 0.13 and 0.17, respectively). Hemothorax developed early (<48 h post-operatively) in 5 patients and presented in a delayed manner (≥48 h post-operatively) in 12 patients. Delayed hemothorax occurred primarily in the setting of anticoagulation (10 out of 12 patients). The hemothorax group had decreased ventilator-free days (p = 0.006), increased ICU length of stay (p = 0.01) and increased hospital length of stay (p = 0.005). Hemothorax was also associated with reduced 90-day survival (p = 0.001), but similar 1, 3, and 5-year survival (p = 0.63, p = 0.30, and p = 0.25), respectively). Conclusion: The development of hemothorax is associated with increased morbidity and decreased short-term survival. Hemothorax may present either within the first 48 h after surgery or in a delayed fashion, most commonly in the setting of anticoagulation.

scholarly journals The Prevalence of Multi-Drug Resistant Organisms and Their Outcomes in an ICU in Mauritius: An Observational Study

2020 ◽  
pp. 71-78
Author(s):  
Dooshanveer Chowbay Nuckchady ◽  
Samiihah Hafiz Boolaky
Keyword(s):  
Length Of Stay ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Drug Resistant ◽  
Retrospective Case ◽  
Carbapenem Resistant

Aims: To assess the prevalence of multi-drug resistant organisms (MDRO) in an ICU of Mauritius and determine the relationship between antibiotic resistance and mortality as well as length of stay and duration of antibiotic use. Study Design: Retrospective case control study. Place and Duration of Study: This study examined the data of patients who were admitted from 2015 to 2016 at an ICU in Port Louis, Mauritius. Methodology: 128 patients on whom cultures were ordered were included. Adjustment was performed using multivariate Cox regression and negative binomial regression. Results: Out of 214 organisms that were isolated, 68% were an MDRO; 78% of Enterobacteriaceae were ESBL, 86% of Acinetobacter spp., 30% of Enterobacteriaceae and 80% of Pseudomonas spp. were carbapenem resistant while 53% of Staphylococcus aureus were MRSA. After adjustment, MDRO were linked to a non-statistically significant 13% increase in mortality (P = .056), a rise in hospital length of stay from 19 days to 29 days (P = .0013) and an escalation in duration of antibiotic use from 11 days to 24 days (P = 1.3E-10). Conclusion: Infections with MDRO are common in Mauritius and strategies should be put into place to reduce their prevalence.

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