scholarly journals Effect of online literature searching on length of stay and patient care costs

1994 ◽  
Vol 69 (6) ◽  
pp. 489-95 ◽  
Author(s):  
M S Klein ◽  
F V Ross ◽  
D L Adams ◽  
C M Gilbert
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Literature Searching ◽  
Care Costs

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 144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Mary Randles ◽  
Sylvia Hickey ◽  
Susanne Cotter ◽  
Carmel Walsh ◽  
Kieran O'Connor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Multidisciplinary Team ◽  
Older Persons ◽  
Patient Flow ◽  
Geriatric Medicine ◽  
City Centre ◽  
Nurse Specialist ◽  
Complex Care ◽  
Clinical Nurse

Abstract Background Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital. Methods The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications. Results There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days). Conclusion Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.

Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

2019 ◽  
Vol 24 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Keith B. Allen ◽  
Ethan Y. Brovman ◽  
Adnan K. Chhatriwalla ◽  
Katherine J. Greco ◽  
Nikhilesh Rao ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Surgery ◽  
Pain Management ◽  
Length Of Stay ◽  
Health Care Costs ◽  
Adverse Drug Events ◽  
Management Strategies ◽  
Coronary Bypass ◽  
Administrative Claims ◽  
Care Costs

Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

Implementation of an Acute Care Surgery Service in a Community Hospital: Impact on Hospital Efficiency and Patient Outcomes

2016 ◽  
Vol 82 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Michael Kalina
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Acute Care ◽  
Patient Outcomes ◽  
Community Hospital ◽  
Hospital Efficiency ◽  
Hospital Charges ◽  
Acute Care Surgery ◽  
Health Evaluation ◽  
Care Surgery

A service led by acute care surgeons managing trauma, critically ill surgical, and emergency general surgery patients via an acute care surgery model of patient care improves hospital efficiency and patient outcomes at university-affiliated hospitals and American College of Surgeons–verified trauma centers. Our goal was to determine whether an acute care surgeon led service, entitled the Surgical Trauma and Acute Resuscitative Service (STARS) that implemented an acute care surgery model of patient care, could improve hospital efficiency and patient outcomes at a community hospital. A total of 492 patient charts were reviewed, which included 230 before the implementation of the STARS [pre-STARS (control)] and 262 after the implementation of the STARS [post-STARS (study)]. Demographics included age, gender, Acute Physiology and Chronic Health Evaluation 2 score, and medical comorbidities. Efficiency data included length of stay in emergency department (ED-LOS), length of stay in surgical intensive care unit (SICU-LOS), and length of stay in hospital (H-LOS), and total in hospital charges. Average age was 64.1 + 16.4 years, 255 males (51.83%) and 237 females (48.17%). Average Acute Physiology and Chronic Health Evaluation 2 score was 11.9 + 5.8. No significant differences in demographics were observed. Average decreases in ED-LOS (9.7 + 9.6 hours, pre-STARS versus 6.6 + 4.5 hours, post-STARS), SICU-LOS (5.3 + 9.6 days, pre-STARS versus 3.5 + 4.8 days, post-STARS), H-LOS (12.4 + 12.7 days, pre-STARS versus 11.4 + 11.3 days, post-STARS), and total in hospital charges ($419,602.6 + $519,523.0 pre-STARS to $374,816.7 + $411,935.8 post-STARS) post-STARS. Regression analysis revealed decreased ED-LOS—2.9 hours [ P = 0.17; 95% confidence interval (CI): -7.0, 1.2], SICU-LOS—6.3 days ( P < 0.001; 95% CI: -9.3, -3.2), H-LOS—7.6 days ( P = 0.001; 95% CI: -12.1, -3.1), and 3.4 times greater odds of survival ( P = 0.04; 95% CI: 1.1, 10.7) post-STARS. In conclusion, implementation of the STARS improved hospital efficiency and patient outcomes at a community hospital.

scholarly journals A User Survey Finds That a Hospital Library Literature Search Service Has a Direct Impact on Patient Care

2015 ◽  
Vol 10 (3) ◽  
pp. 108
Author(s):  
Elizabeth Margaret Stovold
Keyword(s):  
Patient Care ◽  
Questionnaire Survey ◽  
Literature Search ◽  
Assessment Tool ◽  
Multiple Choice ◽  
Patient Treatment ◽  
Literature Searching ◽  
Search Service ◽  
Multiple Choice Questionnaire ◽  
The Impact

A Review of: Farrell, A., Mason, J. (2014). Evaluating the Impact of Literature Searching Services on Patient Care Through the Use of a Quick-Assessment Tool. Journal of the Canadian Health Libraries Association, 35(3),116-123. doi: 10.5596/c14-030 Abstract Objective – To assess the impact of a library provided literature search service on patient care. Design – Multiple choice questionnaire survey. Setting – Hospital library. Subjects – 54 library users who had requested a literature search and indicated the primary purpose of their request was patient care. Methods – A multiple choice questionnaire survey was designed, building on previously published library impact surveys and best practice guidelines, with input from staff in the local research department. The survey was reviewed by library staff, researchers and prospective respondents and piloted. The survey was sent out with the answers to literature search requests and a small incentive was offered to those who completed the survey. The survey was followed up with reminders. Main results – The response rate was 57.5% (n=54/94). The most common staff groups requesting literature searches were physicians (33.3%), nurses (22.2%), therapists (16.7%), pharmacists (11.1%) and residents (7.4%). The majority stated that their questions had been answered (77.8%), while 18.5% indicated their questions had been partially answered, for reasons such as the answer leading to more questions, or parts of the question had not been addressed. Two (3.7%) of the respondents’ questions were not answered, either because no answer existed, or because the question didn’t contain enough detail. Of those who replied that their question had been answered, 64.3% judged the information to have had an immediate impact on patient treatment or management. Other uses of the information included refreshing memory, avoiding an adverse event, diagnosing a patient, or preventing a referral. The percentage of respondents judging there to be no immediate impact on patient care was 16.7%. The impact on diagnosis and treatment was further investigated in those who had said there had been an immediate impact, with 22.2% saying the information determined their choice of drug, 29.6% saying the information confirmed their choice of drug, while 18.5% stated the information changed their choice of drug. All respondents replied that they intended to use this information in the future, regardless of whether the information had an immediate impact, or if their question had been answered. Conclusion – The authors concluded that the survey results show hospital libraries can have an impact on patient care through a literature searching service. They also found that the library was answering its literature service users’ questions.

Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care

2019 ◽  
Vol 87 (2) ◽  
pp. 408-412 ◽  
Author(s):  
Aditya Achanta ◽  
Ask Nordestgaard ◽  
Napaporn Kongkaewpaisan ◽  
Kelsey Han ◽  
April Mendoza ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
General Surgery ◽  
Clinical Factors ◽  
Emergency General Surgery
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