scholarly journals The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data

2022 ◽  
Author(s):  
Theo Georghiou ◽  
Chris Sherlaw-Johnson ◽  
Efthalia Massou ◽  
Stephen Morris ◽  
Nadia E Crellin ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Hospital Admissions ◽  
Local Level ◽  
Research Programme ◽  
Early Discharge ◽  
Hospital Data ◽  
Activity Data ◽  
Discharge From Hospital ◽  
The Impact ◽  
Roll Out

Background There was a national roll out of "COVID Virtual Wards" (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge and avoid readmissions, reducing pressure on beds. This study is an evaluation of the impact of the CVW services on hospital activity. Methods Using retrospective patient-level hospital admissions data, we built multivariate models to analyse the relationship between the implementation of CVW services and hospital activity outcomes: length of COVID-19 related stays and subsequent COVID-19 readmissions within 28 days. We used data from more than 98% of recorded COVID-19 hospital stays in England, where the patient was discharged alive between mid-August 2020 and late February 2021. Findings We found a longer length of stay for COVID-19 patients discharged from hospitals where a CVW was available, when compared to patients discharged from hospitals where there was no CVW (adjusted IRR 1.05, 95% CI 1.01 to 1.09). We found no evidence of a relationship between the availability of CVW and subsequent rates of readmission for COVID-19 (adjusted OR 0.95, 95% CI 0.89 to 1.02). Interpretation We found no evidence of early discharges or reduced readmissions associated with the roll out of COVID Virtual Wards across England. Our analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled) may have meant that true impacts, especially at a local level, were not ultimately discernible. Funding This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme and NHSEI.

scholarly journals Hospital admissions in children who had pelvicalyceal diltation detected on ultrasound scan during pregnancy: an e-cohort study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Melissa Wright ◽  
Shantini Paranjothy ◽  
David Fone ◽  
Sinead Brophy ◽  
Joanne Demmler
Keyword(s):  
Hospital Admissions ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Ultrasound Scan ◽  
Second Trimester ◽  
Proportional Hazard Model ◽  
Activity Data ◽  
Cox Proportional Hazard ◽  
Uncertain Significance ◽  
The Impact

ABSTRACTObjectiveTo explore whether children with pelvicalyceal dilatation (PCD, a marker detected during the 18-20 week gestation ultrasound scan in which there is enlargement of tubes that collect urine in the kidney) have more hospital admissions for kidney problems in childhood compared to children without the marker. Approach We were funded by NISCHR to study outcomes associated with markers of uncertain significance at the second trimester anomaly scan (Welsh Study of Mothers and Babies). Data collected in the WSMB was uploaded to the Secure Anonymised Information Linkage (SAIL) databank and record linked to hospital activity data. Patterns of hospital admissions for renal causes were described and compared between those with no markers and those with PCD. Children were followed up from birth until 31st December 2014 or until the age of 5. A Cox Proportional Hazard Model was used to investigate the impact of PCD on time to first presentation. Results (Preliminary)Of the WSMB cohort, 20,834 children were eligible for inclusion in analyses. Those with PCD had 6.29 times the hazard of a renal admission compared to those without the marker (95% CI: 3.69 to 10.72). Children with PCD were more likely to have multiple renal admissions to hospital - median (interquartile range) number of renal admissions, 2.5 (1 to 5) compared to 1 (1 , 1) in children without markers. ConclusionPreliminary analysis suggests there is increased childhood renal morbidity associated with the presence of a PCD marker detected on the 18-20 week gestation ultrasound scan. These findings will inform the discussions clinicians have with parents when discussing the implications of this marker for the health of the chid.

scholarly journals Respiratory Syncytial Virus-Associated Hospital Admissions in Children Younger Than 5 Years in 7 European Countries Using Routinely Collected Datasets

2020 ◽  
Vol 222 (Supplement_7) ◽  
pp. S599-S605
Author(s):  
Rachel M Reeves ◽  
Maarten van Wijhe ◽  
Sabine Tong ◽  
Toni Lehtonen ◽  
Luca Stona ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Hospital Admissions ◽  
European Countries ◽  
Hospital Data ◽  
Admission Rates ◽  
Time Series Modelling ◽  
Modelling Methodology ◽  
Syncytial Virus ◽  
Future Work ◽  
The Impact

Abstract Background Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infection (RTI) in young children. Registries provide opportunities to explore RSV epidemiology and burden. Methods We explored routinely collected hospital data on RSV in children aged < 5 years in 7 European countries. We compare RSV-associated admission rates, age, seasonality, and time trends between countries. Results We found similar age distributions of RSV-associated hospital admissions in each country, with the highest burden in children < 1 years old and peak at age 1 month. Average annual rates of RTI admission were 41.3–112.0 per 1000 children aged < 1 year and 8.6–22.3 per 1000 children aged < 1 year. In children aged < 5 years, 57%–72% of RTI admissions with specified causal pathogen were coded as RSV, with 62%–87% of pathogen-coded admissions in children < 1 year coded as RSV. Conclusions Our results demonstrate the benefits and limitations of using linked routinely collected data to explore epidemiology and burden of RSV. Our future work will use these data to generate estimates of RSV burden using time-series modelling methodology, to inform policymaking and regulatory decisions regarding RSV immunization strategy and monitor the impact of future vaccines.

scholarly journals Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026927 ◽  
Author(s):  
Anne-Marie Burn ◽  
Frances Bunn ◽  
Jane Fleming ◽  
David Turner ◽  
Chris Fox ◽  
...  
Keyword(s):  
Service Use ◽  
Hospital Admissions ◽  
Case Finding ◽  
Dementia Case ◽  
Quality Of Life Scale ◽  
Acute Hospitals ◽  
Discharge From Hospital ◽  
Unplanned Admissions ◽  
The Impact

ObjectiveBetween 2012 and 2017 dementia case finding was routinely carried out on people aged 75 years and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services. This study explored the impact of dementia case finding on older people and their families and on their use of services.DesignThematic content analysis was conducted on qualitative interview data and costs associated with service use were estimated. Measures included the Mini-Mental State Examination, the EuroQol quality of life scale and a modified Client Service Receipt Inventory.SettingFour counties in the East of England.ParticipantsPeople aged ≥75 years who had been identified by case finding during an unplanned hospital admission as warranting further investigation of possible dementia and their family carers.ResultsWe carried out 28 interviews, including 19 joint patient-carer(s), 5 patient only and 4 family carer interviews. Most patients and carers were unaware that memory assessments had taken place, with many families not being informed or involved in the process. Participants had a variety of views on memory testing in hospital and had concerns about how hospitals carried out assessments and communicated results. Overall, case finding did not lead to general practitioner (GP) follow-up after discharge home or lead to referral for further investigation. Few services were initiated because of dementia case finding in hospital.ConclusionsThis study shows that dementia case finding may not lead to increased GP follow-up or service provision for patients after discharge from hospital. There is a need for a more evidence-based approach to the initiation of mandatory initiatives such as case finding that inevitably consume stretched human and financial resources.

scholarly journals COVID-19 vaccine hesitancy in an ethnically diverse community: descriptive findings from the Born in Bradford study

2021 ◽  
Vol 6 ◽  
pp. 23
Author(s):  
Josie Dickerson ◽  
Bridget Lockyer ◽  
Rachael H. Moss ◽  
Charlotte Endacott ◽  
Brian Kelly ◽  
...  
Keyword(s):  
Ethnic Minorities ◽  
Hospital Admissions ◽  
Ethnically Diverse ◽  
Research Programme ◽  
Vaccine Hesitancy ◽  
Born In Bradford ◽  
Diverse Community ◽  
The Uk ◽  
Roll Out ◽  
Deprived Areas

Background: The roll out of coronavirus disease 2019 (COVID-19) vaccines are underway in the UK, and ensuring good uptake in vulnerable communities will be critical to reducing hospital admissions and deaths. There is emerging evidence that vaccine hesitancy is higher in ethnic minorities and deprived areas, and that this may be caused by distrust and misinformation in the community.  This study aims to understand COVID-19 vaccine hesitancy in an ethnically diverse and deprived population of Bradford through the Born in Bradford (BiB) research programme. Methods: Surveys were sent to parents in BiB who had taken part in a previous Covid-19 survey (n=1727). Cross tabulations explored variation by ethnicity and deprivation. Answers to a question asking the main reason for hesitancy was analysed using thematic analysis. Results: 535 (31%) of those invited between 29 th October-9 th December 2020 participated. 48% were White British, 37% Pakistani heritage and 15% from other ethnicities; 46% were from the most deprived quintile of the Index of Multiple Deprivation. 29% of respondents do want a vaccine, 10% do not. The majority had not thought about it (29%) or were unsure (30%). Vaccine hesitancy differed by ethnicity and deprivation: 43% (95% CIs: 37-54%) of White British and 60% (35-81%) in the least deprived areas do want a vaccine, compared to 13% (9-19%) of Pakistani heritage and 20% (15-26%) in the most deprived areas. Reasons for not wanting a vaccine were commonly explained by confusion and distrust which was linked to exposure to misinformation. Conclusions: There is a risk of unequitable roll out of the vaccination programme in the UK with higher vaccine hesitancy in ethnic minorities and those living in deprived areas. There is an urgent need to tackle misinformation that is leading to uncertainty and confusion about the vaccines.

The Causes and Impact of Crisis for People with Parkinson’s Disease: A Patient and Carer Perspective

2021 ◽  
pp. 1-11
Author(s):  
Sarah Fearn ◽  
Sandra Bartolomeu Pires ◽  
Veena Agarwal ◽  
Helen C. Roberts ◽  
John Spreadbury ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Hospital Admissions ◽  
Health Issues ◽  
Hospital Data ◽  
Care Needs ◽  
Community Based ◽  
Crisis Events ◽  
Personal Experiences ◽  
The Impact

Background: The reasons for acute hospital admissions among people with Parkinson’s disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson’s disease (PwP) uses hospital data and excludes the individual’s own perspective on the crisis trigger and the impact of the crisis on their care needs. Objective: To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective. Methods: A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP. Results: In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications. Conclusion: These findings could improve care of Parkinson’s by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers.

scholarly journals The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

2021 ◽  
Author(s):  
Stephen Sevalie ◽  
Daniel Youkee ◽  
Alex J van Duinen ◽  
Emma Bailey ◽  
Thaimu Bangura ◽  
...  
Keyword(s):  
Health Service ◽  
Sierra Leone ◽  
Health Systems ◽  
Hospital Admissions ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Hospital Data ◽  
Sub Saharan ◽  
The Impact

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

scholarly journals An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting:

2021 ◽  
pp. 1-9
Author(s):  
Jim Swift ◽  
Zoe Harris ◽  
Alex Woodward ◽  
Noel O'Kelly ◽  
Chris Barker ◽  
...  
Keyword(s):  
Patient Safety ◽  
Resource Use ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Community Based ◽  
Discharge From Hospital ◽  
The Impact ◽  
Acute Hospital Setting ◽  
Multi Disciplinary Team

Background/Aims In response to high numbers of hospital admissions as a result of COVID-19, a virtual ward was implemented to achieve accelerated discharge from hospital without compromising patient safety. This study assessed the impact of this virtual ward for patients admitted to the acute hospital setting with COVID-19. Methods A community-based intervention using digital technology and a multi-disciplinary team of specialist clinicians to monitor patients at home was established. An analysis was carried out within the service investigating the safety, health outcomes and resource use of the first 65 patients discharged from hospital into the virtual respiratory ward. Results Red days, where an urgent response was required, decreased from 33.8% of patients in their first 3 days at the virtual ward to 10.8% in their final 3 days (P=0.002). Four patients were readmitted to hospital, all for clotting disorders. There was one death, which was deemed unrelated to COVID-19. Length of stay was also reduced by 40.3% (P<0.001) and estimated overall savings were £68 052 (£1047 per patient). Conclusions The virtual ward appeared to assist with earlier discharges, had a low rate of clinically necessary re-admissions, and seemed to reduce costs without compromising patient safety. The authors believe that this intervention could be applied across other NHS trusts facing similar capacity issues as a result of COVID-19.

scholarly journals 16 An Analysis of the Impact of Establishing an Ambulatory Stroke Team

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Colin Menagh ◽  
David Wilson ◽  
Kevin Dynan ◽  
Michael Power ◽  
Karen Hull ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Early Discharge ◽  
Rapid Identification ◽  
Improvement Project ◽  
Stroke Mimics ◽  
Stroke Team ◽  
Bed Days ◽  
The Impact

Abstract Background The South Eastern Trust established an Ambulatory Stroke Team (AST) in October 2017. This consisted of Stroke Nurses and a Specialty doctor with Stroke consultant support. During the initial pilot the AST team worked Monday – Friday 9-5pm. The majority of assessments took place in the emergency department. The overall aims were to improve length of stay for TIAs / stroke mimics and improve the percentage of strokes being admitted directly to the Stroke Unit. Methods Using quality improvement methodology we worked through several Plan, Do, Study, Act (PDSA) cycles. The most significant intervention was the introduction of a protected direct to stroke unit bed. A database was kept of all patients seen, including final diagnoses and patients discharged after assessment, preventing admission and saving bed days. Results A 6 month period was analysed from April to September 2018. 312 patients were reviewed - 159 (51%) stroke mimics, 108 (35%) strokes and 45 (14%) TIAs. 54 patients were identified for early discharge and appropriate follow-up. Bed days saved was estimated at 110 days. Direct to stroke unit percentage improved from 30% in October 2017 when the AST was introduced to 82% in January 2019. Conclusion A dedicated Ambulatory Stroke Team can prevent hospital admissions and save bed days due to rapid identification and specialist assessment of suspected TIAs and strokes. Multidisciplinary team working as part of a quality improvement project can improve the percentage of strokes admitted directly to the stroke unit.

scholarly journals Crisis resolution and home treatment teams: an evolving model

2013 ◽  
Vol 19 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Sonia Johnson
Keyword(s):  
Hospital Admission ◽  
Mental Healthcare ◽  
Early Discharge ◽  
Acute Hospital ◽  
Home Treatment ◽  
Crisis Resolution ◽  
Evolving Model ◽  
Discharge From Hospital ◽  
The Impact ◽  
Close Integration

SummaryCrisis resolution and home treatment teams have been introduced throughout England as part of a transformation of the community mental healthcare system. They aim to assess all patients being considered for acute hospital admission, to offer intensive home treatment rather than hospital admission if feasible, and to facilitate early discharge from hospital. Key features include 24-hour availability and intensive contact in the community, with visits twice daily if needed. This article describes the main characteristics and core interventions of these teams, and reviews the impact of their nationwide introduction. The model has evolved as a pragmatic response to difficulties in the acute care system, and its adaptation continues. Key challenges include achieving close integration with the rest of the mental health system and delivering continuity of care and effective therapeutic relationships despite the involvement of multiple workers in each crisis.

scholarly journals Hospitalization for self-harm during the early months of the Covid-19 pandemic in France: a nationwide study

2020 ◽  
Author(s):  
Fabrice Jollant ◽  
Adrien Roussot ◽  
Emmanuelle Corruble ◽  
Jean-Christophe Chauvet-Gelinier ◽  
Bruno Falissard ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Administrative Database ◽  
Prevention Strategies ◽  
Hospital Data ◽  
Icd 10 ◽  
Self Harm ◽  
Discharge From Hospital ◽  
The Impact ◽  
Shed Light ◽  
Related Mortality

ABSTRACTIntroductionLittle is known to date about the impact of Covid-19 pandemic on self-harm incidence.MethodsThe number of hospitalizations for self-harm in France (mainland and overseas) from January to August 2020 (which includes the first confinement from March 17th to May 11th) was compared to the same period in 2019-2017. Hospital data with the ICD-10 codes X60-84 were extracted from the national administrative database (PMSI).ResultsThere were 53,583 hospitalizations for self-harm in France between January and August 2020. Compared to the same period in 2019, this represents an overall 8.5% decrease. This decrease started the first week of the confinement and the number of hospitalizations remained at lower levels relative to 2019 until the end of August. The decrease was more marked in women (−9.8%) than men (−6.4%). However, an increase in hospitalizations was observed in individuals aged 75 and older (+5.3 to +11.6%). Moreover, the number of self-harm by firearm (+20.3%), jumping from height (+10.5%), and drowning (+4.7%) increased between 2019 and 2020, as well as the number of hospitalizations in intensive care (+3.5%) and deaths at discharge from hospital (+8.0%). No correlation was found between the evolution in the number of hospitalizations for self-harm and the number of severe cases of Covid-19 (hospitalization and mortality rates) across administrative departments.DiscussionDuring the early months of the Covid-19 pandemic in France - including the first confinement -, a general decrease in the number of hospitalizations for self-harm was observed. However, an increase was found among elderly, a population at higher Covid 19-related mortality risk, and in the number of more severe suicidal acts. These results, therefore, shed light on a complex relationship between the pandemic and self-harm occurrence. This situation may change with time, which requires active suicide prevention strategies.

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