Correlates of lengthy stay in a mental health hospital

2018 ◽  
Vol 11 (1) ◽  
pp. 13-31
Author(s):  
Mostafa Mohamed Al Sayed ◽  
Michael Elnemais Fawzy
Keyword(s):  
Mental Health ◽  
Linear Regression ◽  
Hospital Stay ◽  
Mental Hospital ◽  
Length Of Hospital Stay ◽  
Content Type ◽  
Significant Difference ◽  
Group A ◽  
Inpatient Group ◽  
Main Factors

Purpose The purpose of this paper is to study the role of social factors that determine the length of stay in a mental hospital and also understand the main factors leading to the phenomena as a step to solve it. Design/methodology/approach A case-control cross-sectional observational study is performed which studies correlates for the lengthy stay in a mental hospital. The study population consists of two groups: Group A (94 patients), taken from the patients hospitalized for more than one year, further subdivided into schizophrenia and schizoaffective inpatient group and bipolar affective inpatient group; and Group B (94 patients), receiving their treatment at the outpatient clinic after being admitted for less than six months, this group was further subdivided into same categories as Group A. Findings The study showed that the positive score in positive and negative symptoms scale (PANSS) showed highly statistically significant (p<0.01) correlation with the length of hospital stay for the schizophrenic and schizoaffective patients in the inpatient group. The results showed no statistically significant difference (p>0.05) between the inpatient schizophrenic cases and the inpatient affective cases regarding the length of hospital stay. Research limitations/implications The linear regression model was used to understand the predictors of increased length of hospital stay. The linear regression analyzing the scale data of schizophrenic and schizoaffective patients found that the length of hospital stay for the schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. On the other hand, linear regression model for bipolar affective patients in the study found no statistically significant attributes of the length of hospital stay. Practical implications The study found that the length of hospital stay for schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. Social implications The need for this study stems from the large numbers of mental inpatients who have been lengthily admitted in mental health hospitals in Egypt, while trying to understand main factors leading to the phenomena as a step to solve it. The study found that there is a highly significant difference between inpatient group and outpatient group regarding the marital status, education level, and psychosocial class, with inpatient group having more single, illiterate, and very low social class cases. Originality/value Research in the area of chronic psychiatric hospitalization and its effect on the course and prognosis of mental illness is still scarce, especially in the Arab world; therefore, the research will open the door for further research efforts in the future with a larger sample of patients to study the pros and cons of deinstitutionalization taking into account the past experience of health systems in other countries.

Alvimopan as an essential component of ERAS protocol to decrease length of hospital stay.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 517-517
Author(s):  
Peter Hanna ◽  
Arveen Kalapara ◽  
Subodh Regmi ◽  
Kalyana Srujana ◽  
Joseph Zabell ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Significant Difference ◽  
Bowel Movements ◽  
Group A ◽  
Group B ◽  
Eras Protocol

517 Background: Radical cystectomy for muscle invasive bladder cancer is the gold standard. However, it is frequently associated with a prolonged length of hospital stay (LOS). We study the effect of ERAS protocol implementations and Alvimopan use in patients undergoing radical cystectomy and its impact on length of hospital stay (LOS). Methods: Retrospective cohort study involving consecutive patients undergoing radical cystectomy for bladder cancer at our institution from 2010 through 2018. We evaluated Alvimopan use plus an ERAS protocol post radical cystectomy versus patients who underwent ERAS protocol alone versus those who were managed prior to ERAS protocol implementation. Primary outcome of interest was LOS, controlling for age, sex, smoking status and Charleson comorbidities index. Results: 146 patients (49.32 %) received standard care (non-ERAS) (group A), 102 patients (34.45 %) underwent ERAS protocol alone (group B) and 47 patients (15.87 %) underwent ERAS protocol plus Alvimopan (group C). There was no significant difference in length of stay between group A and group B (p=0.856). However, group C experienced a shorter LOS (16.6%) compared to group A (p=0.015). Similarly, group B was not significantly associated with the days to bowel movements compared to group A (p=0.112), however, group C demonstrated a significantly shorter time (16.3%) to bowel movements compared to group A (p=0.015). On other hand, group c wasn’t significantly associated with time tolerance to regular diet (p=0.068). Limitations include retrospective nature of some of the data, non-randomized approach and confounders such as a mix of robot and open approaches to cystectomy. Conclusions: Of all ERAS protocol components, Alvimopan appeared to be the most significant contributor in accelerating GI recovery and decrease LOS in our cohort.

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

2019 ◽  
Vol 11 (3) ◽  
pp. 555-576 ◽  
Author(s):  
Giovanni Improta ◽  
Carlo Ricciardi ◽  
Anna Borrelli ◽  
Alessia D’alessandro ◽  
Ciro Verdoliva ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Hospital Stay ◽  
Economic Impact ◽  
Six Sigma ◽  
Length Of Hospital Stay ◽  
Content Type ◽  
Asa Score ◽  
Femur Fractures ◽  
Significant Difference ◽  
Socio Economic Impact

Purpose The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process. Design/methodology/approach This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used. Findings The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups. Research limitations/implications The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context. Practical implications There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait. Originality/value This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.

scholarly journals Does Clarithromycin Use in Acute Viral Bronchiolitis Shorten Length of Hospital Stay?

2020 ◽  
pp. 62-65
Author(s):  
Gülnur Esenülkü ◽  
Fatma Hancı
Keyword(s):  
Hospital Stay ◽  
Clinical Status ◽  
Length Of Hospital Stay ◽  
High Rate ◽  
Clinical Practices ◽  
Pediatric Clinic ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Acute Viral Bronchiolitis

Introduction: Acute bronchiolitis is the most common cause of hospitalization among infants. Although antibiotics are not recommended in the absence of secondary bacterial infection, rates of antibiotic usage is high rate in clinical practices Objectives: To test the hypothesis that clarithromycin use in infants with acute viral bronchiolitis shortens length of hospital stay. Materials and Methods: One hundred sixty-seven patients aged 1-24 months hospitalized for treatment with a diagnosis of acute viral bronchiolitis at pediatric clinic between April 2017 and May 2018 were investigated retrospectively. The patients were divided into two separate groups, Group A (122 patients), using clarithromycin therapy during hospitalization, and Group B (45 patients), which did not receive clarithromycin (Group B). Demographic and clinical data, treatments received, and duration of hospital stay were obtained from patients’ records. Results: The rate of clarithromycin use in this study was 73%. No statistically significant difference in length of hospital stay was determined between patients receiving clarithromycin and those receiving no antibiotic therapy. However, length of hospital stay decreased with age. Clarithromycin use elicited no statistically significant decrease in hospital stay in patients with acute viral bronchiolitis. Conclusions: The routine use of clarithromycin is not recommended in acute viral bronchiolitis in the light of its cost and side-effects, and the fact is has no impact on clinical status and hospital stay

scholarly journals Effects of perioperative enteral glutamine on surgical outcome in gastrointestinal cancer patients

2019 ◽  
Vol 6 (3) ◽  
pp. 903
Author(s):  
Raghavendra . ◽  
Raghupathi S.
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leak ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Previous trials have shown that perioperative glutamine could protect patients from infectious complications after gastrointestinal cancer operations.Methods: 54 patients with a planned elective operation for gastrointestinal cancer were divided into two groups: GROUP A: patients given glutamine enriched enteral nutrition perioperatively (n=27), GROUP B: patients given enteral feed without glutamine (n=27). Patients were assessed in terms of post-operative complications like infective complications, anastomotic leak, need for reintervention, length of hospital stay and mortality.Results: In group A seven patients and in group B six patients had surgical site infection post operatively (p=0.750). In group A five patients and in group B three patients had lung and urinary tract infection post operatively (p=0.444). In group A three patients and in group B five patients had intra-abdominal abscess/collection post operatively (p=0.444). In group A one patient and in group B three patients had anastomotic leak post operatively (p=0.299). In group A three patients and in group B three patients had reintervention in form of ultrasound guided aspiration and ultrasound guided pigtail aspiration for intra-abdominal collection (p=1.000). In group A and in group B mean length of hospital stay was 26 days and 23 days respectively (p=0.346). In group A and in group B mean length of post-operative hospital stay was 13 and 12 days respectively (p=0.642). There was no mortality in our study. No significant difference between the groups was found in complication rates, length of hospital stay.Conclusions: Routine perioperative glutamine to the patients undergoing major gastrointestinal surgery is not beneficial.

Audit of the Use of Nurses' Holding Power under Section 5(4) of the Mental Health Act 1983

1998 ◽  
Vol 38 (3) ◽  
pp. 227-232 ◽  
Author(s):  
Emad Salib
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
Psychiatric Patients ◽  
Length Of Hospital Stay ◽  
Psychiatric Nurses ◽  
Mental Health Act ◽  
Holding Power ◽  
Review Period ◽  
Significant Difference ◽  
Maximum Period

Emergency detention of psychiatric patients by doctors under s. 5(2) of the Mental Health Act 1983 is not always preceded by the use of nurses' holding power under s. 5(4). In this review of patients in North Cheshire, all applications of s. 5(4), allowing the emergency detention of voluntary in-patients by registered psychiatric nurses for a maximum period of six hours, were reviewed to examine the extent of its use and to assess its effect on s. 5(2) outcome. Of the 877 detentions under s. 5(2) implemented during the 11-year review period, 140 (16%) were preceded by s. 5(4). There was no significant difference in age, sex, clinical diagnosis, day of the week, reason for detention and length of hospital stay before section application between those who had s. 5(4) applied before 5(2) and those who did not. The latter were less likely to be converted to other sections (53%) compared to a much higher rate of 80% if s. 5(4) preceded s. 5(2). The review has also found that time of section application and length of hospital stay prior to detention may have influenced the use of nurses' holding power. It suggests that s. 5(4) may be a useful predictor of s. 5(2) outcome.

scholarly journals Multiple Factors Affecting Length of Hospital Postpartal Care in Eclampsia Patients

2016 ◽  
pp. 75-80
Author(s):  
Gita Dianty
Keyword(s):  
Renal Failure ◽  
Hospital Stay ◽  
Mode Of Delivery ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Short Stay ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Significant Difference ◽  
Group A

Objective: To identify any factors that could cause longer care at hospitals in eclampsia patients. Methods: It was a retrospective, cross sectional study design and conducted in Dr. Mohammad Hoesin Hospital Palembang from January 2005 to December 2009. This research conducted in 176 samples divided into 2 groups namely short-stay group (1-5 days) with 92 patients and longer stay group (≥ 5 days) with 87 patients, with mean length of hospital stay 5.41±3.43 days. Results: The most common mode of delivery in the group who stayed ≥ 5 days was cesarean section (44.8%), while the most common delivery route in the group who stayed < 5 days was forceps extraction (43.5%). The mean thrombocytes count in the longer stay group was lower than in the short-stay group (213459.77±108391.81 vs 258945.65±92213.24 mm3), which was significantly different (p=0.003). Ureum and LDH concentration in longer stay group was higher, and statistic test was found to be significantly different (p<0.05), while renal failure complication was mostly experienced by the longer stay group (20.7%). Conclusions: Thrombocytes count, LDH, acute renal failure and ICU has significant difference and greater in postpartal eclampsia group that is longer treated. [Indones J Obstet Gynecol 2012; 36-2: 75-80] Keywords: complication, eclampsia, length of hospital stay

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

Sign in / Sign up

Export Citation Format

Share Document