Nursing Diagnoses as Predictors of Hospital Length of Stay: A Prospective Observational Study

Abstract BackgroundDuring COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Study design and MethodsA retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. ResultsA total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16-37] vs 15 days [IQR 9-17] (p=0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p=0.003) and respiratory rate (RR) (p=0.059).ConclusionsA short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s SpO2 improvement and RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

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Determinants of hospital length of stay after transcatheter aortic valve implantation with self-expanding prostheses: a prospective, single centre observational study

Swiss Medical Weekly ◽

10.4414/smw.2019.20095 ◽

2019 ◽

Author(s):

Angela Frei ◽

Dionysios Adamopoulos ◽

Hajo Mller ◽

Bernhard Walder ◽

Nils Perrin ◽

...

Keyword(s):

Aortic Valve ◽

Length Of Stay ◽

Observational Study ◽

Transcatheter Aortic Valve Implantation ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Single Centre ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Effects of Mediterranean diet on hospital length of stay, medical expenses, and mortality in elderly, hospitalized patients: A 2-year observational study

Nutrition ◽

10.1016/j.nut.2020.110868 ◽

2020 ◽

Vol 79-80 ◽

pp. 110868

Author(s):

Christos E. Lampropoulos ◽

Maria Konsta ◽

Vicky Dradaki ◽

Afroditi Roumpou ◽

Irini Dri ◽

...

Keyword(s):

Length Of Stay ◽

Observational Study ◽

Mediterranean Diet ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Medical Expenses ◽

Elderly Hospitalized Patients

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CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

10.21203/rs.3.rs-113418/v1 ◽

2020 ◽

Author(s):

Nicolò Capsoni ◽

Daniele Privitera ◽

Annamaria Mazzone ◽

Chiara Airoldi ◽

Valentina Albertini ◽

...

Keyword(s):

Length Of Stay ◽

Observational Study ◽

Invasive Mechanical Ventilation ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Retrospective Observational Study ◽

Positive Pressure ◽

Number Of Patients ◽

Mechanical Ventilation Time ◽

Medical Wards

Abstract Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

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Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Microorganisms ◽

10.3390/microorganisms9091941 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1941

Author(s):

Bodo Hoffmeister

Keyword(s):

Length Of Stay ◽

Observational Study ◽

Falciparum Malaria ◽

Early Recognition ◽

Tertiary Care ◽

Hospital Length ◽

University Hospital ◽

Hospital Length Of Stay ◽

Acute Pulmonary Oedema ◽

Factors Associated

Outcome of falciparum malaria is largely influenced by the standard of care provided, which in turn depends on the available medical resources. Worldwide, the COVID-19 pandemic has had a major impact on the availability of these resources, even in resource-rich healthcare systems such as Germany’s. The present study aimed to determine the under-explored factors associated with hospital length of stay (LOS) in imported falciparum malaria to identify potential targets for improving management. This retrospective observational study used multivariate Cox proportional hazard regression with time to discharge as an endpoint for adults hospitalized between 2001 and 2015 with imported falciparum malaria in the Charité University Hospital, Berlin. The median LOS of the 535 cases enrolled was 3 days (inter-quartile range, IQR, 3–4 days). The likelihood of being discharged by day 3 strongly decreased with severe malaria (hazard ratio, HR, 0.274; 95% Confidence interval, 95%CI: 0.190–0.396) and by 40% with each additional presenting complication (HR, 0.595; 95%CI: 0.510–0.694). The 55 (10.3%) severe cases required a median LOS of 7 days (IQR, 5–12 days). In multivariate analysis, occurrence of shock (adjusted HR, aHR, 0.438; 95%CI 0.220–0.873), acute pulmonary oedema or acute respiratory distress syndrome (aHR, 0.450; 95%CI: 0.223–0.874), and the need for renal replacement therapy (aHR, 0.170; 95%CI: 0.063–0.461) were independently associated with LOS. All patients survived to discharge. This study illustrates that favourable outcomes can be achieved with high-standard care in imported falciparum malaria. Early recognition of disease severity together with targeted supportive care can lead to avoidance of manifest organ failure, thereby potentially decreasing LOS and alleviating pressure on bed capacities.

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