G206 Does Increased Duration of Consultant Presence Affect Length of Hospital Stay for Unplanned Admissions in Acute Paediatrics?: An Observational Before-And-After Analysis Using Administrative Healthcare Data

2017 ◽  
Author(s):  
D Cromb ◽  
C Carter ◽  
C Lemer ◽  
CR Cheung
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Healthcare Data ◽  
Before And After ◽  
Unplanned Admissions

Does increased duration of consultant presence affect length of hospital stay for unplanned admissions in acute paediatrics?: an observational before-and-after analysis using administrative healthcare data

2016 ◽  
Vol 102 (6) ◽  
pp. 516-521 ◽  
Author(s):  
Daniel Cromb ◽  
Chris Carter ◽  
Claire Lemer ◽  
C Ronny Cheung
Keyword(s):  
Hospital Stay ◽  
Workforce Planning ◽  
Length Of Hospital Stay ◽  
Readmission Rates ◽  
Healthcare Data ◽  
Diagnostic Thresholds ◽  
Significant Difference ◽  
Before And After ◽  
Unplanned Admissions ◽  
Before And After Study

ObjectivesThis study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital.Method (design/setting/participants/interventions/outcome measures)An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission.Results5367 inpatient admissions were analysed: 3386 prior to implementation of the policy and 1981 afterwards. There was no significant difference in median LoS between the two groups or in readmission rates at 24 hours, 48 hours or 7 days. However, among children who stayed in hospital for under 24 hours, and those who were discharged with a diagnosis of acute gastroenteritis, consultant review within 12 hours of admission was associated with a shorter LoS—respectively, 16 hours 23 min versus 15 hours 45 min (p=0.01) and 28 hours 46 min versus 19 hours 41 m (p<0.01).ConclusionsIncreased duration of consultant presence was not associated with significant impact on LoS, other than in admissions of brief duration and in gastroenteritis, where diagnosis is based on clinical judgement in the absence of objective diagnostic thresholds. Future studies should focus on whether these results are generalisable across other settings, and other measures of cost-effectiveness of early consultant review, given the major implications on resource and workforce planning of such policies.

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

scholarly journals Effects of Intermittent Kangaroo Mother Care on Low-Birth-Weight Neonates: A Retrospective Before-and-After Study

2021 ◽  
Vol 55 (9) ◽  
Author(s):  
Jannie Lyne C. Notarte-Palisbo ◽  
Cindy D. Canceko-Llego
Keyword(s):  
Birth Weight ◽  
Mortality Rate ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Kangaroo Mother Care ◽  
Equal Distribution ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Before And After

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome. Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome. Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42). Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.

Evaluation of the Clinical Pathway for Laparoscopic Cholecystectomy

2005 ◽  
Vol 71 (1) ◽  
pp. 40-45 ◽  
Author(s):  
VÍctor Soria ◽  
Enrique Pellicer ◽  
Benito Flores ◽  
Milagros Carrasco ◽  
Maria Fe Candel ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Length Of Hospital Stay ◽  
Care Plans ◽  
Before And After ◽  
The Mean ◽  
Mean Cost

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (±768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (± 618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.

Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay

2018 ◽  
Vol 38 (4) ◽  
pp. 212-219
Author(s):  
Christine Leo Swenne ◽  
Louise Hjelte ◽  
Emma Härdne ◽  
Carin Friberg ◽  
Erebouni Arakelian
Keyword(s):  
Hospital Stay ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Length Of Hospital Stay ◽  
Pain Medication ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Medication Consumption ◽  
Experienced Pain ◽  
Before And After

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.

Evaluation and Monitoring of the Clinical Pathway for Thyroidectomy

2008 ◽  
Vol 74 (1) ◽  
pp. 29-36 ◽  
Author(s):  
VÍCtor Soria-Aledo ◽  
Benito Flores-Pastor ◽  
Mari Fe Candel-Arenas ◽  
AndrÉS Carrillo-Alcaraz ◽  
ÁLvaro Campillo-Soto ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Before And After ◽  
Clinical Variation ◽  
Evaluation And Monitoring ◽  
Surgery Department ◽  
Mean Cost

The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years’ follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 ± 2.1 and 3.6 ± 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 ± 966 and 2695 ± 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 ± 1056 US$) to 2004 (2404 ± 666 US$) with a slight increase during 2005 (2721 ± 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.

scholarly journals Ban Bedcentricity: a Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay

2021 ◽  
Author(s):  
Niek Koenders ◽  
Sandra Potkamp-Kloppers ◽  
Yvonne Geurts ◽  
Reinier Akkermans ◽  
Maria W G Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Sedentary Behavior ◽  
Length Of Hospital Stay ◽  
Cardiothoracic Surgery ◽  
Discharge Destination ◽  
Chi Square ◽  
Behavioral Observations ◽  
Significant Difference ◽  
Before And After ◽  
Ward Level

Abstract Objective The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward-level. Methods The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson’s chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. Results Behavioral observations showed that in 52% of the observations patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards. The mean length of hospital stay after implementation (compared to before implementation) was 5.1 days at the cardiothoracic surgery (n = 1923; mean + +0.13 days; 95%CI = −0.32 to +0.60), 2.6 days at the cardiology (n = 2646; mean = −0.22 days; 95%CI = −0.29 to −0.14), and 2.4 days at the Orthopedics-Traumatology wards (n = 1598; mean = +0.28 days = 95%CI = +0.06 to +0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23]; 95%CI = 1.07 to 1.37) and cardiology wards (OR = 1.37; 95%CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09; 95%CI = 0.88 to 1.27). Conclusions The outcomes indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home, compared to before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity, therefore, outcomes should be interpreted with caution. Impact This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation.

scholarly journals Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016213 ◽  
Author(s):  
Einar Hovlid ◽  
Jan C Frich ◽  
Kieran Walshe ◽  
Roy M Nilsen ◽  
Hans Kristian Flaatten ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Regression Models ◽  
Length Of Hospital Stay ◽  
Linear Regression Models ◽  
Logistic Regression Models ◽  
Before And After ◽  
Ethical Approval ◽  
Data Protection Authority ◽  
Sepsis Detection

IntroductionInspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay.Methods and analysisThe intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations.Ethics and disseminationThe study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier:NCT02747121). Results will be reported in international peer-reviewed journals.Trial RegistrationNCT02747121; Pre-results.

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