A long wait: barriers to discharge for long length of stay patients

2018 ◽  
Vol 94 (1116) ◽  
pp. 546-550 ◽  
Author(s):  
Emma Jane Zhao ◽  
Apurva Yeluru ◽  
Lakshman Manjunath ◽  
Lei Ray Zhong ◽  
Hsiao-Tieh Hsu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Healthcare Staff ◽  
Care Capacity ◽  
Improve Cost

IntroductionReducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.MethodsWe conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.ResultsDischarge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.ConclusionTogether with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

scholarly journals Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

2019 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Bikash Lal Shrestha ◽  
Sameer Karmacharya
Keyword(s):  
Frontal Sinus ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Mucosal Disease ◽  
Complex Anatomy ◽  
Prospective Longitudinal

Introduction The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease.   Materials and Methods This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test.   Results The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease.   Conclusion The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

scholarly journals Emotional & Behavioural Problems among Siblings of Children with Chronic Neuromuscular Illnesses

2020 ◽  
pp. 29-37
Author(s):  
Nidhi Garg ◽  
Krishna Moorthi Adhikari
Keyword(s):  
Behavioral Problems ◽  
Assessment Tool ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Emotional And Behavioral Problems ◽  
Behavioural Problems ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference

Introduction and Objective: To determine the prevalence of emotional and behavioral problems among siblings of children with chronic neuromuscular illnesses by using validated parent completed assessment tool. Method: It is a cross-sectional study conducted in a tertiary care hospital from over a period of 34 months. Siblings of children with chronic neuromuscular illnesses were serially recruited while attending pediatric OPD and IPD. Parents were interviewed and requested to fill the Strength and Difficulty Questionnaire (SDQ) to assess and analyze emotional and behavioral problems among siblings. Results: Study included 171 siblings of children with chronic neuromuscular illnesses. Of 171 siblings, 124 (72.51%) had normal scores, 25 siblings (14.62%) were in borderline range and remaining 22 (12.87%) had abnormal values. The mean ± SD of SDQ score was 12.41 ± 3.6 with median score of 11. There was no significant difference between total SDQ scores of male vs female siblings (p value= 0.229) or between birth order of the sibling or GMFCS class of the affected child to emotional and behavioural problems. Subgroup analysis was not possible because of small sample size.

Self-stigma in patients with major depressive disorder: An exploratory study from India

2020 ◽  
pp. 002076402097581
Author(s):  
Bichitra Nanda Patra ◽  
Vaibhav Patil ◽  
Yatan Pal Singh Balhara ◽  
Sudhir K Khandelwal
Keyword(s):  
Mental Health ◽  
Depressive Disorder ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Mental Health Problems ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Unfair Treatment

Background: One of the barriers to effective care in patients with depression is stigma associated with having a mental disorder, which also acts as a barrier to recovery and increases the disability. Aims: To study the stigma and disabilities experienced by the patients with depressive disorders seeking treatment in a tertiary care hospital Methodology: Fifty patients diagnosed to have depressive disorder as per ICD-10 were recruited by convenient sampling. To measure the stigma, the Discrimination and Stigma Scale -12 was applied. The severity of depression was determined by applying Hamilton Depression Rating Scale (HAMD). The disability was calculated by using WHO Disability Assessment Schedule 2.0 Results: Fifty percentages of the participants reported unfair treatment and they experienced discrimination in at least one life domain. There was significant positive correlation between unfair treatment subscale of stigma and disability. Around one fourth of the participants reported to be treated unfairly by their own families. Seventy percent reported to have concealed their mental health problems, 54% have stopped themselves from having a close personal relationship and 32% didn’t apply for work in anticipating discrimination. Experienced and anticipated discrimination were significantly associated with concealing the mental health problem. Conclusion: Stigma due to having depression acts as a barrier to vocational & social integration and functional recovery. Concealment of the diagnosis of depression is itself barrier for help seeking and to receiving appropriate treatment. Small sample size and adopting the purposive sampling method are the limitations of the study.

Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Faiza Ahmed ◽  
Lubna Abbasi ◽  
Nida Ghouri ◽  
Muhammad Junaid Patel
Keyword(s):  
Gender Differences ◽  
Cardiac Arrest ◽  
Tertiary Care Hospital ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Cross Sectional ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic. Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period. Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%. Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 How to cite this:Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022;38(2):387-392. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Impact of drainage technique on pediatric pyeloplasty: Comparative analysis of externalized uretero-pyelostomy versus double-J internal stents

2015 ◽  
Vol 9 (7-8) ◽  
pp. 453 ◽  
Author(s):  
Linda C. Lee ◽  
Niki Kanaroglou ◽  
Joseph M. Gleason ◽  
Joao L. Pippi Salle ◽  
Darius J. Bägli ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Operative Time ◽  
Small Sample Size ◽  
Small Sample ◽  
Safe Alternative ◽  
Urinary Drainage ◽  
Dj Stent ◽  
The Mean

Introduction: Pediatric pyeloplasty with double J (DJ) stent drainage requires manipulation of the uretero-vesical junction (UVJ) and a second anesthetic for removal. Externalized uretero-pyelostomy (EUP) stents avoid these issues. We report outcomes of laparoscopic and open pyeloplasty with EUP compared to DJ stents in children.Methods: We retrospectively reviewed 76 consecutive children who underwent pyeloplasty for ureteropelvic junction (UPJ) obstruction over a 1-year period by 5 pediatric urologists at a single institution. The exclusion criteria included patients with concomitant urological procedures, other urinary drainage strategies, “stentless” pyeloplasty or patients without follow-up data. Based on surgeon preference, 24 patients had a EUP stent and 38 had a DJ stent placed.Results: The mean follow-up was 23.8 ± 10.9 months and 21.1 ± 11.1 months for the EUP and DJ stent groups, respectively (p = 0.32). The mean age was 40 ± 54 months and 80 ± 78 months for the EUP and DJ groups, respectively (p = 0.04). The EUP group had a greater proportion of open pyeloplasties (n = 17, 71%) versus the DJ group (n = 16, 42%; p = 0.04). There were no statistically significant differences in operative time, length of stay, and overall complication rate between groups. Complications were divided by timing of complication (intraoperative, before and after 3 months) and according to the Clavien Classification system. There were no statistically significant differences between these subgroups. The limitations of this study include small sample size, potential selection bias, and heterogeneity between both study groups.Conclusions: Pyeloplasty using EUP stents does not incur prolonged operative time, longer length of stay or higher complication rate when compared to DJ stents. Within the limitations of this study, EUP stents may be a safe alternative to DJ stents.

scholarly journals Average length of stay in Level III and IV Care of Accident and Emergency Department of Tertiary care Hospital

JMS SKIMS ◽  
2011 ◽  
Vol 14 (2) ◽  
pp. 61-62
Author(s):  
Reyaz A Rangrez ◽  
Sheikh Mushtaq ◽  
Shafa Deva ◽  
Tanveer A Rather ◽  
Sameena Mufti ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Tertiary Care ◽  
Care Hospital ◽  
Emergency Admissions ◽  
Prolonged Length ◽  
Average Length Of Stay ◽  
Accident And Emergency ◽  
Time Gap

BACKGROUND: The scope of Accident and Emergency (A&E) Department is gradually broadening and in fact these are now becoming“mini hospitals within hospitals”.OBJECTIVE:To determine the average length of stay (LOS) in level III and level IV care and factors leading to prolonged length of stay.METHODS:A Hospital based study with follow up of patients received in level III and level IV of A&E Department and the patients were followed till transfer out to respective specialty wards,discharge or death.RESULTS: Emergency beds occupied 9.3% of the total hospital bed strength. Of the total emergency admissions studied, 71.1 % comprised of neurosurgical admissions followed by CVTS (21.4%), neurological (6.8%) and other admissions(1.2%). The average Length of Stay was greatest in CVTS followed by General Surgery i.e. 5.4 days and 4.6 days respectively. The time gap between investigations ordered and reports received was 1.04 days. 67% of the patients who attended A&E Department were of rural background and out of it 54% have read upto high school.CONCLUSIONS: Average Length of stay is 4.3 days which needs to be brought down to 24 hours as per international norms to provide equitable emergency care to wider population. Co-ordination between administration and cliniciansis needed to expedite theproblem.JMS2011;14(2):61-62

scholarly journals Leisure time physical activity, smoking and risk of recent symptomatic urolithiasis: Survey of stone clinic patients

2015 ◽  
Vol 9 (7-8) ◽  
pp. 257 ◽  
Author(s):  
Michael Soueidan ◽  
Susan J. Bartlett ◽  
Yasser A. Noureldin ◽  
Ross E. Andersen ◽  
Sero Andonian
Keyword(s):  
Physical Activity ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Dietary Recommendations ◽  
Convenience Sample ◽  
Physical Activity Guidelines

Introduction: We explore relationships between selected lifestyle factors and recent (≤6 months) symptomatic urolithiasis (RSU).Methods: Surveys querying socio-demographic, medical history, physical activity, diet and smoking were administered to a convenience sample of stone clinic patients at a tertiary care hospital. Leisure time physical activity (LTPA) was assessed with the International Physical Activity Questionnaire (long form). Multivariate logistic regression was used to identify associations between risk factors and RSU.Results: Of the 163 participants, most were male (64%) and white (78%), with a mean (standard deviation) age of 56.3 (14.2) years. The mean body mass index (BMI) was 27.3 (5.4) kg/m2 and 57 (35%) patients reported RSU. No significant (p < 0.05) differences were observed between participants with and without RSU in age, sex, ethnicity, BMI, or diet. Of the cohort, 52 (35%) participants met physical activity guidelines for walking (29%), moderate (27%) or vigorous activity (29%). LTPA did not differ significantly by RSU status. Compared to those without RSU, participants with RSU had higher rates of smoking (7% vs. 21%, p = 0.02 and had 8.5 (95% confidence interval 2.2–32.2) times the odds of being current smokers after controlling for sex, diet, and LTPA.Conclusions: Physical inactivity and smoking are common among stone clinic patients, though LPTA was not associated with RSU. Study limitations include its small sample size, selection bias, and reliance on self-reported RSU (recall bias). In addition, participants may have already been following dietary recommendations to prevent urolithiasis recurrence. Nonetheless, current smoking was a potent predictor of RSU. When desired, smokers should be referred for smoking cessation.

scholarly journals The Use of Dalbavancin for Primary Bloodstream Infections and Infectious Endocarditis: A Retrospective Chart Review

2021 ◽  
Author(s):  
Connor Evins ◽  
Harrison Lancaster MS- ◽  
Amanda E. Schnee
Keyword(s):  
Chart Review ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Small Sample ◽  
Inclusion Criteria ◽  
Hospital Stays ◽  
Positive Results

Abstract Background: Dalbavancin is a semisynthetic antibiotic used as an alternative to vancomycin for skin infections as well as osteomyelitis. It is particularly useful due to its safety profile as well as long half-life, which allows for weekly outpatient infusions. This decreases the need for patients to have long term IV access and reduces hospital stays. This study analyzes the effectiveness of Dalbavancin for bacteremia and infective endocarditis Methods: Upon IRB approval, the authors performed a retrospective chart analysis on patients who fit our inclusion criteria between 2014 and 2020. Their hospitalizations were analyzed for demographics, medical history, indication, and follow up. The results were then analyzed using descriptive statistics. Results: Our cohort had 23 patients treated with Dalbavancin for endocarditis or bloodstream infections. There were no reported side effects from the medication, no readmissions for worsened infection, and no deaths from the infection. 11 patients were treated due to refusal of medical care, and 15 patients had follow-up visits within 90 days. Conclusions: Overall, patients responded well. The lack of readmission to the hospital is promising as it indicates a possible outpatient treatment. This would help decrease cost and comorbidities of long-term hospital stays. These positive results are limited by small sample size and treatment of other antibiotics prior to receiving Dalbavancin. Further research is required to accurately estimate the efficacy of Dalbavancin on bloodstream infections and endocarditis, but these results are promising especially for patients who are not candidates for long term hospitalization or IV access.

Chemo-prophylaxis of COVID-19 with hydroxychloroquine: a study of health care workers attitude, adherence to regime and toxicities/side effects (Preprint)

2020 ◽  
Author(s):  
Debajyoti Bhattacharyya ◽  
Neeraj Raizada ◽  
Bharathnag Nagappa ◽  
Arvind Tomar ◽  
Prateek Maurya ◽  
...  
Keyword(s):  
Side Effects ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Perceived Threat ◽  
Care Hospital ◽  
Care Workers ◽  
Perceived Danger ◽  
Structured Questionnaire

BACKGROUND There are apprehensions among healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemo-prophylaxis for seven weeks as per Government of India guidelines. OBJECTIVE To assess the apprehensions among HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. METHODS A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi structured questionnaire. RESULTS 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemo-prophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. CONCLUSIONS Two third of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemo-prophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.

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