scholarly journals Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wonjin Choi ◽  
Seon Hee Woo ◽  
Dae Hee Kim ◽  
June Young Lee ◽  
Woon Jeong Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
History Of

Background. This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods. This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results. A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001 ), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p = 0.039 ), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p = 0.039 ) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS ( p = 0.018 ), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate ( p = 0.044 ,   p = 0.008 ). Conclusions. This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

scholarly journals Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erica M. Jones ◽  
Amelia K. Boehme ◽  
Aimee Aysenne ◽  
Tiffany Chang ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Adverse Outcomes ◽  
Stroke Patients ◽  
Significant Independent Predictor ◽  
Prolonged Length ◽  
Stroke Center ◽  
Shift Change

Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.

scholarly journals Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

2018 ◽  
Vol 12 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Aroldo Bacellar ◽  
Telma Assis ◽  
Bruno B. Pedreira ◽  
Gersonita Costa ◽  
Osvaldo J.M. Nascimento
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Low Socioeconomic Status ◽  
Neurological Disorders ◽  
Risk Model ◽  
Medical Center ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Neurological Complications ◽  
Low Socioeconomic

Background: Neurological disorders (NDs) are associated with high hospital mortality. We aimed to identify predictors of hospital mortality among elderly inpatients with NDs. Methods: Patients aged ≥60 years admitted to the hospital between January 1, 2009 and December 31, 2010 with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic data, NDs, and comorbidities as independent predictors of hospital mortality. Logistic regression was performed for multivariable analysis. Results: Overall, 1540 NDs and 2679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8±9.1). Of these, 54.5% were female. Diagnostic frequency of NDs ranged between 0.3% and 50.8%. Diagnostic frequency of comorbidities ranged from 5.6% to 84.5%. Comorbidities varied from 0 to 9 per patient (90% of patients had ≥2 comorbidities), mean 3.2±1.47(CI, 3.1-3.3). Patients with multimorbidities presented with a mean of 4.7±1.7 morbidities per patient. Each ND and comorbidity were associated with high hospital mortality, producing narrow ranges between the lowest and highest incidences of death (hospital mortality = 18%) (95% CI, 15%-21%). After multivariable analysis, advanced age (P<0.001) and low socioeconomic status (P=0.003) were recognized as predictors of mortality, totaling 9% of the variables associated with hospital mortality. Conclusion: Neither a particular ND nor an individual comorbidity predicted hospital mortality. Age and low socioeconomic class accounted for 9% of predictors. We suggest evaluating whether functional, cognitive, or comorbidity scores will improve the risk model of hospital mortality in elderly patients admitted with ND.

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients – A Retrospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0135066 ◽  
Author(s):  
Steffie H. A. Brouns ◽  
Patricia M. Stassen ◽  
Suze L. E. Lambooij ◽  
Jeanne Dieleman ◽  
Irene T. P. Vanderfeesten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Organisational Factors

Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

2011 ◽  
Vol 70 (6) ◽  
pp. 1317-1325 ◽  
Author(s):  
Nathan T. Mowery ◽  
Stacy D. Dougherty ◽  
Amy N. Hildreth ◽  
James H. Holmes ◽  
Michael C. Chang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Trauma Activation

Abstract 15935: Socioeconomic Disparities in Urgent versus Elective Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexander M Spring ◽  
Michael A Catalano ◽  
Bruce J Rutkin ◽  
Alan R Hartman ◽  
Pey-Jen Yu
Keyword(s):  
Mitral Valve ◽  
Length Of Stay ◽  
Mitral Valve Repair ◽  
Low Income ◽  
Multivariable Analysis ◽  
Socioeconomic Disparities ◽  
National Database ◽  
National Inpatient Sample ◽  
Valve Repair ◽  
Prolonged Length

Objective: Cardiac interventions performed urgently are known to be associated with poor outcomes compared to electively performed procedures. Transcatheter edge-to-edge mitral valve repair (TMVr) has developed as a reasonable alternative to mitral valve surgery in certain patient populations. We aimed to leverage a national database to identify predictors of urgent versus elective TMVr, as well as the association between urgency and outcomes. Methods: The National Inpatient Sample (NIS) was queried to identify weighted hospital discharge records of patients who underwent TMVr from 2016 - 2017. Hospitalizations are identified within the database as elective versus non-elective. Univariate and multivariable analyses were performed to identify patient characteristics associated with urgent procedures. In-hospital outcomes were assessed. Results: There were 10,195 cases of TMVr in this cohort, 24.2% of which were performed urgently. In multivariable analysis, Hispanic race, Medicaid insurance, and low income were associated with increased likelihood of urgent hospital admission and TMVr. Additionally, small hospital size and Northeast region were associated with increased likelihood of urgent admission and procedure. Older patients were more likely to undergo elective procedures (Table 1). Urgent TMVr was associated with increased mortality (4.5% vs. 1.6%, p < .001), prolonged length of stay (6.0 vs. 2.0, p < .001), and increased cost ($267,292 vs. $167,889, p < .001). Conclusion: Socioeconomic disparities exist in the utilization of TMVr as an urgent versus elective procedure, suggesting differences in access to surveillance and preventive care. Urgent TMVr is associated with increased morbidity and mortality, prolonged length of stay, and increased hospital costs. Priority should be placed on mitigating such disparities to improve outcomes.

scholarly journals P067: Factors associated with prolonged length of stay of admitted patients in a tertiary care emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101
Author(s):  
K. Johns ◽  
S. Smith ◽  
E. Karreman ◽  
A. Kastelic
Keyword(s):  
Length Of Stay ◽  
Multiple Regression ◽  
Significant Relationship ◽  
Demographic Data ◽  
Healthcare Access ◽  
Tertiary Care ◽  
Outcome Variable ◽  
Prolonged Length ◽  
Patient Demographic Data ◽  
Major Predictor

Introduction: Extended length of stay (LOS) in emergency departments (EDs) and overcrowding are a problems for the Canadian healthcare system, which can lead to the creation of a healthcare access block, a reduced health outcome for acute care patients, and decreased satisfaction with the health care system. The goal of this study is to identify and assess specific factors that predict length of stay in EDs for those patients who fall in the highest LOS category. Methods: A total of 130 patient charts from EDs in Regina were reviewed. Charts included in this study were from the 90th-100th percentile of time-users, who were registered during February 2016, and were admitted to hospital from the ED. Patient demographic data and ED visit data were collected. T-tests and multiple regression analyses were conducted to identify any significant predictors of our outcome variable, LOS. Results: None of the demographic variables showed a significant relationship with LOS (age: p=.36; sex: p=.92, CTAS: p=.48), nor did most of the included ED visit data such as door to doctor time (p=.34) and time for imaging studies (X-ray: p=.56; ultrasound: p=.50; CT p=.45). However, the time between the request for consult until the decision to admit did show a significant relationship with LOS (p&lt;.01).Potential confounding variables analyzed were social work consult requests (p=.14), number of emergency visits on day of registration (p=.62), and hour of registration (00-12 or 12-24-p&lt;.01). After adjustment for time of registration, using hierarchical multiple regression, time from consult request to admit decision maintained a significant predictor (p&lt;.01) of LOS. Conclusion: After adjusting for the influence of confounding factors, “consult request to admit decision” was by far the strongest predictor of LOS of all included variables in our study. The results of this study were limited to some extent by inconsistencies in the documentation of some of the analyzed metrics. Establishing standardized documentation could reduce this issue in future studies of this nature. Future areas of interest include establishing a standard reference for our variables, a further analysis into why consult requests are a major predictor, and how to alleviate this in the future.

In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample

2020 ◽  
pp. jim-2020-001501
Author(s):  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Michael Albosta ◽  
Beth Bailey ◽  
Jagmeet Singh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

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