Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

2017 ◽  
Vol 58 (5-6) ◽  
pp. 263-273 ◽  
Author(s):  
Marcos Pajarón-Guerrero ◽  
Manuel Francisco Fernández-Miera ◽  
Juan Carlos Dueñas-Puebla ◽  
Carmen Cagigas-Fernández ◽  
Iciar Allende-Mancisidor ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Hospital Discharge ◽  
Laparoscopic Colorectal Surgery ◽  
Early Discharge ◽  
Care Model ◽  
Early Hospital Discharge ◽  
Discharge Care ◽  
The Mean ◽  
Hospital At Home

Background: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. Methods: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. Results: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. Conclusions: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

#35: Safety of Early Hospital Discharge of Neutropenic Pediatric Oncology Patients After Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Asia Castro ◽  
Miguel Minero ◽  
Martha Avilés-Robles
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Hospital Discharge ◽  
Antibiotic Treatment ◽  
Pediatric Oncology ◽  
Early Discharge ◽  
Infectious Complications ◽  
Oncology Patients ◽  
Early Hospital Discharge ◽  
The Mean

Abstract Background Cancer is one of the leading causes of death in children in Mexico. Infections are the main cause of morbidity and mortality in these patients. Febrile neutropenia (FN) constitutes an infectious emergency and early aggressive antibiotic treatment is the standard of care. Recent guidelines suggest discontinuing empirical antibiotics in patients who have negative blood cultures at 48 hours, who have been afebrile for at least 24 hours, and who have evidence of marrow recovery. Nevertheless, recommendations about discontinuing antibiotics and discharging patients while they are still neutropenic are less clear. We aimed to evaluate the safety of early hospital discharge of FN patients who are still neutropenic. Methods Observational, case–control study nested in a prospective cohort of pediatric oncology patients with FN at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from May 2015 to September 2017. We defined early discharge as when a patient is discharged while neutropenic (ANC <500 cell/mm3) and has completed at least 7 days of antibiotics. Patients with FN who were discharged with neutropenia were defined as cases and patients with FN who were discharged after recovering from neutropenia were controls. To assess the safety of hospital early discharge, the following outcomes were analyzed until 7 days after discharge: new onset of fever, hospital readmission, need to restart antibiotic treatment, septic shock, and death. Descriptive statistics were performed with measures of central tendency. Variables of interest were compared with Pearson’s χ 2 or Student’s test. Results In total, 929 febrile neutropenia episodes were analyzed. The mean age was 7.5 years, 55.3% were female. Hematologic malignancies were the most frequent type of malignances in 50.8%. Acute lymphoblastic leukemia (ALL) was the underlying disease in 41%. Of the 929 FN episodes, 180 (19.3%) were discharged with neutropenia. Patients with ALL were the most frequent in 49.4%, followed by acute myeloid leukemia 18.8% and rhabdomyosarcoma 6.6%. Thirty-five percent were in maintenance therapy, 22% in remission induction therapy, and 9% in consolidation. 19.4% of discharged patients received granulocyte-colony stimulating factor. Ten patients (5.5%) were re-admitted during the 7 days following discharge. Six patients returned for chemotherapy administration and one was scheduled for liver biopsy. Three patients were re-admitted due to infectious complications (1.6%), none of them were under oral antibiotic treatment; two patients due to FN without microbiological isolation and one patient with septic shock due to multi-drug-resistant Pseudomonas aeruginosa. Older patients had a higher risk of readmission, with a mean age of 14.6 years (SD 4.6 years, 95% CI 7.7–21.6) (P = 0.01), compared with the mean of 7.7 years (SD 2.7 years, (95% CI 7.0, – 8.4) of patients who were not re-admitted. Conclusions In our population of pediatric patients with FN who were discharged before neutrophil recovery, readmission due to infectious complications was low (1.6%). Discharging patients with persistent neutropenia who are afebrile and had completed a course of antibiotics seems an acceptable practice with a low risk of readmission.

Follow-up of Newborns and Their Mothers After Early Hospital Discharge

1998 ◽  
Vol 25 (2) ◽  
pp. 471-481 ◽  
Author(s):  
Susan A. Egerter ◽  
Paula A. Braveman ◽  
Kristen S. Marchi
Keyword(s):  
Hospital Discharge ◽  
Early Hospital Discharge

Monitoring c-reactive protein after laparoscopic colorectal surgery excludes infectious complications and allows for safe and early discharge

2014 ◽  
Vol 28 (10) ◽  
pp. 2939-2948 ◽  
Author(s):  
Michel Adamina ◽  
Rene Warschkow ◽  
Franziska Näf ◽  
Bianka Hummel ◽  
Thomas Rduch ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Early Discharge ◽  
Infectious Complications ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals POS0268-HPR PATIENT-REPORTED ACTIVITY LIMITATIONS IN HIP AND KNEE OSTEOARTHRITIS IN PRIMARY CARE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 357-358
Author(s):  
T. Moseng ◽  
H. Solveig Dagfinrud ◽  
B. Natvig ◽  
N. Osteras
Keyword(s):  
Primary Care ◽  
Patient Education ◽  
Patient Specific ◽  
Activity Limitations ◽  
Model Of Care ◽  
Care Model ◽  
New Model ◽  
Knee Oa ◽  
The Mean

Background:To ensure delivery of high-quality osteoarthritis (OA) care, structured care models incorporating patient education and exercise are increasingly implemented in primary care 1. A goal is to improve patients’ physical function and coping with daily life demands and activities. Yet, there is limited knowledge regarding the type and severity of activity limitations experienced by people with hip and knee OA.Objectives:1) To map activity limitations reported by patients with hip and knee OA participating in a research study implementing an OA care model in primary care. 2) To investigate potential changes in self-reported difficulty performing these activities from baseline to 12-weeks follow-up.Methods:A structured OA care model was implemented in six Norwegian municipalities between January 2015 and October 2017, using a stepped-wedge cluster-randomized controlled design. Implementation was facilitated by interactive workshops for general practitioners and physiotherapists (PTs). The PTs provided a 3-hour, group-based patient education program followed by individually tailored 8-12 weeks exercise with twice weekly 1-hour supervised group sessions. Patients with clinically or radiologically verified symptomatic hip or knee OA ≥45 years were eligible. Patients who received the new model of care completed the Patient-Specific Functional Scale (PSFS) at baseline by identifying between one and three “important activities that you are unable to do or are having difficulty with because of your hip or knee OA”. The patients rated their performance of the reported activities on an 11-point numeric rating scale (NRS) ranging from 0 (unable to perform activity) to 10 (perform activity with no problems). After 12 weeks the patients re-rated their previously identified activities. The reported activities were linked to the International Classification of Functioning, Disability and Health (ICF) at Chapter and Domain (second and third) level. Absolute change in scores from baseline to follow-up was calculated as the mean score of the reported activities. Change from baseline to follow-up was investigated using paired samples t-test. P-value was set to <0.05. Clinically important change was regarded 2 points on the 0-10 scale.Results:A total of 284 patients received the new model of care. The mean age was 63 (SD 10) years, and 211 (74%) were female. The main affected OA joint was the knee for 174 (61%), the hip for 100 (35%) and other joints (e.g. hand) for 9 (3%). The PSFS was completed by 152 (53%) patients, of which 13 reported one, 42 reported two and 97 reported three activities. A total of 382 activities were linked with ICF. Of these, 362 (95%) were linked to the Activities and Participation chapter (D). On second-level, 318 (83%) activities were linked to the Mobility domain (D4). On the third-level, the majority of activities were linked to the domains Changing body positions (d410) (26%), Walking (d450) (23%) and Moving around (d455) (25%). The patients reported significantly less difficulty performing their self-reported activities at 12 week follow-up (4.1 (SD 1.7) versus 6.3 (SD 1.8), mean change 2.1 (95% CI 1.8, 2.5), p<0.001).Conclusion:The majority of activity limitations reported by patients receiving a structured OA care model in primary care were within the ICF Mobility domain. The most common third-level ICF domains were Changing body positions, Walking and Moving around. After participating in OA patient education and structured 8-12 weeks of exercise, the patients reported a statistically significant and clinically important improvement in the difficulty of performing their individual activities.References:[1]Allen KD, Choong PF, Davis AM, et al. Osteoarthritis: Models for appropriate care across the disease continuum. Best practice & research. Clinical rheumatology. 2016;30(3):503-535.Disclosure of Interests:None declared

scholarly journals From Small Acorns – Developing a Laparoscopic Colorectal Surgical Service

2008 ◽  
Vol 90 (7) ◽  
pp. 606-611 ◽  
Author(s):  
JK Smith ◽  
AG Acheson ◽  
JAD Simpson ◽  
J Stewart ◽  
IJ Beckingham ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Resection Margin ◽  
Laparoscopic Colorectal Surgery ◽  
Morbidity Rate ◽  
Lymph Node Retrieval ◽  
Clear Resection Margin ◽  
The Mean ◽  
Randomised Controlled

INTRODUCTION Randomised controlled trials have shown that laparoscopic colorectal surgery is equal in terms of safety to open surgery. Benefits have been seen for length of stay, blood loss, immune suppression and analgesia requirements. The aim of this study was to assess the safety and feasibility of introducing laparoscopic colorectal surgery to our unit. PATIENTS AND METHODS Prospectively collected cases of all patients undergoing laparoscopic colorectal surgery between July 2003 and July 2007 were reviewed. RESULTS A total of 143 patients (75 males and 68 females) with amean age of 65.8 years (range, 21–95 years) underwent surgery. Laparoscopic resection for colorectal malignancy was performed in 93 patients (65%). The conversion rate for all cases was 14.7%. Mean operative time was 203 min (range, 100–400 min), with amean blood loss of 180 ml. The mean number of lymph nodes in malignant cases was 13.8 with clear resection margin in all but one case. The mean postoperative stay was 5.6 days (median, 4 days; range, 2–35 days). UKCCR standard for lymph node retrieval was achieved in 62.6% of cases. There were four postoperative deaths. The overall 30-day morbidity rate was 21.7%. The service is consultant-led with 9.8% of cases performed by senior trainees and 37% of procedures performed by two consultants. CONCLUSIONS Laparoscopic colorectal surgery is technically feasible and safe in our hands. Although operative time is longer, this is counterbalanced by shorter hospital stay. The results from this series support the findings of others and continuing development of this service.

scholarly journals Early Hospital Discharge and Early Puerperal Complications

2020 ◽  
Vol 35 (4) ◽  
pp. 294-303
Author(s):  
Zahia Saad Elghazal ◽  
Fatma Abdullah Emtawel ◽  
Ekram Ben Sauod
Keyword(s):  
Urinary Tract ◽  
Prenatal Care ◽  
Hospital Stay ◽  
Hospital Discharge ◽  
Early Discharge ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
Tract Infections ◽  
Late Group

 The study aimed to evaluate the association between the time of postpartum discharge and symptoms indicative of complications during the first postpartum week. The cross-sectional study included 753 women with vaginal delivery at Al-Jamhorya teaching public hospital without complications were interviewed before the hospital discharge and seven days after. The time of postpartum discharge was classified as early (≤24hours) or late (>24hours). A total of 753 mothers were enrolled in the study. The majority (94.3%) of the mothers stayed in the hospital ≤24hours, 4.1% >24hours, and 1.6 % were discharged against medical advice. The mean duration of hospital stay was 12.1±6.1 hours, with a minimum hospital stay of 2 hours and a maximum stay of 46 hours. The prenatal care was satisfactory in 91.2%. Prenatal care was satisfactory in 91% of early discharge mothers and 93.5% in the late group. This slight difference was not statistically significant. After delivery, 8.4% had urinary tract infections. Urinary tract infection after delivery occurred in 8.2% of mothers with early discharge and 12.9 % in mothers with late discharge. This difference was not statistically significant. Complications of episiotomy were recorded in 79.9% of mothers with early discharge and 61.3% in late discharge. This difference was statistically significant. The study’s conclusions indicated that late discharge mothers had received anesthesia and performed episiotomy more than early discharge mothers. Complications of episiotomy were recorded more in mothers with early discharge than in late discharged mothers. It is recommended that a randomized clinical trial is best to evaluate the association between the time of discharge postpartum and the presence of complications, also to attain safety and possible benefits of shorter hospital stay.   

A Randomized Clinical Trial of Early Hospital Discharge and Home Follow-up of Very-Low-Birth-Weight Infants

1986 ◽  
Vol 315 (15) ◽  
pp. 934-939 ◽  
Author(s):  
Dorothy Brooten ◽  
Savitri Kumar ◽  
Linda P. Brown ◽  
Priscilla Butts ◽  
Steven A. Finkler ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Randomized Clinical Trial ◽  
Hospital Discharge ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Early Hospital Discharge

scholarly journals Mobilization and early hospital discharge for patients with acute myocardial infarction: literature review

2008 ◽  
Vol 21 (2) ◽  
pp. 345-350 ◽  
Author(s):  
Juliana de Lima Lopes ◽  
Juliana Turca dos Santos ◽  
Sheila Cristina de Lima ◽  
Alba Lúcia Bottura Leite de Barros
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Literature Review ◽  
Hospital Discharge ◽  
Early Mobilization ◽  
Bed Rest ◽  
Early Discharge ◽  
Early Hospital Discharge ◽  
Resting Period

OBJECTIVE: This study was a literature review with the purpose of analyzing articles comparing early and late mobilization and those comparing early and late discharge for patients with acute myocardial infarction. METHODS: The literature review was performed using the Lilacs and Medline databases (1966-2007), and the length of the resting period, the hospitalization and possible complications were analyzed. RESULTS: We selected 18 articles; 11 of them compared early and late mobilization and 7 compared early and late discharge. The length of the resting period in the early mobilization group varied from 2 to 10 days and 5 to 28 days for the longest resting period. The early discharge group stayed in the hospital from 3 to 14 days and the late discharge group stayed in the hospital from 5 to 21 days. CONCLUSION: The studies show that there is no evidence of complications related to short periods of bed rest and hospitalization.

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