scholarly journals Inpatient Hospitalizations during the First Wave of COVID-19 in Portugal

2021 ◽  
pp. 1-7
Author(s):  
João Rocha ◽  
Patrícia Soares ◽  
Catarina Filipe ◽  
Sílvia Lopes ◽  
Mário Teixeira ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Health Needs ◽  
Inpatient Hospital ◽  
Mainland Portugal ◽  
Inpatient Hospitalizations ◽  
The Impact ◽  
Occupation Rate ◽  
Hospital Characteristics

The objective of this study was to analyze the impact of the pandemic on inpatient hospital admissions during the first wave in Portugal. Data from hospital admissions in mainland Portugal from 2008 to 2017 were used to forecast inpatient hospital admissions for March to May 2020. The observed number of hospitalizations and their characteristics were compared to forecasted values. Variations were compared by hospital and region. Statistical analysis was used to investigate whether patterns of variations existed according to hospital characteristics. There were 119,315 fewer hospitalizations than expected during March to May 2020 in Portugal, which represented a 57% reduction. Non-COVID-19 hospitalizations had a higher mean length of stay and proportion of inpatient deaths than forecasted values. Differences between observed and forecasted values varied greatly among regions and hospitals. These variations were not associated with COVID-19 hospital admissions, region, forecasted number of hospitalizations, type of hospital, or occupation rate. The impact on inpatient hospital admissions for each hospital was not consistent or proportional to the expected use across Portugal, as indicated by variations between forecasted and observed values. The appropriate planning of future responses may contribute to improving the necessary balance between the level of hospital admissions for usual health needs of the population and the response to COVID-19 patients.

scholarly journals Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial (Preprint)

2017 ◽  
Author(s):  
Ahmadreza Argha ◽  
Andrey Savkin ◽  
Siaw-Teng Liaw ◽  
Branko George Celler
Keyword(s):  
Seasonal Variation ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Seasonal Variations ◽  
Chronic Conditions ◽  
Hospital Admissions ◽  
Australian Capital Territory ◽  
Home Telemonitoring ◽  
The Impact ◽  
At Home

BACKGROUND Seasonal variation has an impact on the hospitalization rate of patients with a range of cardiovascular diseases, including myocardial infarction and angina. This paper presents findings on the influence of seasonal variation on the results of a recently completed national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. OBJECTIVE The aim is to evaluate the effect of the seasonal timing of hospital admission and length of stay on clinical outcome of a home telemonitoring trial involving patients (age: mean 72.2, SD 9.4 years) with chronic conditions (chronic obstructive pulmonary disease coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) and to explore methods of minimizing the influence of seasonal variations in the analysis of the effect of at-home telemonitoring on the number of hospital admissions and length of stay (LOS). METHODS Patients were selected from a hospital list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. A total of 114 test patients and 173 control patients were available in this trial. However, of the 287 patients, we only considered patients who had one or more admissions in the years from 2010 to 2012. Three different groups were analyzed separately because of substantially different climates: (1) Queensland, (2) Australian Capital Territory and Victoria, and (3) Tasmania. Time series data were analyzed using linear regression for a period of 3 years before the intervention to obtain an average seasonal variation pattern. A novel method that can reduce the impact of seasonal variation on the rate of hospitalization and LOS was used in the analysis of the outcome variables of the at-home telemonitoring trial. RESULTS Test patients were monitored for a mean 481 (SD 77) days with 87% (53/61) of patients monitored for more than 12 months. Trends in seasonal variations were obtained from 3 years’ of hospitalization data before intervention for the Queensland, Tasmania, and Australian Capital Territory and Victoria subgroups, respectively. The maximum deviation from baseline trends for LOS was 101.7% (SD 42.2%), 60.6% (SD 36.4%), and 158.3% (SD 68.1%). However, by synchronizing outcomes to the start date of intervention, the impact of seasonal variations was minimized to a maximum of 9.5% (SD 7.7%), thus improving the accuracy of the clinical outcomes reported. CONCLUSIONS Seasonal variations have a significant effect on the rate of hospital admission and LOS in patients with chronic conditions. However, the impact of seasonal variation on clinical outcomes (rate of admissions, number of hospital admissions, and LOS) of at-home telemonitoring can be attenuated by synchronizing the analysis of outcomes to the commencement dates for the telemonitoring of vital signs. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6xLPv9QDb)

scholarly journals Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program

2018 ◽  
Vol 42 (5) ◽  
pp. 542 ◽  
Author(s):  
Sharon Lawn ◽  
Sara Zabeen ◽  
David Smith ◽  
Ellen Wilson ◽  
Cathie Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
Length Of Stay ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Hospital Admissions ◽  
Self Management ◽  
Psychosocial Needs ◽  
Post Discharge ◽  
The Impact

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

What impact do specialist and advanced-level nurses have on people living with heart failure compared to physician-led care? A literature review

2020 ◽  
pp. 174498712094679
Author(s):  
Dean A Anderson ◽  
Victoria Clemett
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Length Of Stay ◽  
Literature Review ◽  
Hospital Admissions ◽  
Self Care ◽  
Self Assessment ◽  
Advanced Level ◽  
The Impact

Background The inclusion of specialist nurses in multi-disciplinary teams is the current gold standard for care of people with heart failure (HF) in the UK; however, they remain underutilised in practice. Though existing systematic reviews favourably compare advanced nursing roles to physician-led care, none has focused solely on HF. Aim To investigate the impact of specialist and advanced nurse-led care on the clinical outcomes, quality of life and satisfaction of people with HF compared to physician-led care. Methods Literature review and narrative synthesis. Results This review included 12 studies and categorised their measured outcomes into five domains: mortality; hospital admissions and length of stay; HF diagnosis and management; quality of life and patient satisfaction; and finally, self-assessment and self-care. Five studies appraised as medium or low risk of bias suggest the impact of specialist and advanced-level nurses on people with HF to be broadly equivalent to physicians regarding mortality, hospital admissions and length of stay, while superior in terms of self-assessment and self-care behaviours. Conclusions There were too few studies of sufficient methodological quality to draw definitive conclusions. However, no evidence was found to suggest that nurse-led services are any less effective or safe than physician-led services.

scholarly journals Comparative Statistical Analysis of Inpatients with Diabetic Myocardial Infarction: Patient Length of Stay

2012 ◽  
Author(s):  
Priscilla Okunji ◽  
Afrooz Afghani ◽  
Angela Hegamin ◽  
Frank Gomez
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Data Analysis ◽  
Statistical Analysis ◽  
Linear Regression ◽  
Length Of Stay ◽  
Quality Of Healthcare ◽  
Bivariate Analysis ◽  
Hospital Characteristics

Purpose: The purpose of this study was to assess whether certain patient and hospital characteristics would have significant effects on the length of stay for patients admitted to non-federal hospitals with Type 2 Diabetes (T2D) and Myocardial Infarction (MI) using a comparative data analysis. Methods: This was a retrospective data analysis of inpatient Diabetes and Myocardial Infarction discharges (ages 20-84 years old) from the 2006 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Descriptive, bivariate, and dummy coded linear regression analyses were used to identify the association of patient and hospital characteristics with the inpatient T2D and MI length of stay. Data analysis and management were performed using SPSS version 17.0. Sample selection was based on the International Classification of Diseases, Ninth Revision (ICD-9) codes. Inclusions were inpatients diagnosed with both T2D and MI, admitted in non-federal hospitals, and age 20 years to 84 years old. Results: The descriptive results showed that males (1,862 or 67%) were admitted more than females (912 or 33%). The bivariate analysis showed a significant result between gender and patient insurance, X2 (1, N = 1480) = 1.598, p < .001. The adjusted dummy coded linear regression with MI severity and patient comorbidities on length of stay was significant for Gender (B = .931, p < .000), Age (B = .039, p < .000), and Hispanics (B = .832, p < .017) when compared to Whites. Another significant predictor of patient length of stay was Medicaid (B = 2.266, p < .000). Adjusted statistical analysis with only MI severity was significant for atrial fibrillation (B = 1.740, p < .003) and cardiogenic shock (B = 2.482, p < .000) when compared to cardiac arrest.Conclusions and Recommendations: There were inequalities seen in this study related to age, gender, ethnicity, and insurance possession of diabetic myocardial infarction inpatients. Most importantly is that as patient advocates, healthcare professionals need to screen their patients for complications of heart disease when they present with diabetes on admission. More data driven results are needed to evaluate the inequality that exists in hospitalized patients with both type 2 diabetes and myocardial infarction to improve the quality of healthcare.

Impact of admission month and hospital teaching status on outcomes in subarachnoid hemorrhage: evidence against the July effect

2012 ◽  
Vol 116 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Robert J. McDonald ◽  
Harry J. Cloft ◽  
David F. Kallmes
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Discharge Disposition ◽  
July Effect ◽  
Teaching Status ◽  
Discharge Status ◽  
The Impact ◽  
Hospital Characteristics

Object The authors sought to identify the presence of a “July effect,” a transient increase in adverse outcomes during July, among a cohort of spontaneous subarachnoid hemorrhage (SAH) admissions recorded in the National Inpatient Sample (NIS). Methods The discharge status, admission month, patient demographics, treatment parameters, and hospital characteristics among spontaneous SAH admissions were extracted from the 2001–2008 NIS. Multivariate regression was used to determine whether an unfavorable discharge status and/or in-hospital mortality significantly increased in summer months in a pattern suggestive of a July effect. Additional models were generated to assess the impact of hospital teaching status on these outcomes. Results Among 57,663,486 hospital admissions from the 2001–2008 NIS, 52,879 cases of spontaneous SAH (ICD-9-CM 430) were treated at teaching (36,914 cases [70%]) and nonteaching (15,965 cases [30%]) facilities. Regression models failed to reveal a July effect for in-hospital mortality (χ2 = 0.75, p = 1.000) or unfavorable discharges (χ2 = 1.69, p = 0.999) among monthly SAH admissions, although they did suggest a significant reduction in these outcomes (in-hospital mortality, OR = 0.89, p < 0.001; unfavorable discharges, OR = 0.88, p < 0.001) among teaching hospitals as compared with nonteaching hospitals after adjustment for disparities in demographic, treatment, and hospital characteristics. Conclusions The discharge disposition among SAH admissions within the NIS was not suggestive of a July effect but did reveal that teaching institutions have significantly lower rates of adverse outcomes when compared with nonteaching hospitals. Note, however, that the origins of this difference related to teaching status remain unclear.

scholarly journals Attributable Length of Stay, Mortality Risk, and Costs of Bacterial Health Care–Associated Infections in Australia: A Retrospective Case-cohort Study

2020 ◽  
Author(s):  
X J Lee ◽  
A J Stewardson ◽  
L J Worth ◽  
N Graves ◽  
T M Wozniak
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Hospital Admissions ◽  
Care Hospital ◽  
Retrospective Case ◽  
Health Care Associated Infections ◽  
Tract Infections ◽  
The Impact

Abstract Background Unbiased estimates of the health and economic impacts of health care–associated infections (HAIs) are scarce and focus largely on patients with bloodstream infections (BSIs). We sought to estimate the hospital length of stay (LOS), mortality rate, and costs of HAIs and the differential effects on patients with an antimicrobial-resistant infection. Methods We conducted a multisite, retrospective case-cohort of all acute-care hospital admissions with a positive culture of 1 of the 5 organisms of interest (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, or Enterococcus faecium) from 1 January 2012 through 30 December 2016. Data linkage was used to generate a data set of statewide hospital admissions and pathology data. Patients with bloodstream, urinary, or respiratory tract infections were included in the analysis and matched to a sample of uninfected patients. We used multistate survival models to generate LOS, and logistic regression to derive mortality estimates. Results We matched 20 390 cases to 75 635 uninfected control patients. The overall incidence of infections due to the 5 studied organisms was 116.9 cases per 100 000 patient days, with E. coli urinary tract infections (UTIs) contributing the largest proportion (51 cases per 100 000 patient days). The impact of a UTI on LOS was moderate across the 5 studied pathogens. Resistance significantly increased LOS for patients with third-generation cephalosporin-resistant K. pneumoniae BSIs (extra 4.6 days) and methicillin-resistant S. aureus BSIs (extra 2.9 days). Consequently, the health-care costs of these infections were higher, compared to corresponding drug-sensitive strains. Conclusions The health burden remains highest for BSIs; however, UTIs and respiratory tract infections contributed most to the health-care system expenditure.

scholarly journals Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e026290 ◽  
Author(s):  
Joe Hollinghurst ◽  
Ashley Akbari ◽  
Richard Fry ◽  
Alan Watkins ◽  
Damon Berridge ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Linked Data ◽  
Social Care ◽  
Hospital Admissions ◽  
Care Home ◽  
Frailty Index ◽  
Healthy Ageing ◽  
National Database ◽  
Health And Social Care ◽  
The Impact

IntroductionThis study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and fall prevention.Methods and analysisAll individuals living in Wales, UK, aged 60 years and over, will be included in the study using anonymised linked data from the Secure Anonymised Information Linkage Databank. We will use a national database of home modifications implemented by the charity organisation Care & Repair Cymru (C&R) from 2009 to 2017 to define an intervention cohort. We will use the electronic Frailty Index to assign individual levels of frailty (fit, mild, moderate or severe) and use these to create a comparator group (non-C&R) of people who have not received a C&R intervention. Coprimary outcomes will be quarterly numbers of emergency hospital admissions attributed to falls at home, and the associated length of stay. Secondary outcomes include the time in moving to a care home following a fall, and the indicative financial costs of care for individuals who had a fall. We will use appropriate multilevel generalised linear models to analyse the number of hospital admissions related to falls. We will use Cox proportional hazard models to compare the length of stay for fall-related hospital admissions and the time in moving to a care home between the C&R and non-C&R cohorts. We will assess the impact per frailty group, correct for population migration and adjust for confounding variables. Indicative costs will be calculated using financial codes for individual-level hospital stays. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and prevention.Ethics and disseminationInformation governance requirements for the use of record-linked data have been approved and only anonymised data will be used in our analysis. Our results will be submitted for publication in peer-reviewed journals. We will also work with lay members and the knowledge transfer team at Swansea University to create communication and dissemination materials on key findings.

Length of Stay in Pediatric Neurology Hospital Admissions

2021 ◽  
pp. 088307382110208
Author(s):  
Annie Roliz ◽  
Yash D. Shah ◽  
Sanjeev Kothare ◽  
Kanwaljit Singh ◽  
Sushil Talreja
Keyword(s):  
Length Of Stay ◽  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Neurologic Disorder ◽  
Prolonged Length ◽  
Inpatient Hospital ◽  
Icu Admission ◽  
Unplanned Admissions ◽  
Pediatric Icu

Objective: To describe inpatient length of stay patterns, identify key drivers related to prolonged length of stay, and evaluate the relationship between length of stay and readmission in pediatric neurology Methods: This was a retrospective review of patients <19 years old admitted with a principal neurologic diagnosis to our hospital between January 2017 and July 2019. Scheduled admissions and hospital admissions lasting >30 days were excluded from analysis. Length of stay was obtained in addition to demographic characteristics, principal discharge diagnosis, multispecialty care, use of multiple antiseizure medications, inpatient hospital costs (ie, claims paid), and pediatric intensive care unit (ICU) admission for unplanned admissions and 7- and 30-day readmissions. Results: There were a total of 1579 unplanned admissions. The most common reasons for admission were seizure (n = 942), headache (n = 161), other neurologic diagnosis (n = 121), and psychiatric disorders/functional neurologic disorder (n = 60). Children admitted to the hospital for a neurologic condition have an average length of stay of 2.8±5.0 days for unplanned admissions, 4.5±7.4 days for 7-day readmissions, and 5.2±7.5 days for 30-day readmissions. Average inpatient hospital costs were $44 075±56 976 for unplanned admissions, $60 361±71 427 for 7-day readmissions, and $55 434±56 442 for 30-day readmissions. Prolonged length of stay and increased hospital costs were associated with pediatric ICU admission, multispecialty care, 7- and 30-day readmission, multiple antiseizure medications, and psychiatric disorders / functional neurologic disorders. Conclusions: Pediatric ICU admission, multispecialty care, readmission, multiple antiseizure medications, and psychiatric disorder / functional neurologic disorder prolong length of stay and increase hospital costs.

scholarly journals 208 Assessment of The Impact Of COVID-19 On the Management of Patients with Neck of Femur Fractures in A Major Trauma Center In Wales

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Solari ◽  
Z Ansar
Keyword(s):  
Length Of Stay ◽  
Operative Treatment ◽  
Major Trauma ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Neck Of Femur ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
The Impact

Abstract Introduction Neck of femur (NOF) fractures form a significant proportion of trauma. Especially since they do not benefit from COVID-19 social isolation policies. Surgery and hospital admissions present risks to patients during the COVID-19 pandemic. Method Retrospective analysis of all NOF fractures from 24/3/20 to 26/6/20 in Morriston Hospital. Directly compared with 2019, allowing assessment of COVID-19’s impact. Results 179 NOF fractures were admitted, 158 had an operation. Increased from 127 patients in 2019. Average time to surgery increased from 39 to 67 hours. There were operation delays for 98 patients, and non-operative treatment increased from 2 to 21 patients. Prompt orthogeriatric reviews completed in 80.4% patients in 2020, up from 72.5%. Prompt physiotherapy review increased from 66.9% to 74.6%. Mortality remained similar at 8.6% (2019) and 8.5% (2020). Average length of stay reduced; 17.4 to 11 days in 2020. Conclusions 2020 saw increased waits for operations. There was reduction in length of stay and improved promptness of orthogeriatric and physiotherapy reviews. Increased non-operative treatment in 2020, reflecting decisions about risks and benefits of surgery in the pandemic. Mortality remained stable. This department improved some aspects of care, potentially due to pressures of COVID-19 heightening awareness of patient's needs.

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