Abstract 3524: Implementation of the American Heart Association Get With the Guidelines Heart Failure Program (GWTG-HF) Reduces Length of Stay and Decreases Cost for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert T Faillace ◽  
Richard B Siegrist ◽  
Steven Duchensky ◽  
Lorraine Marut ◽  
Ilene Matza ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Direct Cost ◽  
Average Length ◽  
Standards Of Care ◽  
Contribution Margin ◽  
Heart Failure Patients ◽  
Average Length Of Stay ◽  
Hospital Days ◽  
Multi Disciplinary Team

Hospitalized heart failure patients (HF) may not consistently receive standards of care and hospitals frequently realize a financial loss in the care of HF patients. GWTG-HF makes it more likely to ensure optimal care, decrease direct cost and increase hospital profit in the management of HF patients. HYPOTHESIS: Utilization of GWTG-HF with a multi-disciplinary team would be associated with a consistent application of standards of care, shorter duration of hospitalization and less direct cost for hospitalized HF patients. METHODS: GWTG-HF was fully operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. APNs utilized GWTG-HF at the point of service and worked collaboratively with attending physicians. We compared the average length of stay, total number of hospitalized days, patient revenue, total direct cost, contribution margin, and the profit/loss for hospitalized HF patients in 2005 to those in 2006. RESULTS: There were 773 cases of HF admissions in 2005 as compared to 781 in 2006. Overall compliance with GWTG-HF Core Measures in 2006 was 98% (HF-1 D/C Instructions 99%; HF-2 Left ventricular systolic (LVS) function evaluation 96%; HF-3 ACEI/ARB for LVS dysfunction 98%; HF-4 Smoking cessation advice 100%; Beta Blocker Use 95%). The average length of stay (LOS) in 2005 was 6.7 days as compared to 6.3 days in 2006 (p <0.02). The total number of hospital days in 2005 was 5,145 as compared to 4,880 in 2006 (p<0.02). Between 2005 and 2006 patient revenue increased by $279,847 (p<0.01), direct cost decreased by $348,014 (p<0.05), contribution margin increased by $627,861 (p=0.06) and the full cost profit margin increased by $309,460 (NS). CONCLUSION: Utilization of GWTG-HF at SJRMC is associated with a high compliance with standards of hospitalized HF care, decrease in average LOS, decrease in total number of hospital days and decrease in direct cost. Although not statistically significant, hospital contribution margin and profit increased for acutely decompensated HF patients.

scholarly journals Factors that influence the length of hospitalization for acute heart failure patients in RSUP Dr. M Djamil

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
M. Syaoqi ◽  
Andri Andri ◽  
Citra Kiki Krevani ◽  
Muhammad Syukri
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Medical Records ◽  
Average Length ◽  
Descriptive Analysis ◽  
Heart Failure Patients ◽  
Average Length Of Stay ◽  
Baseline Characteristics ◽  
Length Of Hospitalization

More than 500,000 new patients were diagnosed with heart failure each year in all developing countries. Previous studies had shown that longer hospitalizations for patients with acute heart failure are associated with worse outcome. We analyzed factors that influence length of stay in our centre. We used a retrospective and descriptive analysis of acute heart failure patients at RSUP DR. M. Djamil from January to March 2018. We collected patient data from medical records including baseline characteristics, laboratory and echocardiographic results. We used statistical analysis to find the average length of stay (LOS) and possible causes of longer hospitalization. Among 30 patients had been collected, mean LOS was 6.23 days. Mean for age, BMI, and LVEF were 59.87 years, 23.55 kg/m2, and 36.93%, respectively. Patients those had LOS > 6 days may had relationship with initial degree edema pretibial (p=0.025) and systolic BP below 120 mmHg (p=0.018), but no significant with rales (p=0.543) and pulmonary infection (p=0.709). Length of stay associated with the degree of pretibial pitting edema and systolic blood pressure at admission.

Total Population Estimate of Newborn Special-Care Bed Needs

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 993-996
Author(s):  
August L. Jung ◽  
Nan Sherman Streeter
Keyword(s):  
Length Of Stay ◽  
Total Population ◽  
Average Length ◽  
Special Care ◽  
Care Hospital ◽  
Total Hospital ◽  
Live Births ◽  
Average Length Of Stay ◽  
Study Results ◽  
Hospital Days

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: (1) convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; (2) compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; (3) census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and (4) the low birth rate of a population is intimately related to the bed needs.

Abstract 2710: Emergency Room Utilization of Continuous Intravenous Furosemide Together With the American Heart Association Get With the Guideline Heart Failure Care (GWTG-HF) Decreases Length of Stay for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert T Faillace ◽  
James Pruden ◽  
David Adinaro ◽  
Lorraine Marut ◽  
Ilene Matza ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Emergency Room ◽  
Usual Care ◽  
Standards Of Care ◽  
Team Approach ◽  
Group I ◽  
Group Ii ◽  
Multi Disciplinary Team ◽  
Order Set

The main goals of therapy for hospitalized congestive heart failure (CHF) patients are to achieve euvolemia and to administer optimal standards of care. No study to date has examined ways to implement use of continuous intravenous furosemide (IVF) in the Emergency Room (ER) and ensure that each CHF patient consistently receives optimal standards of care throughout their hospitalization. Therefore, we hypothesized that a multi-disciplinary team approach with coordination of care from ER arrival to discharge (DC) with use of the AHA GWTG-HF Program will decrease length of stay (LOS) and provide optimal care for CHF patients as compared to usual care. METHODS: GWTG-HF was operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. In June of 2006 the IVF program was implemented in coordination with the ER, Cardiology and Medicine Departments. ER physicians were prompted by an electronic medical record provider order entry (EMR-POE) CHF order set. GWTG-HF APNs followed these patients throughout their hospitalization. We compared the average LOS of CHF patients who received usual care in 2005 (Group I) to CHF patients who received IVF and GWTG-HF care from 6/06 to 4/07 (Group II). RESULTS: CHF cases in Group I equaled 773 as compared to 212 cases in Group II. Average LOS in I was 6.7 days as compared to 5.5 days in II (p = 0.001). Overall compliance with GWTG-HF Core Measures in 2006 was 98%. CONCLUSIONS: 1. Implementation of IVF in the ER with an EMR-POE order set helps ensure utilization of IVF in the ER at time of admission for CHF patients; 2. A multi-disciplinary team approach with use of IVF along with GWTG-HF is associated with a significant decrease in the LOS as compared to usual care; 3. A multi-disciplinary team approach to care for the CHF patient is superior to usual care with regards to LOS; and 4. GWTG-HF is associated with a high compliance with standards of hospitalized CHF care.

scholarly journals Synchronous primary lung and breast carcinoma removed via a single incision

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Saifullah Mohamed ◽  
Faisal Jawad ◽  
Adnan Darr ◽  
Thomas Decker Christensen ◽  
Richard Steyn
Keyword(s):  
Length Of Stay ◽  
Multidisciplinary Approach ◽  
Average Length ◽  
Axillary Node ◽  
General Anaesthetic ◽  
Average Length Of Stay ◽  
Axillary Node Clearance ◽  
Complex Procedure ◽  
Improve Patient ◽  
Multi Disciplinary Team

Abstract We describe a case of a middle-aged female who was diagnosed with synchronous primary lung and breast cancer following a bout of recurrent chest infections. Subsequent Multi Disciplinary Team (MDT) discussion proposed that in light of the patients’ multiple comorbidities, both lesions should be resected simultaneously under one general anaesthetic. The patient underwent an initial left mastectomy and axillary node clearance. Through the same incision, a left anterolateral thoracotomy was created to complete a left lower lobectomy. Post-operatively she made an uncomplicated recovery and was discharged 7 days after the procedure. Despite undergoing a longer and more complex procedure, her length of stay was in keeping with the average length of stay for a patient undergoing a thoracotomy and lobectomy [1]. This case highlights the importance of a pre-planned multidisciplinary approach to deal with synchronous pathology in an efficiently synchronous manner to improve patient outcomes.

Longer-than-average length of stay in acute heart failure

Herz ◽  
2017 ◽  
Vol 43 (2) ◽  
pp. 131-139 ◽  
Author(s):  
H. R. Omar ◽  
M. Guglin
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Average Length ◽  
Average Length Of Stay

Impact of patient-centred home telehealth programme on outcomes in heart failure

2018 ◽  
Vol 25 (7) ◽  
pp. 425-430 ◽  
Author(s):  
Anshul Srivastava ◽  
Jacquelyn-My Do ◽  
Virna L Sales ◽  
Samantha Ly ◽  
Jacob Joseph
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Urgent Care ◽  
Control Group ◽  
Emergency Room Visits ◽  
Total Hospital ◽  
Heart Failure Patients ◽  
Home Telehealth ◽  
One Year ◽  
Hospital Days

Background Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure. Methods We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits. Results Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, p < 0.0001) and to the control group (3.8 ± 5.3, p < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, p < 0.05 and 9.5 ± 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year. Conclusions Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.

P2593Evaluation of an ambulatory heart failure service - a 2 years' experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Doleman ◽  
M Santon ◽  
J Clewes ◽  
C Laithwaite ◽  
R McIntosh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Hospital Admissions ◽  
Average Length ◽  
Health Care Expenditure ◽  
Inpatient Setting ◽  
Hospital Data ◽  
Heart Failure Patients ◽  
Heart Failure Unit

Abstract Background Heart failure accounts for 1–2% of health care expenditure in the National Health Service in the United Kingdom. Approximately 60–70% of that cost is in hospitalization for treatment. Various methods have been employed to reduce hospitalization in chronic heart failure; however effectiveness and safety of these methods have yet to be evaluated. Our ambulatory heart failure unit, run by specialist heart failure nurses, seeks to reduce admissions to hospital for heart failure by administering intravenous (I.V) diuretics in a day unit setting for ambulatory patients. Purpose We have reviewed data from December 2016 to December 2018 of patients using the ambulatory heart failure services in our hospital and evaluated its safety and effectiveness. Methods Retrospective evaluation of data collected from the ambulatory heart failure unit over a 24-month period as well as hospital data on admissions and length of stay of heart failure patients. Qualitative data was also collected from patients using the ambulatory heart failure unit. Results Since the opening of the ambulatory heart failure unit in December 2016, we have had 393 patient episodes. Referrals were largely from the community (265, 67%) however 128 (33%) patients were referred from an inpatient setting. Patients were treated for a mean of 12 days with intravenous furosemide infusion. The minimum dose of furosemide used was 120mg over 1 hour whereas maximum dose was 360mg over 2 hours. This translated into 4351 hospital bed days saved in a 24-month period. 144 (37%) of patients had heart failure with preserved ejection fraction (EF >40%), and 239 (61%) had heart failure with reduced ejection fraction (EF <40%). 28 patients (7%) referred to the unit were deemed inappropriate for unit and required admission. A further 35 patients (9%) were admitted to hospital for other illnesses whilst being treated on the unit due to various reasons. 3 patients (0.8%) died in the community during the period they were receiving care on the unit. Of the 63 patients (16%) admitted to hospital 23 (6%) died during that hospital admission. The number of all cause mortality of our patients was 26 (7%) during the time they were treated on the unit. Whilst the number of heart failure hospital admissions remained similar, the average length of stay in hospital for heart failure dropped by 0.99 days. Patient feedback on the unit was excellent, with patients feeling more independent and in control of their health. Conclusions The ambulatory heart failure unit reduces the burden on the hospital by reducing the length of stay of heart failure patients and may be preferred by patients. Intravenous diuretics on a day case basis are safe, as evident by unchanged overall mortality of heart failure patients.

scholarly journals Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment

2021 ◽  
Vol 10 (5) ◽  
pp. 969
Author(s):  
Javier Marco-Martínez ◽  
José Luis Bernal-Sobrino ◽  
Cristina Fernández-Pérez ◽  
Francisco Javier Elola-Somoza ◽  
Javier Azaña-Gómez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Average Length ◽  
Fracture Treatment ◽  
Hospital Outcomes ◽  
Average Length Of Stay ◽  
Neck Fracture

Background: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007–2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient’s diseases and procedures performed during the episode were evaluated. Results: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). Conclusions: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged.

scholarly journals Factors Affecting the Length of Stay in the Intensive Care Unit: Our Clinical Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Mehmet Toptas ◽  
Nilay Sengul Samanci ◽  
İbrahim Akkoc ◽  
Esma Yucetas ◽  
Egemen Cebeci ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Cerebrovascular Diseases ◽  
Factors Affecting ◽  
Average Length Of Stay ◽  
Lengths Of Stay ◽  
Life Threatening ◽  
Hospital Days

Background and Aim. Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU.Materials and Method. We retrospectively analyzed 3925 patients. We obtained the patients’ demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records.Results. The mean age of the study was 61.6 ± 18.9 years. The average length of stay in intensive care unit was 10.2 ± 25.2 days. The most common cause of hospitalization was because of multiple diseases (19.5%). The length of stay was positively correlated with urea, creatinine, and sodium. It was negatively correlated with uric acid and hematocrit levels. Length of stay was significantly higher in patients not operated on than in patients operated on (p<0.001).Conclusion. Our study showed a significantly increased length of stay in patients with cardiovascular system diseases, multiple diseases, nervous system diseases, and cerebrovascular diseases. Moreover we showed that when urea, creatinine, and sodium values increase, in parallel the length of stay increases.

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