Abstract 17306: The Most Expensive Patients in the Hospital

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Karen E Joynt ◽  
Maggie Makar ◽  
Atul Gawande ◽  
David Cutler ◽  
Ziad Obermeyer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prolonged Mechanical Ventilation ◽  
Medicare Beneficiaries ◽  
Maximum Charge ◽  
Medicare Data ◽  
Clinical Innovation ◽  
Medicare Patients ◽  
The Mean ◽  
Poor Outcomes

Introduction: In the Medicare population, 1% of the patients is responsible for 15% of spending. There are two patterns typical of highest-cost patients: those who cycle in and out of the hospital with preventable conditions, and those who have a single catastrophic event. While a great deal of focus has been placed on the former, much less is known about the latter. We do know that a large proportion of these most-expensive patients receive prolonged mechanical ventilation (PMV). Methods/Results: We used national Medicare data to explore diagnoses, procedures, and costs associated with these most-expensive patients. There were 91,054 hospitalizations for Medicare patients with a DRG containing PMV in 2010. The majority of PMV patients were admitted emergently (71.9%); an additional 16.7% were admitted urgently. Elective admissions represented 9.5%, and trauma accounted for 1.8%. Median length of stay was 16 days, and the median stay in the intensive care unit was 11 days. Procedures were performed in the majority of these patients, and clinical outcomes were exceedingly poor (table). The financial costs associated with this group of patients were high. The average total hospitalization charge was $227,917; the maximum charge was over $9 million. The mean Medicare payment for PMV patients in 2010 was $61,995, with a maximum of $1.3 million. This was largely through the set DRG price (mean $59,491), though outlier payments (mean $5,957, maximum $1.2 million) and patient-paid coinsurance (mean $835, maximum $88,644) played a significant role as well. Conclusions: A small group of Medicare beneficiaries undergoing PMV have extremely high costs and poor outcomes. This shared clinical pathway suggests that there is room for improvement, both in terms of identifying these patients early during hospitalization to prevent progression to PMV, as well as in terms of clinical innovation to improve care within the intensive care unit for those who are already ventilated.

scholarly journals 1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S713-S713
Author(s):  
Carlo Fopiano Palacios ◽  
Eric Lemmon ◽  
James Campbell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Linear Regression ◽  
Length Of Stay ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
P Value ◽  
Fisher Exact Test ◽  
The Mean ◽  
Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

scholarly journals The use of score for neonatal acute physiology perinatal extention II (SNAPPE II) in predicting neonatal outcome in neonatal intensive care unit

2016 ◽  
Vol 45 (6) ◽  
pp. 241
Author(s):  
Mia R A ◽  
Risa Etika ◽  
Agus Harianto ◽  
Fatimah Indarso ◽  
Sylviati M Damanik
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Characteristic Curve ◽  
Newborn Care ◽  
Scoring Systems ◽  
Laboratory Observation ◽  
The Mean ◽  
Overall Mortality

Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

scholarly journals Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

2021 ◽  
Vol 9 ◽  
pp. 205031212110011
Author(s):  
Thabit Alotaibi ◽  
Abdulrhman Abuhaimed ◽  
Mohammed Alshahrani ◽  
Ahmed Albdelhady ◽  
Yousef Almubarak ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Acinetobacter Baumannii ◽  
Care Setting ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Published Data ◽  
Tertiary Teaching ◽  
The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Barry Burstein ◽  
Vidhu Anand ◽  
Bradley Ternus ◽  
Meir Tabi ◽  
Nandan S Anavekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Power Output ◽  
Critically Ill Patients ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Power ◽  
The Mean ◽  
Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

scholarly journals Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

2017 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
L.K. Rajbanshi ◽  
M. Dali ◽  
S.B. Karki ◽  
K. Khanal ◽  
B. Aryal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Ventilatory Support ◽  
Control Mode ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support ◽  
The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit in Saudi Arabia: A 30-Month Prospective Surveillance

2004 ◽  
Vol 25 (9) ◽  
pp. 753-758 ◽  
Author(s):  
Maha Almuneef ◽  
Ziad A. Memish ◽  
Hanan H. Balkhy ◽  
Hala Alalem ◽  
Abdulrahman Abutaleb
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Pediatric Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Prospective Surveillance ◽  
The Mean ◽  
Prior Antibiotic Therapy

AbstractObjective:To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients.Methods:This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions.Results:Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP.Conclusions:The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

scholarly journals Risk Factors for 28-Day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul

2021 ◽  
Author(s):  
Ahmet Tolga Erol ◽  
Sinan Aşar ◽  
Mehmet Süleyman Sabaz ◽  
Beyza Ören Bilgin ◽  
Zafer Çukurova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Query Language ◽  
Disease Risk ◽  
Tertiary Care ◽  
World Health ◽  
Laboratory Parameters ◽  
Risk Of Death ◽  
Hospitalization Period ◽  
The Mean

Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19. Methods: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusions: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

Abstract 339: Relationship Between Post-arrest Care Hemodynamics and Cerebral Oxygen Saturation in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Juan J Russo ◽  
Paul Boland ◽  
Simon Parlow ◽  
Jordan Bernick ◽  
Rebecca Mathew ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Oxygen Delivery ◽  
Cerebral Oxygen ◽  
Shockable Rhythm ◽  
The Mean ◽  
The Relationship ◽  
Capital Return

Introduction: Comatose survivors of OHCA develop a post cardiac arrest syndrome (PCAS) characterized by myocardial dysfunction and cerebrovascular dysregulation. Hemodynamic derangements related to PCAS can jeopardize cerebral oxygen delivery and therefore impair neurologic recovery. However, optimal hemodynamic targets to ensure adequate cerebral oxygen delivery following OHCA remain undefined. Accordingly, we examined the relationship between cardiac index (CI), mean arterial pressure (MAP), and regional cerebral oxygen saturation (rO 2 %) following OHCA. Methods: CAPITAL-RETURN was a prospective, single-center observational study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management after an initial shockable rhythm. Between August 2016 and December 2017, comatose survivors of OHCA underwent continuous, blinded, non-invasive monitoring of CI and rO 2 % using bioimpedance (Cheetah Medical, Portland, OR, USA) and near-infrared spectroscopy (Covidien, Boulder, CO, USA), respectively, for 96 hours after intensive care unit admission. In the present study, we examined the relationship between CI, MAP, and rO 2 % using multivariable linear regression. Results: In 56 patients in this analysis, the mean CI and MAP during the first 96 hours of intensive care unit admission were 3.2±0.5 L/min/m 2 and 76±6 mmHg, respectively (Figure). The mean rO 2 % was 63±9% and increased over time (+0.1% per hour; p<0.001). Higher CI was associated with improved rO 2 % (+3.2% per L/min/m2 increase in CI; p<0.0001). There was no association between MAP and rO 2 % (p=0.42). After adjustment for MAP, the association between CI and rO 2 % remained significant (+3.1% per L/min/m2 increase in CI; p<0.0001). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI is associated with improved rO 2 %. Further studies are needed to determine whether CI targets improve rO2% and neurologic outcomes following OHCA.

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