Thirty-Day Readmission Rate Using an Outpatient Infusion Pathway after Laparoscopic Roux-en-Y Gastric Bypass

2018 ◽  
Vol 84 (9) ◽  
pp. 1429-1432 ◽  
Author(s):  
William P.L. Main ◽  
Amy E. Murphy ◽  
Lala R. Hussain ◽  
Katherine M. Meister ◽  
Kevin M. Tymitz
Keyword(s):  
Gastric Bypass ◽  
Folic Acid ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Readmission Rate ◽  
Length Of Hospital Stay ◽  
Inclusion Criteria ◽  
Cent Saline ◽  
Postoperative Length

The objective of this study was to determine whether implementing an outpatient infusion pathway (OIP) resulted in a decreased 30-day readmission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB). Data were retrospectively gathered on all patients who underwent LRYGB at our institution between April 1, 2015, and March 31, 2016, after instituting an OIP (postinfusion group). Thirty-day readmission rate, length of stay, and 30-day mortality rate were compared with patients who underwent LRYGB between January 1, 2014, and December 31, 2014, before implementing the OIP (preinfusion group). Patients not able to take 40 ounces of fluid orally at discharge after surgery were enrolled in the OIP. One OIP session would include an antiemetic, 1 liter bolus of 0.9 per cent saline, and intravenous multivitamin, thiamine, and folic acid. A total of 174 patients were included for analysis. Seventy-nine patients were in the pre-infusion group and 95 patients in the postinfusion group. Of the 95 patients in the postinfusion group, 18 patients (18.9%) met inclusion criteria for the OIP. There was a 45 per cent decrease in 30-day readmission rate after the institution of the OIP for patients who underwent LRYGB, however this was not statistically significant (11.39% vs 6.31%; OR 1.907; 95% confidence interval: 0.648–5.613, P = 0.235). There was no difference in postoperative length of hospital stay (1.65 vs 1.41 days, P = 0.114) or mortality (0.7% vs 0%, P = 0.454), in the pre- and postinfusion groups, respectively. Implementation of an OIP decreased 30-day readmission rate after LRYGB by 45 per cent; however, this was not statistically significant.

Abstract TP300: Implementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and Mortality

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jayme Strauss ◽  
Andrew Waisbrot ◽  
Daniel D'Amour ◽  
Amy K Starosciak
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Readmission Rate ◽  
Clinical Pathways ◽  
Transitions Of Care ◽  
Fiscal Year ◽  
Variable Cost ◽  
Total Cost ◽  
Iv Tpa ◽  
Order Set

Introduction: Acute stroke is a major contributor to healthcare costs. In 2012, estimated direct costs associated with stroke was $71B, which is projected to double to $184B by 2030. As healthcare evolves and reimbursements decrease, cost control in disease specific populations is critical. In November 2017, length of stay (LOS) peaked at 5.78 days, as did variable and total cost/case (Table). In fiscal year 2017 the 30-d readmission rate was 9% and the mortality rate was 12%. Compliance with stroke admission order sets was at 55%. Methods: A multidisciplinary committee was formed in February 2017 to develop standardized, evidence-based clinical pathways for three populations: Ischemic stroke (IS) treated with IV tPA, TIA/IS without IV tPA, and intracerebral hemorrhage. The team met biweekly to standardize clinical pathways, decrease time to follow-up imaging, focus on physician order set utilization, and control costs. A comprehensive education program for all clinical staff was completed; official implementation of the pathways was in November 2017. A stroke financials team meets monthly to continue to look at opportunities and transitions of care. We reviewed a retrospective financial report of all in-hospital cases coded as MS-DRG 61-69 from 12/2017 through 7/31/2019 and compared it the 11/2017 report. Results: A total of 83 cases were available for 12/2017 and 2192 for 1/2018 through 7/2019. There was a reduced LOS by 26% (4.34 days), reduced variable cost/case by 24% ($5,958), reduced total cost/case by 23% ($13,790), reduced the 30-d readmission rate to 6%, and reduced the mortality rate to 4%. Case mix index was 12% higher at 1.3272 (vs. 1.2055 previously). Order set compliance improved to 94% (Table). A total cost saving dollar realization of $4.5 million. Discussion: Standardization of stroke clinical pathways led to improved order set compliance, almost 1/4 reduction in variable and total costs per case, shortened LOS, and reduced mortality and readmission rates.

Decreasing Laboratory Testing for Neonatal Jaundice Through Revision of a Clinical Practice Pathway

2022 ◽  
Author(s):  
Erin Preloger ◽  
Michael Wedoff ◽  
Jennifer T. Lemke ◽  
Amy Pan ◽  
Anika Nelson
Keyword(s):  
Clinical Practice ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Outcome Measures ◽  
Bilirubin Level ◽  
Readmission Rate ◽  
Laboratory Tests ◽  
Poisson Model ◽  
Median Number ◽  
Neonatal Hyperbilirubinemia

OBJECTIVES: The purpose of this study was to minimize unnecessary laboratory services for hospitalized neonates with hyperbilirubinemia by revising a local clinical practice pathway (CPP). METHODS: A retrospective cohort study was performed to compare the number of laboratory tests and blood draws in patients hospitalized with neonatal hyperbilirubinemia before and after implementation of a revised CPP. The study included infants with neonatal hyperbilirubinemia <14 days old admitted after their birth hospitalization between April 2017 and October 2019. Primary outcome measures included the total number of blood draws and the number of laboratory tests obtained per patient and length of stay. Secondary outcome measures included 7-day readmission rate, charges, and discharge bilirubin level. RESULTS: The median number of blood draws per patient after implementation of the CPP decreased to 2 (interquartile range [IQR], 2–3) compared with 3 (IQR, 2–3) before implementation (Poisson model–based estimated mean difference, 1.1; 95% confidence interval, 1.0–1.3; P = .018). The median number of laboratory tests per patient after implementation decreased from 4 (IQR, 3–6) to 3 (IQR, 2–4; Poisson model–based estimated mean difference, 1.3; 95% confidence interval, 1.2–1.5; P < .0001). There was no significant change in length of stay, readmission rate, charges, or discharge bilirubin level. CONCLUSIONS: Implementation of a revised CPP was associated with a significant decrease in the number of blood draws and laboratory tests per patient for infants admitted to the hospital for neonatal hyperbilirubinemia.

scholarly journals Day of surgery: the impact on patient length of stay in a tertiary vascular unit

2020 ◽  
Vol 102 (2) ◽  
pp. 98-103 ◽  
Author(s):  
NC Holford ◽  
C Ní Ghuidhir ◽  
L Hands
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Support Services ◽  
Length Of Hospital Stay ◽  
Abdominal Aortic Aneurysm Repair ◽  
Significant Difference ◽  
Postoperative Length ◽  
The Difference ◽  
Aneurysm Repair ◽  
The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

ID: 4: OUTCOMES IN CONGESTIVE HEART FAILURE PATIENTS UNDERGOING TRANSFEMORAL VERSUS TRANSRADIAL CARDIAC CATHETRIZATION: RESTROSPECTIVE CHART ANALYSIS

2016 ◽  
Vol 64 (4) ◽  
pp. 921.1-921
Author(s):  
H Alkhawam ◽  
R Sogomonian ◽  
N Vyas ◽  
A Al-khazraji ◽  
JJ Lieber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Length Of Stay ◽  
Cardiac Catheterization ◽  
Readmission Rate ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Study Population ◽  
Transradial Catheterization ◽  
Diagnostic Coronary Angiography

BackgroundSeveral studies addressed outcomes in terms of NACE and MACE in patients undergoing transradial vs tranfemoral cardiac catheterization. However, data on core quality measures such as length of stay and rehospitalization rates is lacking in the congestive heart failure population.MethodA retrospective chart analysis of 9,320 patients who were admitted to the hospital for chest pain and underwent cardiac catheterization. Based on ICD-9 codes, we included only patients with Congestive Heart Failure (CHF) with an Ejection Fracture ≤40 (HFrEF). We compared readmission rate and Length of stay in patients who underwent Transradial cardiac catheterization vs Transfemoral cardiac catheterization.ResultsOf a total 9,320 patients undergoing diagnostic coronary angiography, 800 patients had HFrEF. Four hundred patients underwent Transradial cardiac catheterization and 400 patients underwent Transfemoral cardiac catheterization. In the transfemoral cardiac catheterization group, 37 (9%) were readmitted within 30 days of discharge while 17 (4%) patients of 400 patients who underwent transradial cardiac catheterization were readmitted within 30 days of discharged (Odds ratio: 2.3, 95% CI: 1.8–3, p value 0.005).Length of stay was ∼5.2 days in transradial catheterization vs. ∼6 days in Transfemoral catheterization group (p 0.4).ConclusionIn our study population, transradial cardiac catheterization in HFrEF patients seemed to have a better outcome when compared to transfemoral cardiac catheterization in terms of 30-days readmission rate. Length of hospital stay was higher in the transfemoral group but did not achieve statistical significance, however. Larger studies that may also include patients with heart failure with preserved ejection fraction (HFpEF) are needed to investigate factors that may contribute to such outcomes.

scholarly journals 55 A Review of Stroke Demographics and Outcomes at a Regional Hospital without a Stroke Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Lushen Pillay ◽  
Kushan Galav ◽  
Deeptish Tulsi ◽  
Joanna McGlynn ◽  
John Doherty ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Stroke Unit ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Local Analysis ◽  
Stroke Patients ◽  
Stroke Units ◽  
Average Length Of Stay ◽  
Stroke Register

Abstract Background According to the 2017 National Stroke Register Report; 75% of strokes occur in patients aged 65 years and older. Within the audit 19 stroke units reported that 70.6% of stroke patients were admitted to a stroke unit and their median length of stay of 9 days. Numerous studies have shown better outcomes in patients admitted to a stroke unit versus a medical unit leading to national stroke networks and bypass protocols for patients. However, stroke patients can still be found in non-stroke unit hospitals such as our own. Methods Demographics from HIPE data was collected on all stroke patients admitted to our hospital between January 1st and December 31st 2017. Basic statistical methods were used to analyse the data. Results We analyzed 103 patient records. The average age at presentation was 73 years (range: 35-97) and 60.1% were males. The average length of hospital stay was 16.1 days (range 1- 130 days). Ischemic (77%) events were more common than haemorrhagic events (23%). The three most common co-morbidities were hypertension (45%), hyperlipidemia (30%) and atrial fibrillation (19%). Discharge destination was home (66%), nursing home (14%), national rehabilitation (2%) and an 18% mortality rate within 3 months. The mortality rate was higher in the hemorrhagic (42%) compared to ischemic (11%). Conclusion The average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.

scholarly journals Prediction of Prolonged Length of Hospital Stay After Cancer Surgery Using Machine Learning on Electronic Health Records: Retrospective Cross-sectional Study

10.2196/23147 ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. e23147
Author(s):  
Yong-Yeon Jo ◽  
JaiHong Han ◽  
Hyun Woo Park ◽  
Hyojung Jung ◽  
Jae Dong Lee ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Cancer Surgery ◽  
Gradient Boosting ◽  
Prolonged Length ◽  
Extreme Gradient Boosting ◽  
Postoperative Length ◽  
After Cancer

Background Postoperative length of stay is a key indicator in the management of medical resources and an indirect predictor of the incidence of surgical complications and the degree of recovery of the patient after cancer surgery. Recently, machine learning has been used to predict complex medical outcomes, such as prolonged length of hospital stay, using extensive medical information. Objective The objective of this study was to develop a prediction model for prolonged length of stay after cancer surgery using a machine learning approach. Methods In our retrospective study, electronic health records (EHRs) from 42,751 patients who underwent primary surgery for 17 types of cancer between January 1, 2000, and December 31, 2017, were sourced from a single cancer center. The EHRs included numerous variables such as surgical factors, cancer factors, underlying diseases, functional laboratory assessments, general assessments, medications, and social factors. To predict prolonged length of stay after cancer surgery, we employed extreme gradient boosting classifier, multilayer perceptron, and logistic regression models. Prolonged postoperative length of stay for cancer was defined as bed-days of the group of patients who accounted for the top 50% of the distribution of bed-days by cancer type. Results In the prediction of prolonged length of stay after cancer surgery, extreme gradient boosting classifier models demonstrated excellent performance for kidney and bladder cancer surgeries (area under the receiver operating characteristic curve [AUC] >0.85). A moderate performance (AUC 0.70-0.85) was observed for stomach, breast, colon, thyroid, prostate, cervix uteri, corpus uteri, and oral cancers. For stomach, breast, colon, thyroid, and lung cancers, with more than 4000 cases each, the extreme gradient boosting classifier model showed slightly better performance than the logistic regression model, although the logistic regression model also performed adequately. We identified risk variables for the prediction of prolonged postoperative length of stay for each type of cancer, and the importance of the variables differed depending on the cancer type. After we added operative time to the models trained on preoperative factors, the models generally outperformed the corresponding models using only preoperative variables. Conclusions A machine learning approach using EHRs may improve the prediction of prolonged length of hospital stay after primary cancer surgery. This algorithm may help to provide a more effective allocation of medical resources in cancer surgery.

scholarly journals Evaluating the effect of inpatient diabetes education on length of stay, readmission rates and mortality rates: a systematic review

2020 ◽  
Vol 20 (2) ◽  
pp. 96-103
Author(s):  
Zeeshan Hussain ◽  
Mohammed Alkharaiji ◽  
Iskandar Idris
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Readmission Rate ◽  
Diabetes Education ◽  
Free Text ◽  
Readmission Rates ◽  
Inpatient Diabetes ◽  
Hospitalised Patients ◽  
Patients With Diabetes

Background: Hospitalised patients with diabetes experience a longer duration of inpatient stay, increased readmission rates and excess mortality compared with patients without diabetes.Objectives: To determine whether inpatient diabetes education (IDE), provided to hospitalised patients with diabetes, is an effective intervention in improving one or all of the following clinical outcomes: length of stay (LOS), readmission rate and mortality rate.Methods: A free-text search on MEDLINE, PubMed, CINAHL, BNI and EMBASE was conducted on literature published from the date of each databases’ inception to March 2019. In addition, grey literature was used to support the search with the following key terms: ‘IDE’, ‘LOS’, ‘readmission’ and ‘mortality’, along with their possible substitutes and alternatives combined.Results: In total, eight studies met the inclusion criteria with a total number of 3,828 participants. Seven studies investigated LOS outcome for which accumulated mean LOS and median LOS were both lower (16.5% and 26.67%, respectively) in the IDE group compared with the non-IDE group. Six studies investigated readmittance rates, for which accumulated readmission rate (up to 12 months) was 15.9% lower in the IDE group than in the non-IDE group. Finally, the mortality rate was 36.6% lower in the IDE group compared with the non-IDE group, but this was non-significant and only one study reported this outcome.Conclusion: The findings of this review support the efficacy of an IDE programme in a hospital setting by reducing LOS and readmission rates in patients with diabetes. In addition, a possible trend towards a decreased mortality rate was observed. IDE is therefore recommended to improve clinical outcomes of hospitalised patients with diabetes.

scholarly journals Etiology, Incidence And Risk Factors For Meningitis After Craniotomy

2021 ◽  
Author(s):  
Gregory Lauar e Souza ◽  
Handerson Dias Duarte de Carvalho ◽  
Nicole Meireles Sacco ◽  
Lucca Gontijo Giarola ◽  
Estevão Urbano Silva ◽  
...  
Keyword(s):  
Risk Factor ◽  
Standard Deviation ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Main Risk Factor ◽  
Significance Level ◽  
Etiologic Agents ◽  
The Impact

Background: Meningitis after craniotomy can cause devastating outcomes. Objectives: Estimate the risk of meningitis after craniotomy (MAC). Find the most prevalent pathogens. Assess the impact of meningitis over length of stay and mortality. Find the main risk factor for MAC. Design and setting: Multicentric, longitudinal and quantitative analysis of data collected between 2013-2017 from nine different hospitals from Minas Gerais, Brazil. Methods: Surveillance data was based on NHSN/CDC protocols. Observed outcomes were meningitis, hospital death and total length of stay. Twentythree variables were analyzed in Epi-Info in a two-tailed statistical test with a significance level of 5%. Results: 4,549 patients were analyzed. Risk of MAC was 1.9% (95%CI=1.6%; 2.4%). The mortality rate in patients without infection was 9%, increasing to 33% in infected patients (P<0.01). Length of hospital stay (HS) in uninfected patients (in days): mean=18, median=7, standard deviation=36. HS in infected patients: mean=56, median=37, standard deviation=63 P<0.001).The duration of the procedure ≤4 hours presented a 1.5% risk of MAC compared to 2.5% versus ≥4 hours (RR=1.7; P=0.041). From 88 MAC cases, pathogen was identified in 68 (77%): K.pneumoniae (20%), S.aureus (16%), A.baumannii (13%), P.aeruginosa (9%), Staphylococcus sp . (8%), Acinetobacter sp. (7%), S.epidermidis (5%) among others (20%).Conclusion: MAC risk was 1.9%. Mortality rate was high compared to literature. Meningitis caused threefold increase on HS. Procedure duration ≥4 hours was the main risk factor, presenting RR of 1.7. The most prevalent etiologic agents were K.pneumoniae and S.aureus. Considering the findings, infectious surveillance is paramount for patient safety.

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