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 Validity of the diagnosis of pneumonia in hospitalised patients with COPD

2019 ◽  
Vol 5 (2) ◽  
pp. 00031-2019 ◽  
Author(s):  
Lydia J. Finney ◽  
Vijay Padmanaban ◽  
Samuel Todd ◽  
Nadia Ahmed ◽  
Sarah L. Elkin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chest Radiograph ◽  
Hospital Admissions ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Prolonged Length ◽  
High Dependency ◽  
Copd Patients ◽  
Hospitalised Patients

RationaleExacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia are two of the most common reasons for acute hospital admissions. Acute exacerbations and pneumonia present with similar symptoms in COPD patients, representing a diagnostic challenge with a significant impact on patient outcomes. The objectives of this study were to compare the prevalence of radiographic consolidation with the discharge diagnoses of hospitalised COPD patients.MethodsCOPD patients admitted to three UK hospitals over a 3-year period were identified. Participants were included if they were admitted with an acute respiratory illness, COPD was confirmed by spirometry and a chest radiograph was performed within 24 h of admission. Pneumonia was defined as consolidation on chest radiograph reviewed by two independent observersResultsThere were 941 admissions in 621 patients included in the final analysis. In 235 admissions, consolidation was present on chest radiography and there were 706 admissions without consolidation. Of the 235 admissions with consolidation, only 42.9% had a discharge diagnosis of pneumonia; 90.7% of patients without consolidation had a discharge diagnosis of COPD exacerbation. The presence of consolidation was associated with increased rate of high-dependency care admission, increased mortality and prolonged length of stay. Inhaled corticosteroid use was associated with recurrent pneumonia.ConclusionsPneumonia is underdiagnosed in patients with COPD. Radiographic consolidation is associated with worse outcomes and prolonged length of stay. Incorrect diagnosis could result in inappropriate use of inhaled corticosteroids. Future guidelines should specifically address the diagnosis and management of pneumonia in COPD.

scholarly journals Inpatient Hospital Costs And Length Of Stay For The Treatment Of Osteoporosis Fractures In China

2013 ◽  
Vol 16 (3) ◽  
pp. A220-A221
Author(s):  
J. Li ◽  
R.T. Burge ◽  
W.W. Ye ◽  
Y. Yang ◽  
F. Du ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Costs ◽  
Treatment Of Osteoporosis ◽  
Inpatient Hospital

scholarly journals End-stage organ disease–Healthcare utilisation: Impact of palliative medicine

2021 ◽  
pp. bmjspcare-2021-003288
Author(s):  
Allyn Hum ◽  
Chun Wei Yap ◽  
Mervyn Yong Hwang Koh
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Healthcare Utilisation ◽  
Exact Matching ◽  
Inpatient Hospital ◽  
Ed Visits ◽  
End Stage

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.MethodsPatients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.ResultsPatients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (p all <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).ConclusionPalliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.

Emergency department (ED) utilization and hospital admission rates among oncology patients at a large academic center and the need for improved urgent care access.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 19-19 ◽  
Author(s):  
Kerin B. Adelson ◽  
Vanna Dest ◽  
Salimah Velji ◽  
Richard Lisitano ◽  
Rogerio Lilenbaum
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
New Haven ◽  
Oncology Patients ◽  
Prolonged Length ◽  
Palliative Care Consultation ◽  
Ambulatory Oncology

19 Background: In the US, 30% of the total cancer expenditure is spent in the last year of life and 55% of this is spent on inpatient care. For patients with advanced cancer, most hospitalizations arise from expected disease progression. With the ultimate goal reducing hospital admissions at the Smilow Cancer Hospital at Yale New Haven, we sought to understand our patterns of ED referral, hospital admission, and length-of-stay. Methods: An analysis of all oncology patients coming to the Yale New Haven Hospital (YNHH) ED was performed by executing reports through our EPIC electronic medical record. We looked at a 5-month time frame from January 1, 2014, through May 31, 2014. Results: A total of 391 oncology patients from each of our disease groups presented to the ED and 90% were admitted. Mean length of stay (LOS) was 6.74 days. 62% of patients arrived during the hours of 9:00AM-5:00PM. The average daily cost per admission was $1886 per day/ $12,711.64 for the mean hospitalization (largely spent on nursing, pharmacy, and laboratory). At least 50% of these presentations could have been addressed in the ambulatory setting including but not limited to dehydration, abdominal pain and failure-to-thrive. Conclusions: Despite a 6-day/wk ambulatory oncology practice, our patients are presenting to the ED during standard daytime hours resulting in admission and prolonged length-of-stay. We will launch a same-day visit program with access to urgent palliative care consultation, pharmacy and infusion chairs. We will treat dehydration, nausea, vomiting, pain, DVT, and other urgent presentations. This cultural change will require education of physicians, nurses, staff, patients and caregivers. We estimate that a 50% reduction in admissions would yield a cost savings of approximately $6 million annually. [Table: see text]

Psychiatric co-morbidity and hospital utilization in the general medical sector

1999 ◽  
Vol 29 (2) ◽  
pp. 457-464 ◽  
Author(s):  
ELIZABETH SAVOCA
Keyword(s):  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Disabled Persons ◽  
Economic Evaluations ◽  
Medical Conditions ◽  
Medical Sector ◽  
Co Morbidity ◽  
Wide Range ◽  
Hospital Use

Background. This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population.Methods. The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay.Results. Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition.Conclusions. One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.

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.

Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

2018 ◽  
pp. emermed-2018-208032 ◽  
Author(s):  
Zhongheng Zhang ◽  
Faran Bokhari ◽  
Yizhan Guo ◽  
Hemant Goyal
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Prolonged Length ◽  
Icu Admission ◽  
Risk Of Death ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Increased Risk ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Background and objectivesDelayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis.MethodsPatients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse. The primary endpoint was in-hospital mortality. Length of stay in ED (EDLOS) was compared between survivors and non-survivors. A multivariable regression model was employed to adjust for potential confounding due to patient clinical condition.ResultsA total of 1997 patients, including 473 non-survivors and 1524 survivors, were included. The crude mortality rate for patients with EDLOS <6 hours was 21.4%, which was significantly lower than patients with EDLOS of 12–24 hours (31.9%), and those with EDLOS >24 hours (31.8%). After adjusting for PaO2/FiO2, serum creatinine, age, Sequential Organ Failure Assessment, body mass index, lactate, comorbidities and infection site, EDLOS continued to be independently associated with increased risk of hospital mortality. Compared with the group with EDLOS <6 hours, those with EDLOS between 12and24 hours (OR 1.82, 95% CI 1.28 to 2.58) and EDLOS >24 hours (OR 1.79, 95% CI 1.27 to 2.52) showed a significantly increased risk of death.ConclusionsOur study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.

scholarly journals The effect of COPD on length of stay and in-hospital mortality of diabetic patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Di Martino ◽  
P Di Giovanni ◽  
F Cedrone ◽  
M D'Addezio ◽  
M Masciarelli ◽  
...  
Keyword(s):  
General Population ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Diabetic Patients ◽  
Surveillance Systems ◽  
Prolonged Length ◽  
Baseline Characteristics

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. It is currently one of the leading cause of death worldwide. Metabolic syndrome has been recognized as one of the most relevant clinical comorbidities associated with COPD. Diabetes is more prevalent in COPD than in the general population, ranging between 10.1-23.0%. However, the link between COPD and diabetes is much less clear. The aim of this study was to investigate the effect of COPD on diabetic patients, focusing on length of stay and in-hospital mortality. Methods The study considered all hospital admissions of diabetic patients aged over 65 years performed between January 2006 and December 2015 in Abruzzo, a region of Italy. Data were collected from all hospital discharge records. A 1:1 propensity score-matching algorithm was used to match patients with and without COPD, according to their baseline characteristics. Logistic regression analysis was performed to evaluate the risk of in-hospital mortality and prolonged length of stay among diabetic patients with COPD. Results A total of 140,556 ?patients were included: 18,379 with COPD and 122,177 without COPD. After matching procedure, 36,758 patients were included into the analysis: 18,379 with COPD and 18,379 controls. After matching, all the baseline characteristics resulted well balanced, with a standardized mean difference less than 10% for all the variables considered. COPD patients showed a higher risk of in-hospital mortality (OR: 1.10; 95%CI 1.01-1.20; p = 0.036) and length of stay over 15 days (OR:1.18; 95%CI 1.06-1.31; p = 0.002). Conclusions In a cohort of Italian patients, diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD. Defining the causes of these differences would improve public health surveillance systems and policies. Key messages Diabetes is more prevalent in COPD than in the general population. Diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD.

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