Planes, Kangaroos, and the Capd Manual

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 452-454 ◽  
Author(s):  
Dale M. Carruthers ◽  
Jennifer M. Whishaw ◽  
Mark A.B. Thomas ◽  
Geoffrey Thatcher
Keyword(s):  
Prior Experience ◽  
Remote Area ◽  
Staff Turnover ◽  
Emergency Medical Care ◽  
Treatment Protocols ◽  
Admission Rates ◽  
Number Of Patients ◽  
Informal Assessment ◽  
Area Health ◽  
Western Australian

The Western Australian (WA) Remote Area Dialysis Programme was developed in 1988 due to the cultural need to dialyze an increasing number of aboriginal patients in their own communities, rather than relocating them up to 3000 km away in Perth. The success of the program relies on remote area health services (RAHS), which have no prior experience in continuous ambulatory peritoneal dialysis (CAPD), providing consistent routine and emergency medical care to the patients. Our aim was to standardize the care of all CAPD patients in remote WA by providing the RAHS with an easy -to-follow manual. Although the RAHS received treatment protocols and in-service education, consistent care was not always provided. We confirmed this by: (1) examining the existing quality assurance tools, peritonitis and hospital admission rates, (2) discussion with remote area staff regarding patients, and (3) informal assessment of remote area staff receptiveness to in-service education by a CAPD nurse. We identified the causes of the inconsistent care to be: (1) high remote area staff turnover (six months average for a registered nurse), (2) the protocols were difficult to follow, and (3) confusion for the RAHS as to the appropriate contact person at our hospital. In 1994, the situation was exacerbated by the dramatic increase in the number of patients and RAHS involved (14 new patients, bringing the total to 20 patients in 12 centers) plus the introduction of a second treating hospital (with differing protocols). A team of two CAPD nurses and two nephrologists was established, to collaborate with two remote area hospitals and the second treating hospital to produce the “Remote Area CAPD Manual.” The manual is an easy-to-follow, stepby-step guide for the management of CAPD by nondialysis personnel. It has led to improved management of CAPD, improvement in communication with RAHS, and the increased confidence of remote area staff in the management of CAPD patients. In conclusion, RAHS can give consistent care if provided with clear, concise guidelines.

Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamshed Ali ◽  
Osman Faheem ◽  
Pirbhat Shams ◽  
ghufran adnan ◽  
Maria Khan
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Electronic Record ◽  
Medical Attention ◽  
Care Hospital ◽  
Record System ◽  
Admission Rates ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

scholarly journals LO046: Factors associated with hospital admission following asthma exacerbations: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S46-S46 ◽  
Author(s):  
B.H. Rowe ◽  
N. Arrotta ◽  
J. Hill ◽  
E. Dennett ◽  
M. Harries
Keyword(s):  
Hospital Admissions ◽  
Data Extraction ◽  
Statistical Significance ◽  
Grey Literature ◽  
Included Study ◽  
Significance Level ◽  
Factors Associated ◽  
Admission Rates ◽  
Literature Searches ◽  
Number Of Patients

Introduction: Patients with asthma frequently present to the emergency department (ED) with exacerbations; however, a select number of patients require admission to hospital. The objective of this study was to summarize the evidence regarding asthma-related hospital admissions and factors associated with these admissions following ED presentation. Methods: Comprehensive literature searches were conducted in seven electronic databases (database inception to 2015); manual and grey literature searches were also performed. Studies reporting disposition for adults after ED presentation were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS); standardized data-collection forms were used for data extraction. Admission proportions and factors associated with admission at a statistical significance level (p<0.05) were reported. Results: Out of an initial 5865 identified articles, 37 articles met full inclusion criteria. Admission proportions were reported in 25/37 studies, ranged from 1% to 37%, and collectively demonstrated a decline of ~9% in admissions between 1993 and 2012. Studies including a >50% Caucasian ethnicity were found to have a median admission proportion of 13% (interquartile range [IQR]= 7, 20) versus studies with >50% non-Caucasian ethnicity at 22% (IQR=20, 28). Age, female sex, and previous hospitalizations for asthma exacerbation were the most individually identifiable factors associated with admission. Presenting features and medication profile were the most frequent domains associated with admission. Conclusion: Admission rates have decreased approximately 9% in a nearly 20-year span and seem to be higher in studies involving mostly non-Caucasian ethnic groups. Demographic factors, markers of severity obtained by history or at ED presentation, and medication profile could be assessed by ED clinicians to effectively discern patients at high risk for admission.

Surgical ICU Underutilization Does not Significantly Discourage Discharge

1996 ◽  
Vol 9 (4) ◽  
pp. 238-242 ◽  
Author(s):  
F. Dexter ◽  
K. Pearson ◽  
D. L. Griffiths ◽  
P. Jebson
Keyword(s):  
Discharge Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Patient Discharge ◽  
Poor Quality ◽  
Excess Capacity ◽  
Admission Rates ◽  
Discharge Rates ◽  
Number Of Patients

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

scholarly journals P057: Impact of a clinical pathway for the treatment of acute asthma in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S84-S85
Author(s):  
F. Messier ◽  
J. Deshaies ◽  
G. Breault
Keyword(s):  
Emergency Department ◽  
Clinical Pathway ◽  
Acute Asthma ◽  
Final Diagnosis ◽  
Beta Agonist ◽  
Triage Nurse ◽  
Respiratory Therapist ◽  
Time To Treatment ◽  
Admission Rates ◽  
Number Of Patients

Introduction: In Canada, acute asthma is a common cause of emergency department (ED) attendance and its treatment is affected by ED overcrowding and increasing wait times. Literature suggests that a clinical pathway (CP) for the treatment of acute asthma can increase the use of medical therapy, reduce hospital admission rates and decrease associated costs. However, only few have looked at the effect on ED length of stay (ED LOS) when such a CP is initiated by triage nurse/respiratory therapist among adults. In this optic, an asthma CP was launched on Feb. 2016 at Centre Hospitalier Universitaire de Sherbrooke (QC) and included medical directives allowing triage nurse and respiratory therapist initiation of treatment. Methods: The objectives are to determine the effect of an ED nurse/respiratory therapist-initiated asthma CP on (1) ED LOS, (2) time-to-treatment (beta-agonist, corticosteroids), time-to-MD and other secondary outcomes. This was a retrospective before-after study. Adults presenting to the ED before and after CP implementation with a final diagnosis of asthma or asthma exacerbation were eligible. The groups A (before implementation) and B (after implementation) were compared for ED LOS. Three subgroups of 50 patients were generated and compared for outcomes: A1 (before implementation), B1 (after implementation without CP) and B2 (after implementation with CP). All five groups were controlled for triage level and sex. Results: In total, 1086 patients were included; 543 before implementation (Mar. 2011 – Feb. 2016) and 543 after (Feb. 2016 – Jun. 2019), of whom 14% (N = 77) were treated by CP. The average ED LOS was similar (10.36h vs 10.65h; (p = 0,31)) in group A and in group B. In groups A1, B1 and B2, the median ED LOS were respectively 6.00, 6.84, 4.80; these differences were not statistically significant. The average time-to-treatment for beta-agonist in A1, B1 and B2 was respectively 148, 180 and 50 mins; the differences between B2 and A1 and between B2 and B1 were both statistically significant (p < 0,05). Conclusion: Although this study indicates a low compliance to the CP, it shows that time-to-treatment can be reduced. It didn't demonstrate any statistically significant decrease in ED LOS, most likely due to low number of patients and non-normal distribution, but the 1.2h shorter could be a major advantage if it proves true. Further studies are essential to understand facilitators and alleviate the barriers in anticipation of a multi-centric implementation.

Eco-efficiency improvement of Western Australian remote area power supply

2019 ◽  
Vol 230 ◽  
pp. 820-834 ◽  
Author(s):  
Aldrick Arceo ◽  
Wahidul K. Biswas ◽  
Michele John
Keyword(s):  
Power Supply ◽  
Remote Area ◽  
Efficiency Improvement ◽  
Western Australian

Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients

2013 ◽  
Vol 127 (5) ◽  
pp. 483-488 ◽  
Author(s):  
T C Biggs ◽  
P Baruah ◽  
J Mainwaring ◽  
P G Harries ◽  
R J Salib
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Treatment Algorithm ◽  
University Hospital ◽  
Routine Practice ◽  
Admission Rates ◽  
Antiplatelet Medication ◽  
Number Of Patients ◽  
Audit Cycle ◽  
The Uk

AbstractBackground and objectives:There is currently little published guidance on the management of anticoagulant and antiplatelet medication in patients admitted with epistaxis. The routine practice of withholding such medication in an attempt to control the epistaxis is common in the UK. However, this practice is not evidence-based, is often unnecessary, and can be associated with significant morbidity. This study introduces a treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients, validated through a completed audit cycle.Methods:One hundred patients admitted with epistaxis to the University Hospital Southampton NHS Foundation Trust were studied via a two-audit cycle covering the implementation of a new treatment algorithm formulated jointly by the otolaryngology and haematology departments.Results:On admission, 58 per cent of patients were taking some form of anticoagulant or antiplatelet medication. The number of patients having such medication withheld decreased significantly between the two audits, for all drugs studied (i.e. aspirin, clopidogrel and warfarin). There was no significant increase in re-bleeding or re-admission rates between the audits.Conclusion:Implementation of this treatment algorithm would help standardise management for epistaxis patients taking anticoagulant or antiplatelet drugs, and should reduce morbidity associated with unnecessary routine discontinuation of such medication.

scholarly journals A Simulation Approach to Evaluate the Effect of Demographic Changes on Healthcare Demand

2020 ◽  
Author(s):  
Bozena Mielczarek
Keyword(s):  
Older Age ◽  
Population Projections ◽  
Regional Health ◽  
Demographic Trends ◽  
Admission Rates ◽  
Healthcare Needs ◽  
Number Of Patients ◽  
Gender Groups ◽  
The Impact ◽  
Des Model

Abstract Background: The world’s changing demographic trends inevitably lead to new challenges in the delivery of healthcare services. As the population ages, the consequent demand for various types of medical treatments changes as well, but the process is not uniform, neither for particular age–gender cohorts nor for different diagnoses’ groups. Medium and long-term forecasts of future healthcare needs, which are crucial at the level of regional health policy decision making, should therefore be built taking into account different scenarios that describe possible alternative changes in population structure.Methods: A discrete event simulation (DES) model was built to forecast future healthcare demand based on population projections for one Polish region. Demographic projections were formulated based on simulation experiments carried out in previous studies. Population forecasts were inputted into the DES model, together with patient data taken from the regional health fund. A simulation was run up to 2030 to predict future healthcare needs of older age–gender groups across different diagnosis categories. An additional experiment was performed with the hypothesis that admission rates for older cohorts will gradually increase starting from 2021.Results: Three scenarios involved different assumptions regarding forecasted population changes as published by the Polish Government Council. The fourth scenario assumed gradually increasing admission rates expressed by the older age–gender groups. The results indicate that the expected small increase in the region's overall population will translate into a bigger increase in the number of patients. The largest increase of hospitalisations is projected for the age groups 7579 and older. The number of patients in the oldest women’s group will be much higher than in the corresponding men’s group. Meanwhile, the forecasted changes for particular disease categories are characterised by a high degree of variation, both in terms of gender and age.Conclusions: A simulation provides wide possibilities for studying the impact of demographic trends in healthcare demand, as it allows conducting analyses in various cross sections. The results show that a change in the demographic structure and in particular, in the population’s ageing, will lead to significant shifts in the distribution of health needs for hospital treatment.

scholarly journals Home clinical nutrition and prospects for its development

2020 ◽  
Vol 1 (2) ◽  
pp. 92-98
Author(s):  
K. Yu. Krylov ◽  
M. V. Petrova ◽  
A. E. Shestopalov ◽  
S. V. Sviridov ◽  
V. V. Zozulya ◽  
...  
Keyword(s):  
United States ◽  
United States Of America ◽  
Patient Monitoring ◽  
Prior Experience ◽  
The United States ◽  
Clinical Nutrition ◽  
Routine Practice ◽  
Energy Needs ◽  
Number Of Patients ◽  
The Russian Federation

There is an increase in the number of patients worldwide who require special home feeding after discharge from the hospital Home clinical nutrition (HCN). The yearly prevalence of home clinical nutrition in 2017 was at 463 cases per million in the United States of America whereby in the 90s it was around 163360 per million in the United States of America and Europe. There isnt an established practice of HCN in the Russian Federation and thereby no data on the amount of patients who require HCN and the new risks associated with it because there isnt prior experience in conducting it. To study the routine practice and identify patients who need HCN, we planned a multicenter observational monitoring programme. The goal of the study is patient monitoring who are unable to completely cover their energy needs with the help of conventional nutrition.

scholarly journals Treatment of critically ill COVID-19 patients: Practical guidelines

2021 ◽  
Vol 72 (3) ◽  
pp. 49-64
Author(s):  
Predrag Stevanović
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Health Workers ◽  
Extensive Experience ◽  
Treatment Protocols ◽  
Care Clinic ◽  
Number Of Patients ◽  
Short Period ◽  
Practical Guidelines

The coronavirus disease pandemic (2019) has burdened health systems around the world with a large number of severe patients in a short period of time. According to the law of large numbers, a significant number of critically ill COVID-19 patients appear in such conditions which require treatment in the intensive care unit. That percentage of those patients is around 3 - 5% in different countries. It is similar in Serbia; however, every rule has its exceptions. KBC "Dr Dragiša Mišović-Dedinje" in Belgrade has been determined to take care of the most difficult COVID-19 patients since the beginning of the epidemic due to its space, organizational and personnel possibilities. Out of the total number of patients treated in KBC "Dr Dragiša Mišović-Dedinje", about 25% of patients were treated in the intensive care unit for the above mentioned reasons. Guided by valid treatment protocols, Anesthesiology and Intensive Care clinic of the KBC "Dr Dragiša Mišović-Dedinje" has developed its own work protocols for rapid diagnosis, isolation and clinical management of such difficult patients. These protocols are important not only for the treatment of the most severe COVID-19 patients, but also for the best utilization of hospital resources, as well as for the prevention of the spread of the infection to the medical staff. Extensive experience in the treatment of critically ill patients was gained from the entire engagement during the epidemic, experienced doctors, anesthesiologists-intensivists with great knowledge in the field of work in the intensive care unit, but also managers of clinics and institutions, who can share their experience with health care policy makers. It is clear that in the future, the capacities and organization of work in the field of intensive care medicine should be redefined, as well as health workers should be trained to work in the most demanding field of medicine. Expert experience in the form of practical guidelines, derived from over fourteen months of continuous work in the red zone of COVID-19, where they fought for every breath of the patient, in this review are translated into simplified guidelines for orientation of those who find themselves in a similar situation.

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