Characteristics of Hospitalized Patients Screening Positive for Delirium

2019 ◽  
Vol 37 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Trinh H. Nguyen ◽  
Rabia S. Atayee ◽  
Katrina L. Derry ◽  
Jeremy Hirst ◽  
Anthony Biondo ◽  
...  
Keyword(s):  
Chart Review ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Screening Tools ◽  
Inpatient Stay ◽  
Tertiary Referral ◽  
Average Length Of Stay ◽  
General Psychiatry

Background: Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. Objective: To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. Design, Settings, Patients: Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. Measurements: Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement. Results: Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. Conclusion: In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

scholarly journals Necrotizing fasciitis: presentation, microbiology and outcomes in a community hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2471
Author(s):  
Mercy N. Jimenez ◽  
Emily S. Seltzer ◽  
Bhavana Devanabanda ◽  
Martine Louis ◽  
Nageswara Mandava
Keyword(s):  
New York ◽  
Necrotizing Fasciitis ◽  
Clinical Decision Making ◽  
Community Hospital ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Blood Cultures ◽  
Average Length Of Stay

Background: Necrotizing fasciitis (NF) is an aggressive and often fatal, soft tissue infection. Delayed surgical therapy leads to worsened outcomes. This study evaluates the mortality, outcomes, and characteristics of patients with NF in a diverse New York City Community Hospital Network.Methods: Retrospective chart review from 2012 to 2019 using ICD-9 and ICD-10 codes of gas gangrene, Fournier’s gangrene, and necrotizing fasciitis was done. Of the 297 patients reviewed 28 met inclusion criteria of imaging findings, operative reports, and clinical diagnosis of NF by an attending surgeon.Results: On average patients in ER were seen by the surgical team within less than 12 hours. Most patients were debrided within 10 hours of surgical consultation and on average received 2.2 procedures. Of the wound cultures obtained 65.38% were polymicrobial in nature. The average length of stay was 17.4 days and 32% of patients required ICU admission. The surgical mortality rate was 7.61%.Conclusions: Necrotizing fasciitis is a rare entity and increasing provider knowledge on patient characteristics as well as the complexity of these patients and the types and number of procedures they require may help guide clinical decision making. We identified that while most of our patients had negative blood cultures on admission, those that had positive blood cultures had multiple organisms growing. Knowing that these patients are complex and likely require multiple procedures, prompt operative intervention is key.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

scholarly journals P.003 Autoimmune Encephalitis and related disorders are not rare in British Columbia

2021 ◽  
Vol 48 (s3) ◽  
pp. S20-S21
Author(s):  
C Uy ◽  
M Chedrawe ◽  
P Chivukula ◽  
J Wade ◽  
S Wong ◽  
...  
Keyword(s):  
Chart Review ◽  
Average Length ◽  
Autoimmune Encephalitis ◽  
Patient Characteristics ◽  
Antibody Testing ◽  
Average Length Of Stay ◽  
Medical Centers ◽  
Academic Medical ◽  
Neuropsychiatric Manifestations ◽  
Electronic Hospital

Background: Autoimmune encephalitis (AE) is a recently described entity that presents with seizures, neuropsychiatric manifestations, and movement disorders. This observational chart review of AE aims to assess the burden of AE and related disorders at two Vancouver academic medical centers. Methods: All patients with Mitogen Laboratory AE antibody testing in 2018 were identified. Electronic hospital records were used to determine patient characteristics. Results: 1266 unique tests were ordered on 315 inpatients and outpatients. Of 37/315 (11.7%) seropositive patients, 26/37 (70.2%) patients had clinical data. Seropositive results included autoantibodies to NMDA (n=3), LG1 (n=2), CASPR2 (n=1) and paraneoplastic autoantibodies included GAD65 (n=2), PNMA2 (n=5), recoverin (n=3). There were four AE cases in 14 seronegative patients based on discharge diagnosis. 15/30 of patients had seizures and three developed status epilepticus. 15 had neuropsychiatric manifestations. 14 had a movement disorder. For inpatients, average length of stay was 24.3 days and there were 5 intensive care unit (ICU) admissions. Immunotherapies used included corticosteroids, PLEX, rituximab, IVIg, and cyclophosphamide. Conclusions: In two hospitals serving approximately two million people in 2018, there were 30 cases of AE in 2018. AE presents with a broad range of neurologic symptoms and seronegative testing does not preclude AE.

Comparison of care patterns for hospitalized immune-related adverse events (irAEs) between melanoma patients on combination immune checkpoint inhibitor (ICI) therapy versus ICI monotherapy.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 85-85
Author(s):  
RuiQui Chen ◽  
Elliot Charles Smith ◽  
Sze Wah Samuel Chan ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Chart Review ◽  
Immune Checkpoint Inhibitor ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Readmission Rates ◽  
Admission Rates ◽  
Average Length Of Stay ◽  
Care Patterns ◽  
Melanoma Patients

85 Background: Prior clinical trials in melanoma have demonstrated higher rates of irAEs from combination ICI therapy compared to monotherapy. However, this has not been well studied in the real-world where patients often have greater co-morbidities and less organ reserve. We aim to compare irAEs hospitalizations for melanoma patients on combination vs monotherapy ICIs. Methods: We performed a single centre retrospective chart review (Princess Margaret Cancer Centre, Toronto, ON) for all melanoma patients receiving ICI as standard of care (2012-2017) admitted with irAEs. Data collected include demographics, investigations, management and outcomes of hospitalizations. Descriptive analyses were performed to characterize hospitalizations and compare between ICI combination vs monotherapy groups. Results: Among 381 melanoma patients identified on standard of care ICI, 41 (11%) were admitted for irAE. Among those admitted, 10% received monotherapy with nivolumab, 22% pembrolizumab, 39% ipilimumab and 29% combination ICI. Admission rates were higher among patients receiving combination ICI compared to monotherapy (20% vs 8% p = 0.003). Prevalence of the most common irAEs were similar between combination and monotherapy groups: colitis (58% vs 59%), pneumonitis (8% vs 14%) and hepatitis (8% vs 10%). Less than half received invasive diagnostic tests (i.e, endoscopy) (42% combination vs 35% monotherapy, p = 0.50) with 3 (60%) and 5 (50%) confirming irAEs, respectively. Rates of infliximab use were similar between the combination and monotherapy group (25% vs 21%, p = 0.70). Average length of stay was shorter for patients on combination ICI compared to monotherapy (5 days vs 15 days, p = 0.08). irAE readmission rates were similar between patients receiving combination ICI compared to monotherapy (20% vs 17%, p = 0.65). Conclusions: Despite higher admission rates among patients receiving combination ICI, there was a trend towards shorter hospitalizations. Other outcomes including diagnoses, investigations and management were not significantly different between patients receiving combination vs ICI monotherapy.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

Patient characteristics and outcomes of an interdisciplinary menopause clinic: a retrospective chart review

Maturitas ◽  
2015 ◽  
Vol 81 (1) ◽  
pp. 178-179
Author(s):  
Beate C. Sydora ◽  
Nicole Veltri ◽  
Christoph P. Sydora ◽  
Justin Marillier ◽  
Lori Battochio ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

scholarly journals The Costs of Caring for Patients in a Tertiary Referral Australian Intensive Care Unit

2005 ◽  
Vol 33 (4) ◽  
pp. 477-482 ◽  
Author(s):  
I. J. Rechner ◽  
J. Lipman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Average Length ◽  
Cost Driver ◽  
Full Time ◽  
Tertiary Referral ◽  
Agency Staff ◽  
Average Length Of Stay ◽  
Percentage Difference ◽  
Full Time Employment

We determined the direct cost of an Intensive Care Unit (ICU) bed in a tertiary referral Australian ICU and the cost drivers thereof, by retrospectively analysing a number of prospectively designed Hospital- and Unit-specific electronic databases. The study period was a financial year, from 1 July 2002 to 30 June 2003. There were 1615 patients occupying 5692 fractional occupied bed days at a total cost of A$15,915,964, with an average length of stay of 3.69 days (range 0.5–77, median 1.06, interquartile range 2.33). The main cost driver not incorporated into this analysis was blood products (paid for centrally). The average costs of an ICU day and total stay per patient were A$2670 and A$9852 respectively. Staff-related charges were 68.76%, with consumables related expenditure making up 19.65%, clinical support services 9.55% and capital equipment 2.04%. Overtime charges and nursing agency staff were 19.4% of staff-related charges (2.9% for agency staff), 3.9% lower than expenditure associated with full-time employment charges, such as pension and leave. The emergency nature of ICU means it is difficult to accurately set a nursing establishment to cater for all admissions and therefore it is hard to decide what is an acceptable percentage difference between agency/overtime costs compared with the costs associated with full-time staff appointments. Consumable expenditure is likely to increase the most with new innovation and therapies. Using protocol driven practices may tighten and control costs incurred in ICU.

Laparoscopic Repair of Gastrointestinal Leaks after Laparoscopic Gastric Bypass

2006 ◽  
Vol 72 (7) ◽  
pp. 586-591 ◽  
Author(s):  
Atul K. Madan ◽  
Brock Lanier ◽  
David S. Tichansky
Keyword(s):  
Gastric Bypass ◽  
Laparoscopic Repair ◽  
Average Length ◽  
Gastric Pouch ◽  
Retrospective Chart Review ◽  
Multiple Organ ◽  
Open Approach ◽  
Significant Morbidity ◽  
Average Length Of Stay ◽  
Average Operative Time

Gastrointestinal (GI) leak after gastric bypass is a cause of significant morbidity and a mortality that may exceed 50%. This study was performed to review our experience with laparoscopic repair of GI leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB). A retrospective chart review of all patients who underwent LRYGB over a 25-month period was performed. Patients who had any operation for a GI leak after LRYGB were included in this study. There were 300 patients who underwent LRYGB. No intraoperative conversions occurred. Eight (2.7%) patients underwent operative repair of a GI leak. Another patient had a gastrojejunostomy leak that was managed nonoperatively. The rate of GI leaks reduced from 5.3 per cent in the first 150 cases to 0.7 per cent in the last 150 cases (P < 0.05). One patient was converted to an open approach. Average operative time for the laparoscopic repairs was 133 minutes (range, 75–182 minutes). Sources of leak found at operation were gastrojejunostomy (3), enterotomy (3), jejunojejunostomy (2), gastric pouch (1), and cystic duct stump (1). Two patients had a GI leak from two sources. Average length of stay was 28 days (range, 4–78 days). Three patients whose stay was greater than a month were the result of sepsis and ventilator dependence. Further reoperations were required in two patients (laparoscopic) for abdominal washout and one patient (open) for enterotomy repair. One patient required computed tomography-guided drainage of an abscess. Mortality was 22 per cent (2) in patients who developed GI leaks. One patient died from sepsis-induced multiple organ failure and the other patient from a presumed pulmonary embolus. GI leaks cause significant morbidity and mortality. GI leak rates decrease with experience. Laparoscopic repair of GI leaks should be used judiciously. Conversions and further reoperations may be necessary.

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