scholarly journals Covid-19 Mortality in an Acute Care Hospital: Association of Patient Factors With Decision to Forego the Intensive Care Unit

2021 ◽  
pp. 104990912110288
Author(s):  
Barry R. Meisenberg ◽  
Sadaf Qureshi ◽  
Monika Thandalam Somasekar ◽  
Qurat Ali ◽  
Mitchell Karpman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Public Awareness ◽  
Acute Care Hospital ◽  
Normal Body Mass Index ◽  
Care Hospital ◽  
Patient Factors ◽  
Goals Of Care ◽  
Factors Associated ◽  
Poor Outcomes ◽  
Time Of Admission

Background: Public awareness of the large mortality toll of COVID-19 particularly among elderly and frail persons is high. This public awareness represents an enhanced opportunity for early and urgent goals-of-care discussions to reduce medically ineffective care. Objective: To assess the end-of-life experiences of hospitalized patients dying of COVID-19 with respect to identifying the clinical factors associated with utilization or non-utilization of the ICU. Methods: Retrospective cohort study of hospital outcomes using electronic medical records and individual chart review from March 15, 2020 to October 15, 2020 of every patient with a COVID-19 diagnosis who died or was admitted to hospice while hospitalized. Logistic regression multivariate analysis was used to identify the clinical and demographic factors associated with non-utilization of the ICU. Results: 133/749 (18%) of hospitalized COVID-19 patients died or were admitted to hospice as a result of COVID-19. Of the 133, 66 (49.6%) had no ICU utilization. In multivariate analysis, the significant patient factors associated with non-ICU utilization were increasing age, normal body mass index, and the presence of an advanced directive calling for limited life sustaining therapies. Race and residence at time of admission (home vs. facility) were significant only in the unadjusted analyses but not in adjusted. Gender was not significant in either form of analyses. Conclusion: Goals of care discussions performed by an augmented palliative care team and other bedside clinicians had renewed urgency during COVID-19. Large percentages of patients and surrogates, perhaps motivated by public awareness of poor outcomes, opted not to utilize the ICU.

scholarly journals Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium: a qualitative descriptive study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047247
Author(s):  
Emily J Tomlinson ◽  
Helen Rawson ◽  
Elizabeth Manias ◽  
Nicole (Nikki) M Phillips ◽  
Peteris Darzins ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Health Professionals ◽  
Acute Care Hospital ◽  
Nursing Workload ◽  
Care Hospital ◽  
Antipsychotic Medications ◽  
Factors Associated ◽  
Multiple Factors ◽  
Qualitative Descriptive

ObjectivesTo explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium.DesignQualitative descriptive.SettingTwo acute care hospital organisations in Melbourne, Australia.ParticipantsNurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.ResultsParticipants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications.ConclusionsThe decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.

scholarly journals Cognitive and Functional Impairment of Hospitalized Patients over 65 Years of Age

2013 ◽  
Vol 4 (1) ◽  
pp. 5-18
Author(s):  
Mª José Calero-García ◽  
Alfonso J. Cruz Lendínez
Keyword(s):  
Cognitive Impairment ◽  
Marital Status ◽  
Acute Care ◽  
Functional Impairment ◽  
Acute Care Hospital ◽  
Education Level ◽  
Care Hospital ◽  
Elderly Men ◽  
Time Of Admission ◽  
The Relationship

The first objective of this research is to establish and study how the different stages of cognitive impairment and the levels of dependence evolve in patients over 65 years of age, admitted to an acute care hospital, as well as the relationship between these factors and the different social and demographical variables. The results show that the level of dependence decreases suddenly at the time of admission and undergoes a slight recovery at the time of discharge. Although this recovery continues at home after discharge, patients do not get the same level of independence that they used to have before admission. In addition, significant differences in terms of age, marital status and education level were found. In general, our results show that elderly men over 80 years of age, without no education and widowers are more likely to suffer from severe cognitive impairment and be more functionally dependent when admitted to hospital.

scholarly journals Can This Patient Be Discharged Home? Factors Associated With At-Home Death Among Patients With Cancer

2011 ◽  
Vol 29 (9) ◽  
pp. 1159-1167 ◽  
Author(s):  
Alberto Alonso-Babarro ◽  
Eduardo Bruera ◽  
María Varela-Cerdeira ◽  
María Jesús Boya-Cristia ◽  
Rosario Madero ◽  
...  
Keyword(s):  
Social Support ◽  
Decision Making ◽  
Perceived Social Support ◽  
Acute Care Hospital ◽  
Place Of Death ◽  
Care Hospital ◽  
Home Death ◽  
Factors Associated ◽  
Decision Making Model ◽  
At Home

Purpose The purpose of this study was to identify factors associated with at-home death among patients with advanced cancer and create a decision-making model for discharging patients from an acute-care hospital. Patients and Methods We conducted an observational cohort study to identify the association between place of death and the clinical and demographic characteristics of patients with advanced cancer who received care from a palliative home care team (PHCT) and of their primary caregivers. We used logistic regression analysis to identify the predictors of at-home death. Results We identified 380 patients who met the study inclusion criteria; of these, 245 patients (64%) died at home, 72 (19%) died in an acute-care hospital, 60 (16%) died in a palliative care unit, and three (1%) died in a nursing home. Median follow-up was 48 days. We included the 16 variables that were significant in univariate analysis in our decision-making model. Five variables predictive of at-home death were retained in the multivariate analysis: caregiver's preferred place of death, patients' preferred place of death, caregiver's perceived social support, number of hospital admission days, and number of PHCT visits. A subsequent reduced model including only those variables that were known at the time of discharge (caregivers' preferred place of death, patients' preferred place of death, and caregivers' perceived social support) had a sensitivity of 96% and a specificity of 81% in predicting place of death. Conclusion Asking a few simple patient- and family-centered questions may help to inform the decision regarding the best place for end-of-life care and death.

scholarly journals Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

2019 ◽  
Vol 13 (3) ◽  
pp. 192-199
Author(s):  
Hai-Won Yoo ◽  
Myo-Gyeong Kim ◽  
Doo-Nam Oh ◽  
Jeong-Hae Hwang ◽  
Kun-Sei Lee
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Functional Decline ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Factors Associated

Surgical intervention and patient factors associated with poor outcomes in patients with traumatic brain injury at a tertiary care hospital in Uganda

2021 ◽  
pp. 1-10
Author(s):  
Charis A. Spears ◽  
Syed M. Adil ◽  
Brad J. Kolls ◽  
Michael E. Muhumza ◽  
Michael M. Haglund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Low Income ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Care Hospital ◽  
Treatment Variable ◽  
Patient Factors ◽  
Poor Outcome ◽  
Poor Outcomes

OBJECTIVE The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors. METHODS Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13–15), moderate TBI (moTBI; GCS scores 9–12), and severe TBI (sTBI; GCS scores 3–8). Poor outcomes constituted Glasgow Outcome Scale scores 2–3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10. RESULTS Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23–0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04–0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14–0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17–1.17). CONCLUSIONS In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

scholarly journals Adequacy of antidote stocking in British Columbia hospitals: The 2005 Antidote Stocking Study

CJEM ◽  
2006 ◽  
Vol 8 (06) ◽  
pp. 409-416 ◽  
Author(s):  
Matthew O. Wiens ◽  
Peter J. Zed ◽  
Katherine J. Lepik ◽  
Riyad B. Abu-Laban ◽  
Jeffrey R. Brubacher ◽  
...  
Keyword(s):  
British Columbia ◽  
Hospital Pharmacy ◽  
Acute Care Hospital ◽  
Future Research ◽  
Care Hospital ◽  
Small Hospital ◽  
Hospital Size ◽  
Information Centre ◽  
Factors Associated ◽  
Made In

ABSTRACTBackground:Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals. In response to this issue the British Columbia Drug and Poison Information Centre developed provincial antidote stocking guidelines in 2003. We sought to determine the compliance with antidote stocking in BC hospitals and any factors associated with inadequate supply.Methods:A 2-part survey, consisting of hospital demographics and antidote stocking information, was distributed in 2005 to all acute care hospital pharmacy directors in BC. The 32 antidotes examined (21 deemed essential) and the definitions of adequacy were based on the 2003 BC guidelines. Availability was reported as number of antidotes stocked per hospital and proportion of hospitals stocking each antidote. For secondary purposes, we assessed factors potentially associated with inadequate stocking.Results:Surveys were completed for all 79 (100%) hospitals. A mean of 15.6 ± 4.9 antidotes were adequately stocked per hospital. Over 90% of hospitals had adequate stocks ofN-acetylcysteine, activated charcoal, naloxone, calcium salts, flumazenil and vitamin K; 71%–90% had adequate dextrose 50% in water (D50W), ethyl alcohol or fomepizole, polyethylene glycol electrolyte solution, protamine sulfate, and cyanide antidotes; 51%–70% had adequate folic acid, glucagon, methylene blue, atropine, pralidoxime, leucovorin, pyridoxine, and deferoxamine; and <50% had adequate isoproterenol and digoxin immune Fab. Only 7 (8.9%) hospitals sufficiently stocked all 21 essential antidotes. Factors predicting poor stocking included small hospital size (p < 0.0001), isolation (p = 0.01) and rural location (p < 0.0001).Conclusion:Although antidote stocking has improved since the implementation of the 2003 guidelines, essential antidotes are absent in many BC hospitals. Future research should focus on determining the reasons for this situation and the effects of corrective interventions.

scholarly journals Predictors of Transfer to Different Facility at Discharge in Patients Admitted with Hematologic Malignancy: A Nationwide Inpatient Sample (NIS) Database Analysis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2132-2132
Author(s):  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
Rohit Kumar ◽  
Olekdandra Lupak ◽  
Philip Kuriakose
Keyword(s):  
Regression Analysis ◽  
Inpatient Care ◽  
Primary Outcome ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Multivariate Logistic Regression Analysis ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Multivariate Logistic Regression ◽  
Factors Associated

Background: Improvement in cancer treatment has led to an increase in prevalence of hematological malignancies with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer to another non-acute facility (including nursing home, subacute rehab and other institutional care) at the time of discharge. Methods: This is a retrospective cohort analysis of NIS database from 2014. Inclusion criteria was any admission of adults (≥18 years) with hematological malignancy (identified by ICD-9-CM diagnosis codes). We identified subgroups of hematological malignancies as follows: multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute myeloid and lymphoid leukemia, chronic myeloid and lymphoid leukemias. Patients transferred in from a different acute care hospital or another type of health facility were excluded. Aggressive inpatient care was defined by use of mechanical ventilation, vasopressors, hemodialysis (end stage renal disease excluded) or cardiopulmonary resuscitation. Primary outcome was transfer upon discharge to a different facility excluding acute care hospital (transfer out). Factors associated with this outcome were analyzed using multivariate logistic regression analysis. Statistical analysis was done using STATA. Results: There were 505,230 admissions of patients with hematological malignancy in the year 2014. Of the entire study population, 15.5% (n= 78,390) were transferred out at discharge and the most common primary diagnosis at admission for them was unspecified septicemia. Among those who were transferred out, mean age was 75.4 years (compared to 63.3 years for those not transferred out), mean length of stay was 9.7 days (compared to 6.7 days for those not transferred out) and 75.1% had Charlson Comorbidity Index (CCI) ≥3 (compared to 55.9% for those not transferred out). Also, among those who were transferred out, admission was elective in only 12.6% (compared to 24.9% for those not transferred out), aggressive inpatient care was utilized in 7.8% (compared to 2.1% for those not transferred out) and inpatient chemotherapy was given in 7.2% admissions (compared to 23.3% for those not transferred out). Breakdown of type of insurance for the two cohorts is shown in table 1. Result of multivariate logistic regression analysis for factors associated with primary outcome (transfer out) are summarized in table 2. We adjusted for the factors listed in the table and others such race, mean income quartile of patient's zip-code, hospital factors (urban or rural location, teaching status, geographical region and bed-size) and day of admission (weekend or weekday). Conclusion: Among admissions of patients with hematological malignancies, older age, female gender, presence of co-morbidities, longer length of stay, diagnosis of myeloma and chronic leukemias were associated with higher odds of transfer to a different non-acute facility at discharge. Whereas, elective admission, insurance type other than medicare, diagnosis of acute leukemias and those receiving inpatient chemotherapy had lower odds of being transferred to a different non-acute facility at discharge. A future area of exploration is development of a scoring system using the most clinically relevant and strongly associated factors to predict risk of transfer to a different non-acute facility at discharge. This will allow early decision making and mobilization of resources by healthcare systems for these patients with complex healthcare needs. Disclosures Kuriakose: Alexion: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy.

scholarly journals Predictors of Mortality in Patients of COVID-19 Pneumonia in Intensive Care Unit: An Observational Study in a Tertiary Care Hospital, Lucknow, India

2021 ◽  
Author(s):  
Hemant Kumar ◽  
Preeti Gupta ◽  
Shobhit Shakya ◽  
Sumeet Dixit ◽  
Manoj Kumar Pandey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Observational Study ◽  
Acute Phase ◽  
Biochemical Parameters ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Time Of Admission

Introduction: Coronavirus Disease-2019 (COVID-19) is caused by the Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) which is an enveloped positive-sense single-stranded RNA virus. Initial steps of the infection involve binding of the spike protein (S) of the virus to Angiotensin Converting Enzyme-2 (ACE-2) receptor on the mucosal surfaces of various organs like lungs, kidney, heart, intestine. Pathogenesis of complications are still poorly understood. Aim: This study was designed to find out the baseline biochemical parameters at the time of admission which may predict outcome in COVID-19 patients. Materials and Methods: This observational study was conducted in a dedicated COVID-19 hospital, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr. RMLIMS), Lucknow, Uttar Pradesh, India, from 1st July, 2020 to 30th November, 2020. A total of 109 moderate to severe COVID-19 pneumonia patients who required Intensive Care Unit (ICU) admission, were enrolled. Based on their outcome, patients were divided into two groups: “Survived” and “Expired”. Biochemical characteristics of patients were compared among the two groups using univariate and multivariate analysis. Results: On Univariate analysis Coagulation profile, Prothrombin Time (PT), International Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT) and D-Dimer values were raised significantly in the expired group. Among other acute phase reactants Lactate Dehydrogenase (LDH), C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Creatinine Phosphokinase-MB (CPKMB) were raised in expired group and this difference was significant statistically too. On Multivariate analysis among all acute phase reactant only IL-6 was increased significantly. All other variables were found to be non significantly associated with mortality, statistically (p-value <0.05). Conclusion: Baseline biochemical parameters have prognostic values in COVID-19 patients. Raised IL-6 levels can be viewed as an independent predictor of mortality among COVID-19 patients at the time of admission in ICU.

scholarly journals New Predictive Models for Falls in Acute Care Setting Classified Using An Activities of Daily Living Scale in Japan: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Chihiro Saito ◽  
Eiji Nakatani ◽  
Yoko Sato ◽  
Naoko Katuki ◽  
Masaki Tago ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Prediction Model ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Daily Living ◽  
Retrospective Cohort ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Fall Prediction

Abstract Background In several current fall prediction models, the reported predictors vary from one model to another. We developed and validated a new fall prediction model for patients admitted to an acute care hospital by identifying predictors of falls considering a combination of background factors and one crucial stratum. Methods We conducted a retrospective cohort study of patients admitted to Shizuoka General Hospital from April 2019 to September 2020, aged 20 years or older. We developed and validated a new fall prediction model by identifying predictors of falls stratified by essential activities of daily living (ADL) indicators and integrating these models. Results A total of 22,988 individuals were included in the analysis, with 653 (2.8 %) experiencing all falls and 400 (1.7 %) experiencing falls with medical resources during the study period. Multivariate analysis was performed after one stratification level, using bedridden rank (ability to move around in daily life) as a stratifying variable, a clinically important variable and highly correlated with 17 other variables. The results of multivariate analysis showed that the risk factors for falls (high risk) were age (high), sex (men), and ambulance transport (yes) for rank J (independence/autonomy); age (high),) and sex (men) for rank A (house-bound); There were no predictors for rank B (chair-bound); and there was ophthalmologic disease (no) for rank C (bed-bound). The c-index indicating the prediction model’s performance for falls within 28 days of hospitalisation was 0.705 (95 % CI, 0.664–0.746). Hosmer-Lemeshow goodness-of-fit statistics were significant (χ2 = 192.06; 8 degrees of freedom; p < 0.001). The c-index for the entire unstratified sample was 0.703 (95 % CI, 0.661–0.746), indicating that the predictive model stratified by bedriddenness rank was accurate (p < 0.001). Conclusion We identified predictors of falls using important ADLs (bedriddenness rank) and developed a more accurate prediction model in acute care hospital settings. This predictive model is an essential tool for fall prevention.

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