scholarly journals Healthcare costs and outcomes for patients undergoing tracheostomy in an Australian tertiary level referral hospital

2018 ◽  
Vol 19 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Shailesh Bihari ◽  
Shivesh Prakash ◽  
Paul Hakendorf ◽  
Christopher MacBryde Horwood ◽  
Steve Tarasenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Healthcare Costs ◽  
Morbidity And Mortality ◽  
Tertiary Level ◽  
High Morbidity ◽  
Hospitalised Patients

Objective Patients undergoing tracheostomy represent a unique cohort, as often they have prolonged hospital stay, require multi-disciplinary, resource-intensive care, and may have poor outcomes. Currently, there is a lack of data around overall healthcare cost for these patients and their outcomes in terms of morbidity and mortality. The objective of the study was to estimate healthcare costs and outcomes associated in tracheostomy patients at a tertiary level hospital in South Australia. Design Retrospective review of prospectively collected data in patients who underwent tracheostomy between July 2009 and May 2015. Methods Overall healthcare-associated costs, length of mechanical ventilation, length of intensive care unit stay, and mortality rates were assessed. Results A total of 454 patients with tracheostomies were examined. Majority of the tracheostomies (n = 386 (85%)) were performed in intensive care unit patients, predominantly using bedside percutaneous approach (85%). The median length of hospital stay was 44 (29–63) days and the in-hospital mortality rate was 20%. Overall total cost of managing a patient with tracheostomy was median $192,184 (inter-quartile range $122560–$295553); mean 225,200 (range $5942–$1046675) Australian dollars. There were no statistically significant differences in any of the measured outcomes, including costs, between patients who underwent percutaneous versus surgical tracheostomy and patients who underwent early versus late tracheostomy in their intensive care unit stay. Factors that predicted (adjusted R2 = 0.53) the cost per patient were intensive care unit length of stay and hospital length of stay. Conclusion Hospitalised patients undergoing tracheostomy experience high morbidity and mortality and typically experience highly resource-intensive and costly healthcare.

scholarly journals Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 1979
Author(s):  
Frank R. Halfwerk ◽  
Jeroen H. L. van Haaren ◽  
Randy Klaassen ◽  
Robby W. van Delden ◽  
Peter H. Veltink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Heart Surgery ◽  
Mixed Model ◽  
Postoperative Recovery ◽  
Time In Bed ◽  
Surgical Ward

Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.

scholarly journals Carbapenem-resistant Enterobacteriaceae carriage risk for parameterization of a regional healthcare network agent-based model

2020 ◽  
Vol 41 (S1) ◽  
pp. s148-s149
Author(s):  
Sarah Rhea ◽  
Lei Li ◽  
Pooja Iyer ◽  
Lauren DiBiase ◽  
Kasey Jones ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Stay ◽  
Agent Based ◽  
Healthcare Network ◽  
Transmission Parameters ◽  
Carbapenem Resistant ◽  
Comorbidity Index ◽  
Systemic Antibiotics

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly common in the United States and have the potential to spread widely across healthcare networks. Only a fraction of patients with CRE carriage (ie, infection or colonization) are identified by clinical cultures. Interventions to reduce CRE transmission can be explored with agent-based models (ABMs) comprised of unique agents (eg, patients) represented by a synthetic population or model-generated representation of the population. We used electronic health record data to determine CRE carriage risk, and we discuss how these results can inform CRE transmission parameters for hospitalized agents in a regional healthcare network ABM. Methods: We reviewed the laboratory data of patients admitted during July 1, 2016−June 30, 2017, to any of 7 short-term acute-care hospitals of a regional healthcare network in North Carolina (N = 118,022 admissions) to find clinically detected cases of CRE carriage. A case was defined as the first occurrence of Enterobacter spp, Escherichia coli, or Klebsiella spp resistant to any carbapenem isolated from a clinical specimen in an admitted patient. We used Poisson regression to estimate clinically detected CRE carriage risk according to variables common to data from both the electronic health records and the ABM synthetic population, including patient demographics, systemic antibiotic administration, intensive care unit stay, comorbidities, length of stay, and admitting hospital size. Results: We identified 58 (0.05%) cases of CRE carriage among all admissions. Among these cases, 30 (52%) were ≥65 years of age and 37 (64%) were female. During their admission, 47 cases (81%) were administered systemic antibiotics and 18 cases (31%) had an intensive care unit stay. Patients administered systemic antibiotics and those with an intensive care unit stay had CRE carriage risk 6.5 times (95% CI, 3.4–12.5) and 4.9 times (95% CI, 2.8–8.5) higher, respectively, than patients without these exposures (Fig. 1). Patients ≥50 years of age and those with a higher Elixhauser comorbidity index score and with longer length of stay also had increased CRE carriage risk. Conclusions: Among admissions in our dataset, CRE carriage risk was associated with systemic antibiotic exposure, intensive care unit stay, higher Elixhauser comorbidity index score, and longer length of stay. We will use these risk estimates in the ABM to inform agents’ CRE carriage status upon hospital admission and the CRE transmission parameters for short-term acute-care hospitals. We will explore CRE transmission interventions in the parameterized regional healthcare network ABM and assess the impact of CRE carriage underestimation.Funding: This work was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreement number U01CK000527. The conclusions, findings, and opinions expressed do not necessarily reflect the official position of CDC.Disclosures: None

scholarly journals COVID-19-Associated Coagulopathy: A Case Report of Thrombosis despite Therapeutic Anticoagulation

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Habiba Hussain ◽  
Matthew Sehring ◽  
Bhagat Singh Aulakh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Severe Acute Respiratory Syndrome ◽  
Hospital Stay ◽  
Inflammatory Markers ◽  
Morbidity And Mortality ◽  
Management Guidelines ◽  
Disease Prognosis ◽  
Therapeutic Anticoagulation

The Coronavirus disease (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has led to tremendous morbidity and mortality. Various inflammatory markers have been monitored and considered to be associated with disease prognosis. One of the major sources of comorbidity involved has been development of thrombosis alongside the infection. This prothrombotic phenomenon considered, COVID-19-associated coagulopathy (CAC), has been the center of discussion in dealing with this infection. There still remains ambiguity regarding management guidelines for thromboprophylaxis dosing and therapeutic anticoagulation. We present a case of severe SARS-CoV-2 infection complicated by thrombosis despite therapeutic anticoagulation contributing to prolonged intensive care unit and hospital stay.

scholarly journals The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

Medicina ◽  
2007 ◽  
Vol 43 (2) ◽  
pp. 137 ◽  
Author(s):  
Algimantas Pamerneckas ◽  
Andrei Pijadin ◽  
Giedrius Pilipavičius ◽  
Gintaras Tamulaitis ◽  
Vytautas Toliušis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Ventilation Time ◽  
Polytrauma Patients ◽  
The Mean

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

scholarly journals Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Claudia Dziegielewski ◽  
Robert Talarico ◽  
Haris Imsirovic ◽  
Danial Qureshi ◽  
Yasmeen Choudhri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Healthcare Spending ◽  
Population Based ◽  
Icu Length Of Stay

Abstract Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.

scholarly journals Association of prescription opioid use on mortality and hospital length of stay in the intensive care unit

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250320
Author(s):  
Nicole Hardy ◽  
Fatima Zeba ◽  
Anaelia Ovalle ◽  
Alicia Yanac ◽  
Christelle Nzugang-Noutonsi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Icu Admission ◽  
Prescription Opioid Use

Objective Several studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission. Design A single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database. Setting Medical Information Mart for Intensive Care III database based in the United States. Patients Adult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting. Interventions None. Measurements and main results The final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63–2.01; p<0.001) and 1.88 (95% CI, 1.77–1.99; p<0.001), respectively. Conclusions Chronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.

Risk Factors for Mortality and Prolonged Hospitalization in Electric Burn Injuries

2020 ◽  
Author(s):  
Riccardo Schweizer ◽  
Nadine Pedrazzi ◽  
Holger J Klein ◽  
Tony Gentzsch ◽  
Bong-Sung Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
High Voltage ◽  
Morbidity And Mortality ◽  
Prolonged Stay ◽  
Prolonged Hospitalization ◽  
Prolonged Hospital ◽  
Electrical Injuries

Abstract Electrical injuries are rare, but very destructive with high morbidity and mortality, prolonged hospital length of stay and need for repeated procedures. The aim of study was to investigate characteristics and management of electrical injuries and predisposing factors for mortality and prolonged length of stay. Patient charts were reviewed retrospectively to identify patients admitted with electrical injuries at the Zurich Burns Center (2005–2019). Patient characteristics, management, and outcome were analyzed and risk factors for mortality and prolonged hospitalization were assessed. Eighty-nine patients were included, mostly males (86.5%), between 21 and 40 years (50.6%), with high-voltage (74.2%) occupational injuries (66.3%). Median intensive care unit and hospital stays were 6 (first and third IQR: 2.0; 30.0) and 18 (9.0; 48.0) days. Low-voltage patients had a median of 2 (1.5; 3.0) procedures, compared to 4 (2.0; 10.8) in high-voltage. The amputation rate was 13.5%, and a total of 46 flaps were required. Fifty-four patients had at least one serious complication. Mortality was 18% in high-voltage patients, mostly after multiple organ failure (35%). High total body surface area (TBSA), renal failure and cardiovascular complications were risk factors for mortality (P &lt; .001) in multivariate regression models. Determinants for prolonged hospital stay were TBSA and sepsis (P &lt; .01), and additionally abdominal complications and limb loss for intensive care unit stay (P &lt; .05). Electrical injuries are still cause of significant morbidity and mortality, mostly involve young men in their earning period. Several risk factors for in-hospital mortality and prolonged stay were identified and can support physicians in the management and decision making in these patients.

Adult tetralogy repair: factors affecting early outcome in the current era

2019 ◽  
Vol 27 (9) ◽  
pp. 731-737
Author(s):  
Sowmya Ramanan ◽  
Navaneetha Sasikumar ◽  
Krishna Manohar ◽  
Salla Sweta Ramani ◽  
RaghavanNair Suresh Kumar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Tetralogy Of Fallot ◽  
Pulmonary Atresia ◽  
Total Correction ◽  
Factors Affecting ◽  
Early Outcome ◽  
The Mean

Background The benefits of surgical correction of adult tetralogy of Fallot are well known. The current recommendation is for total correction regardless of age. This study analyzed perioperative factors affecting early outcome after corrective surgery in adulthood in the current era. Methods This was a retrospective chart review of 40 consecutive patients over 18 years of age who underwent total correction of tetralogy of Fallot from September 2006 to June 2013. Patients with pulmonary atresia and absent pulmonary valve were excluded. The mean age at surgery was 26.60 ± 8.69 years (range 18–49 years). Results The mean intensive care unit stay was 3.30 ± 2.29 days (range 0.75–12 days) and hospital stay was 9.97 ± 3.39 days (range 7–22 days). Mortality was 5% (2/40). Multiple parameters indicating immediate postoperative outcomes and their relationships to selected pre-, intra-, and postoperative factors were analyzed. Multivariate analysis showed that postoperative right ventricular dysfunction had a significant influence on mortality ( p < 0.001) and hospital stay ( p = 0.01). Performing zero-balance ultrafiltration decreased the need for renal replacement therapy ( p = 0.034), duration of ventilation ( p = 0.009), incidence of low cardiac output ( p = 0.006), intensive care unit stay ( p = 0.01), and hospital stay ( p = 0.009). Conclusions Total correction of tetralogy of Fallot is a safe option for presentations as late as adulthood. The protective effect of zero-balance ultrafiltration on postoperative morbidity needs to be reassessed in larger studies.

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