scholarly journals Strategies to minimize readmission rates following major urologic surgery

2017 ◽  
Vol 9 (5) ◽  
pp. 111-119 ◽  
Author(s):  
Janet Baack Kukreja ◽  
Ashish M. Kamat
Keyword(s):  
Negative Impact ◽  
Early Discharge ◽  
The United States ◽  
Time Frame ◽  
Major Surgery ◽  
Readmission Rates ◽  
Urologic Oncology ◽  
Improve Symptom ◽  
Significant Negative Impact ◽  
Recovery Pathways

Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families. Here, we explore the reasons patients are readmitted, using radical cystectomy as a case study, and means to decrease the incidence of readmissions. Since time to readmission for most major urologic oncology surgeries is within the first 2 weeks after discharge, this time frame is critical for efforts to improve symptom identification and reduce the total number and severity of readmissions. Readmission reduction to zero is unlikely for any major surgery, but with effective coordinated strategies, we must strive to reduce the rates as much as possible, as a means to improve the care continuum for our patients.

scholarly journals Reserved Bed Program Reduces Neurosciences Intensive Care Unit Capacity Strain: An Implementation Study

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 132-138
Author(s):  
Christopher D Shank ◽  
Nicholas J Erickson ◽  
David W Miller ◽  
Brittany F Lindsey ◽  
Beverly C Walters
Keyword(s):  
Intensive Care ◽  
Economies Of Scale ◽  
Negative Impact ◽  
The United States ◽  
Fiscal Year ◽  
Implementation Study ◽  
Service Line ◽  
Hospital Units ◽  
Significant Negative Impact ◽  
Operational Issues

Abstract BACKGROUND Neurosciences intensive care units (NICUs) provide institutional centers for specialized care. Despite a demonstrable reduction in morbidity and mortality, NICUs may experience significant capacity strain with resulting supraoptimal utilization and diseconomies of scale. We present an implementation study in the recognition and management of capacity strain within a large NICU in the United States. Excessive resource demand in an NICU creates significant operational issues. OBJECTIVE To evaluate the efficacy of a Reserved Bed Pilot Program (RBPP), implemented to maximize economies of scale, to reduce transfer declines due to lack of capacity, and to increase transfer volume for the neurosciences service-line. METHODS Key performance indicators (KPIs) were created to evaluate RBPP efficacy with respect to primary (strategic) objectives. Operational KPIs were established to evaluate changes in operational throughput for the neurosciences and other service-lines. For each KPI, pilot-period data were compared to the previous fiscal year. RESULTS RBPP implementation resulted in a significant increase in accepted transfer volume to the neurosciences service-line (P = .02). Transfer declines due to capacity decreased significantly (P = .01). Unit utilization significantly improved across service-line units relative to theoretical optima (P < .03). Care regionalization was achieved through a significant reduction in “off-service” patient placement (P = .01). Negative externalities were minimized, with no significant negative impact in the operational KPIs of other evaluated service-lines (P = .11). CONCLUSION Capacity strain is a significant issue for hospital units. Reducing capacity strain can increase unit efficiency, improve resource utilization, and augment service-line throughput. RBPP implementation resulted in a significant improvement in service-line operations, regional access to care, and resource efficiency, with minimal externalities at the institutional level.

scholarly journals Maternal and Neonatal Outcome following Day Two versus Day Five or Seven Discharge after an Uncomplicated Elective Caesarean Section: A Randomized Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Fidelis A. Onu ◽  
Chidebe C. Anikwe ◽  
Johnbosco E. Mamah ◽  
Okechukwu B. Anozie ◽  
Osita S. Umeononihu ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Hospital Discharge ◽  
Negative Impact ◽  
Elective Caesarean Section ◽  
Early Discharge ◽  
Control Group ◽  
Maternal Satisfaction ◽  
Significant Difference ◽  
Significant Negative Impact ◽  
Maternal And Neonatal Outcomes

Background. In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources. Objective. To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS. Materials and Methods. Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1st October 2018 and 30th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5th or 7th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22. Results. Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge ( χ 2 = 0.95 , P = 0.329 ). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group ( χ 2 = 1.65 , P = 0.649 ). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge ( χ 2 = 16.64 , P = 0.0001 , OR = 0.857 , 95 % CI = 0.59 – 1.25 ). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 ( χ 2 = 4.45 , P = 0.108 ). Early hospital discharge did not have any significant negative impact on neonatal health ( χ 2 = 1.063 , P = 0.303 ). Conclusion. Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS.

scholarly journals Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Abhijit S. Nair ◽  
Sandeep Diwan
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Early Discharge ◽  
Major Surgery ◽  
Emergency Laparotomy ◽  
Early Recovery ◽  
Recovery Pathways ◽  
Perioperative Care Pathway ◽  
The Cost

Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

scholarly journals Labor Market Adjustment In High-Tech Industries: A Critical Review

2011 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Amlan Mitra ◽  
Bhaskar J. Das
Keyword(s):  
Labor Market ◽  
Negative Impact ◽  
Local Level ◽  
Relevant Literature ◽  
The United States ◽  
High Tech ◽  
Significant Negative Impact ◽  
Occupational Composition ◽  
Social Debate ◽  
Labor Market Adjustment

Capitalist restructuring in the United States has been a key fore in reshaping cities and regions in the late 1970s and 1980s. The emergence of high-tech industries and its impact on the level of employment, the quality of work, and the condition of labor is at the core of the social debate over the high-tech led economic development. Some researchers argue that high-tech industries have a positive effect on labor markets. Others seem to support the idea of a significant negative impact exercised by high-technologies on employment patterns and occupational composition. The purpose of this paper is to provide some insights on this debate by critically examining the relevant literature. We conclude that there is a need to inquire further into the labor market adjustment at the local level to unravel the inner complexities.

scholarly journals Discontinuation of the Bleeding Time Test without Detectable Adverse Clinical Impact

2001 ◽  
Vol 47 (7) ◽  
pp. 1204-1211 ◽  
Author(s):  
Christopher M Lehman ◽  
Robert C Blaylock ◽  
Donald P Alexander ◽  
George M Rodgers
Keyword(s):  
Platelet Aggregation ◽  
Bleeding Time ◽  
Negative Impact ◽  
Invasive Procedure ◽  
Bleeding Complications ◽  
Major Surgery ◽  
Populations At Risk ◽  
Before And After ◽  
Significant Negative Impact ◽  
The Mean

Abstract Background: The bleeding time (BT) test predicts a higher bleeding complication rate in populations at risk for inherited or acquired platelet dysfunction, but it is of limited assistance in evaluating individual patients. There are no reports of clinical outcomes after discontinuation of the BT test. Methods: Interviews with a subset of the physicians who had ordered the BT test before discontinuation of the test were conducted. The total number of platelet-aggregation tests, the mean number of monthly, unmodified platelet units transfused, the incidence of kidney biopsy complications, and the number of doses of 1-deamino-8-d-arginine vasopressin (DDAVP) administered 5 months before and after discontinuation of the BT test were compared. We recorded the rates of bleeding complications in the Major Surgery Risk Pool during the 12 months before and the 5 months after the discontinuation of the BT test. Results: Clinicians reported they did not significantly change their preprocedural work-ups, postpone an invasive procedure, experience an increase in bleeding complications, or increase their use of blood products after discontinuation of the BT test. Platelet-aggregation tests (n = 9, before and after), platelet transfusions (P = 0.958), and DDAVP administration (before = 24; after = 10) did not increase after discontinuation of the BT test. The rate of postprocedural bleeding complications did not increase significantly in either Major Surgery Risk Pool cases (<3ς deviation from the mean rate) or in patients undergoing renal biopsies (P = 0.225 for decrease in hematocrit; P = 1.000 for the percentage of patients transfused) after discontinuation of the BT test. Conclusions: Our study failed to identify a clinically significant, negative impact of discontinuing the BT test.

scholarly journals Mental Retirement

2010 ◽  
Vol 24 (1) ◽  
pp. 119-138 ◽  
Author(s):  
Susann Rohwedder ◽  
Robert J Willis
Keyword(s):  
Instrumental Variables ◽  
Early Retirement ◽  
Negative Impact ◽  
Causal Effect ◽  
The United States ◽  
Substantial Body ◽  
Labor Force Status ◽  
Retirement Behavior ◽  
Significant Negative Impact ◽  
Cross Country

Early retirement appears to have a significant negative impact on the cognitive ability of people in their early 60s that is both quantitatively important and causal. We obtain this finding using cross-nationally comparable survey data from the United States, England, and Europe that allow us to relate cognition and labor force status. We argue that the effect is causal by making use of a substantial body of research showing that variation in pension, tax, and disability policies explain most variation across countries in average retirement rates. (In an informal manner, we are arguing that public policies that affect the age of retirement may be used as instrumental variables to generate cross-country variation in retirement behavior in order to identify the causal effect of retirement on cognition.)

scholarly journals Specific aspects of indian foreign policy: stagnation and changes

2020 ◽  
Vol 3 (5) ◽  
pp. 55-64
Author(s):  
Rano Tuychiyeva Almamatovna
Keyword(s):  
United States ◽  
Foreign Policy ◽  
Main Part ◽  
Negative Impact ◽  
The United States ◽  
External Factors ◽  
Significant Negative Impact ◽  
Internal And External Factors ◽  
Indian Foreign Policy ◽  
Positive Results

This article focuses on how India organized its foreign policy from the time of independence until the beginning of the 21st century and on the basis of which strategies it pursued. The paper also examines in detail the internal and external factors that have helped the country to achieve effective, positive results in foreign policy and, conversely, have had a significant negative impact. In addition, the article pays special attention to India's relations with the United States, China and Russia, which are currently striving for global hegemony, and the competition between these countries in India. At the same time, the successes, shortcomings and conflicts in India’s relations with its neighbors - Pakistan, Bangladesh, Myanmar, Nepal and Bhutan - are highlighted, as well as their specific reasons. Chronological approach, comparison and synthesis-analysis methods were used in writing the article. It consists of an abstract, keywords, introduction, main part, conclusion and bibliography.

scholarly journals Supply of immigrant entrepreneurs and native entrepreneurship

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Keshar M. Ghimire
Keyword(s):  
Least Squares ◽  
Negative Impact ◽  
The United States ◽  
Ordinary Least Squares ◽  
Self Employment ◽  
Immigrant Entrepreneurs ◽  
Significant Negative Impact ◽  
State Variation ◽  
Nationally Representative ◽  
Least Squares Estimates

Abstract Using nationally representative data from the United States, the author estimates the causal impact of immigrant entrepreneurship on entrepreneurial propensities of natives. The author draws data from the Annual Social and Economic Supplement of the Current Population Survey and uses within-state variation in supply of immigrant entrepreneurs for identification. To address concerns of endogeneity in the supply of immigrant entrepreneurs, the author takes advantage of a quasi-experiment provided by the State Children's Health Insurance Program. While the Ordinary Least Squares estimates indicate a positive effect, the Two Stage Least Squares estimates suggest that, on average, there is no significant effect of immigrant entrepreneurs on native entrepreneurship. Moreover, there is no net effect on subgroups of natives separated by skill level. There is also some evidence that immigrant entrepreneurs may “crowd-in” Blacks into certain types of self-employment. These results are in contrast to the significant negative impact suggested by the previous literature.

scholarly journals Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009–2013

2018 ◽  
Vol 67 (5) ◽  
pp. 727-735 ◽  
Author(s):  
Marya D Zilberberg ◽  
Brian H Nathanson ◽  
Rachel Harrington ◽  
James R Spalding ◽  
Andrew F Shorr
Keyword(s):  
United States ◽  
High Risk ◽  
Propensity Score ◽  
Confidence Interval ◽  
Invasive Aspergillosis ◽  
Propensity Score Matching ◽  
The United States ◽  
Major Surgery ◽  
Readmission Rates ◽  
Excess Costs

Abstract Background Though invasive aspergillosis (IA) complicates care of up to 13% of patients with immunocompromise, little is known about its morbidity and mortality burden in the United States. Methods We analyzed the Health Care Utilization Project’s data from the Agency for Healthcare Research and Quality for 2009–2013. Among subjects with high-risk conditions for IA, IA was identified via International Classification of Diseases, Ninth Revision, Clinical Modification codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). Using propensity score matching, we calculated the IA-associated excess mortality and 30-day readmission rates, length of stay, and costs. Results Of the 66634683 discharged patients meeting study inclusion criteria, 154888 (0.2%) had a diagnosis of IA. The most common high-risk conditions were major surgery (50.1%) in the non-IA and critical illness (41.0%) in the IA group. After propensity score matching, both mortality (odds ratio, 1.43; 95% confidence interval, 1.36–1.51) and 30-day readmission (1.39; 1.34–1.45) rates were higher in the IA group. IA was associated with 6.0 (95% confidence interval, 5.7–6.4) excess days in the hospital and $15542 ($13869–$17215) in excess costs per hospitalization. Conclusions Although rare even among high-risk groups, IA is associated with increased hospital mortality and 30-day readmission rates, excess duration of hospitalization, and costs. Given nearly 40000 annual admissions for IA in the United States, the aggregate IA-attributable excess costs may reach $600 million annually.

Health Communication: Implications for Diverse Populations

2011 ◽  
Vol 18 (1) ◽  
pp. 12-19
Author(s):  
Amy Hasselkus
Keyword(s):  
Health Care ◽  
Health Communication ◽  
Negative Impact ◽  
Linguistically Diverse ◽  
Good Health ◽  
The United States ◽  
Poor Health ◽  
Health Care Decisions ◽  
Diverse Backgrounds ◽  
Health Related

The need for improved communication about health-related topics is evident in statistics about the health literacy of adults living in the United States. The negative impact of poor health communication is huge, resulting in poor health outcomes, health disparities, and high health care costs. The importance of good health communication is relevant to all patient populations, including those from culturally and linguistically diverse backgrounds. Efforts are underway at all levels, from individual professionals to the federal government, to improve the information patients receive so that they can make appropriate health care decisions. This article describes these efforts and discusses how speech-language pathologists and audiologists may be impacted.

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