scholarly journals Safety and Costs of Stroke Unit Admission for Select Acute Intracerebral Hemorrhage Patients

2017 ◽  
Vol 8 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Corey R. Fehnel ◽  
Kimberly M. Glerum ◽  
Linda C. Wendell ◽  
N. Stevenson Potter ◽  
Brian Silver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Skilled Nursing Facility ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Group 5

Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment. The primary outcome was poor functional status at discharge (modified Rankin score [mRS] ≥3). Secondary outcomes included complications, discharge disposition, hospital length of stay, and direct inpatient costs. Results: The study population included 104 patients (41 admitted to the ICU and 63 admitted to the SU). After controlling for differences in baseline characteristics, there were no differences in poor functional outcome at discharge (93% vs 85%, P = .26) or in mean mRS (2.9 vs 3.0, P = .73). Similarly, there were no differences in the rates of complications (6% vs 10%, P = .44), discharged dead or to a skilled nursing facility (8% vs 13%, P = .59), or direct patient costs (US$7100 vs US$6200, P = .33). Median length of stay was significantly longer in the ICU group (5 vs 4 days, P = .01). Conclusions: This study revealed a shorter length of stay but no large differences in functional outcome, safety, or cost among patients with minor ICH admitted to a dedicated SU compared to an ICU.

Abstract WP355: Intracerebral Hemorrhage Care in a Stroke Unit is Safe and Associated With Lower Costs

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Corey R Fehnel ◽  
Linda C Wendell ◽  
N. Stevenson Potter ◽  
Kimberly Glerum ◽  
Richard N Jones ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Stroke Unit ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Total Hospital ◽  
Reduced Costs ◽  
Reducing Costs ◽  
Ich Score ◽  
Median Hospital

Background: There is little data to support level of care decisions for lower risk intracerebral hemorrhage (ICH) patients. The addition of a dedicated stroke unit (SU) at our institution allowed for a comparison of such patients cared for in the intensive care unit (ICU) or SU. We hypothesized that SU care of select ICH patients would not change functional outcome, and result in reduced costs. Methods: Two retrospective cohorts of consecutive patients with small (<20 cc) supratentorial ICH and the absence of anticoagulation were enrolled. In the first study period from August 1, 2008 to February 1, 2011, patients were admitted to the neurological or medical ICU (historical control). In the second study period from August 1, 2012 to January 30, 2014, patients were admitted to a dedicated SU. Intubated patients, those requiring vasopressors, osmotic therapy, or ventriculostomy were excluded. Primary outcomes were discharge modified Rankin Score (mRS) and total hospital charges. Multivariate analyses were used for predicting mRS and early complications. Results: There were 104 patients included in the analysis (41 ICU, 63 SU). Mean age, gender and race did not differ significantly between groups. Mean ICH volume was 6cc in the SU group and 8cc in the ICU group (P>.05). Prior antiplatelet use, ICH location, and ICH score did not differ between groups. Intraventricular hemorrhage and hydrocephalus were more common in the ICU group (P<.001). Two SU patients transferred to the ICU for pneumonia and acute myocardial infarction. There were no significant differences in complications such as ICH expansion, use of osmotic therapy, seizures, or pneumonia. There was no difference in discharge mRS between groups (P>.05). Median hospital length of stay was 6 days in the ICU group and 3 days in SU group (P<.001). Median direct costs for the ICU group were $5,859 (IQR 4,782-9,733) and were $4,078 (IQR 2,861-6,865) for the SU group (P<.001). Unit of admission was not a significant predictor of early complication (P=.73) or discharge mRS (P=.43) in multivariate analysis. Conclusions: This preliminary retrospective study provides support for select low-risk ICH patients to be safely cared for in a lower intensity setting with potential for reducing costs.

Abstract 17191: Intraprocedural Dobutamine Use is Independently Associated With Prolonged Length of Stay (LOS) Following Ventricular Tachycardia (VT) Ablation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Jeffrey D Graham ◽  
Michael Rosenberg ◽  
Amneet Sandhu ◽  
Alexis Tumolo ◽  
Wendy Tzou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Impact Factors ◽  
Vasoactive Drugs ◽  
Prolonged Length ◽  
Procedural Time ◽  
Minimal Data ◽  
Vt Ablation

Introduction: Use of inotropes such as dobutamine remains controversial in the management of heart failure (HF) due to uncertain efficacy and lack of mortality benefit. Furthermore, vasoactive drugs are frequently utilized during VT ablations despite minimal data regarding their effects on outcomes. Vasoactive drugs may impact factors such as long-term VT recurrences and hospital length of stay. Hypothesis: We sought to evaluate the hypothesis that the use of dopamine, dobutamine or phenylephrine have differential effects on outcomes after VT ablations. Methods: A retrospective analysis was completed for all VT ablations from 2013-17 at our institution. Patient characteristics and procedural details were collected for 149 VT ablation cases. Results: The cohort was 81% male, and 67% had cardiomyopathy of which 53% were ischemic with a mean EF of 29% (CI 26.7- 31.4). Average procedure time was 368 minutes (CI 347-388). Vasoactive drugs were used in 87% of patients undergoing VT ablation: phenylephrine (67%), dopamine (40%), dobutamine (37%). The median LOS for all patients was 5 days (mean 7 days, range 1 - 56 days, IQR 2 - 9 days). After adjusting for inducibility, HF and procedural time, the dose of dobutamine, but not dopamine or phenylephrine, was significantly associated with increased length of stay (Fig. 1a). Inducible VT at the end of the procedure also correlated with increased LOS (5.4±0.3 vs 8.6±0.3, p < 0.0001). Procedural time did not associate with increased LOS. Of all covariates, only the number of VTs induced during the procedure was significantly associated with increased VT recurrence (HR 1.22/VT morphology (CI 1.11-1.34, p < 0.001)). Conclusions: Dobutamine, but not phenylephrine or dopamine, was significantly associated with increased length of stay after adjusting for HF, procedural time and inducibility of VT. More research is needed regarding vasoactive drug use in VT ablations and their significance to procedural and post-procedure outcomes.

Impact of acute stroke unit on hospital length of stay

2009 ◽  
Vol 49 (1) ◽  
pp. e12-e15 ◽  
Author(s):  
Liang-Kung Chen ◽  
Jacqueline McClaran ◽  
Alastair Mitchell Buchan
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acute Stroke Unit

Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 165-165
Author(s):  
Ali John Zarrabi ◽  
Karen Armstrong ◽  
Kimberly A. Curseen ◽  
Tammie E. Quest
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Commercial Insurance ◽  
Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

Predictors of hospital length of stay and cost in patients with intracerebral hemorrhage

Neurology ◽  
2006 ◽  
Vol 67 (7) ◽  
pp. 1279-1281 ◽  
Author(s):  
M. W. Russell ◽  
A. V. Joshi ◽  
P. J. Neumann ◽  
L. Boulanger ◽  
J. Menzin
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Hospital Length ◽  
Hospital Length Of Stay

Hospital length of stay after hip fracture and its association with 4-month mortality – Exploring the role of patient characteristics

2021 ◽  
Author(s):  
Stina Ek ◽  
Anna C Meyer ◽  
Margareta Hedström ◽  
Karin Modig
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Mortality Risk ◽  
Cox Regression ◽  
Living Arrangement ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Care Homes ◽  
Hospital Length Of Stay ◽  
Increased Risk

Abstract Background Hospital length of stay (LoS) is believed to be associated with higher mortality in hip fracture patients, however, previous research has shown conflicting results. We aimed to explore the association between LoS and 4-month mortality in different groups of hip fracture patients. Methods The study population in this Swedish register-based cohort study was 47,811 patients ≥65 years old with a first hip fracture during 2012-2016, followed for 4 months after discharge. LoS was categorized by cubic splines and the association between LoS and mortality was analyzed with Cox regression models, adjusted for sociodemographic- and health related factors. Results Mean LoS was 11.2±5.9 days and 12.3% of the patients died within 4 months. Both a shorter and a longer LoS, compared to the reference 9-12 days, was associated with higher mortality (HR [95% CI]); 2-4 days 2.15 (1.98-2.34), 5-8 days 1.58 (1.47-1.69) and 24+ days 1.29 (1.13-1.46). However, in fully-adjusted models, only the association with a long LoS remained; 13-23 days 1.08 (1.00-1.17) and 24+ days 1.42 (1.25-1.61). Stratifying by living arrangement revealed that the increased risk for a short LoS was driven by the group living in care homes. For patients living at home, a short LoS was associated with a lower risk, HR 0.65 (0.47-0.91) and 0.85 (0.74-0.98) for 2-4 and 5-8 days, respectively. Conclusions A long LoS after a hip fracture is associated with increased 4-month mortality risk even after considering patient characteristics. The association between mortality and a short LoS, however, is explained by individuals coming from care homes (with higher mortality risk), being discharged early.

Abstract P570: Arterial Stenosis in Posterior Reversible Encephalopathy Syndrome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Monica Scarsella ◽  
Meghan Purohit ◽  
Karlo Toljan ◽  
Ken Uchino ◽  
Dolora R Wisco
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Arterial Stenosis ◽  
Hospital Length Of Stay ◽  
Posterior Reversible Encephalopathy ◽  
Discharge Disposition ◽  
Reversible Encephalopathy ◽  
Arterial Imaging

Objectives: Posterior Reversible Encephalopathy Syndrome (PRES) is characterized as reversible vasogenic cerebral edema in a posterior-dominant distribution. Some patients with PRES have diffusion-weighted imaging (DWI) changes on MRI, as well as transient arterial stenosis. We examined the association between arterial stenosis and presence of hemorrhage and MRI-DWI changes in PRES. Methods: We retrospectively identified patients with PRES in electronic health records at a single health system from January 2008 to December 2018. We included patients age 18 years or older with clinical and radiographic evidence of PRES and arterial imaging (CT or MR angiography or digital subtraction angiogram). Any arterial stenosis was noted, with reversibility determined by repeat imaging. Patient characteristics, disease presentation, hospital lengths of stay and discharge dispositions, as well as imaging findings were collected and statistical analysis was used. Results: Of 281 patients with PRES, 169 had arterial imaging. Thirty-two (18.9%) had arterial stenosis and 60% had resolved arterial stenosis on follow-up imaging. Patients with arterial stenosis were younger compared to those without (47 v 55 years, p =0.03), however they did not differ in symptoms of presentation or comorbid conditions. Of note, arterial stenosis was associated with intracerebral hemorrhage[34% with stenosis and 18% without stenosis, p=0.05). However, the presence of MRI DWI lesions did not correlate with arterial stenosis [14/32 (44%) with stenosis, 49/137 (36%) without stenosis, p=0.42]. Among 97 patients with follow-up MRI, the presence of arterial stenosis was not associated with greater FLAIR reversibility. Furthermore, hospital length of stay or discharge disposition was not associated with arterial stenosis in PRES. Conclusions: Arterial stenoses are found in 19% of PRES patients, and most are reversed on follow-up imaging. They are also associated with hemorrhagic PRES, but not with MRI-DWI lesions or degree of FLAIR reversibility.

Surgical Scheduling Impacts Hospital Length of Stay and Associated Healthcare Costs for Patients Undergoing Total Hip and Knee Arthroplasty

2021 ◽  
pp. 155633162110400
Author(s):  
Sofia Ahsanuddin ◽  
Daniel J. Snyder ◽  
Hsin-Hui Huang ◽  
Aakash Keswani ◽  
Jashvant Poeran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Skilled Nursing ◽  
Total Hip ◽  
Surgical Scheduling ◽  
Modifiable Factor ◽  
Day Of The Week

Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.

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