Neurological Considerations for the Care of Patients With Severe Obesity

Patients with severe obesity tend to have higher rates of morbidities which can complicate and even lengthen their hospital admission course. Hospitals which do not have the resources to efficiently manage bariatric patients due to equipment weight-restrictions should be proactive in their care and knowledgeable about their options to avoid long delays in treatment. Amid this obesity epidemic, the neurologist plays a role in the inpatient management of patients with severe obesity and could serve as a channel to improve the quality of care and reduce the length of stay. We present a case of a patient with severe obesity who presented with visual loss secondary to idiopathic intracranial hypertension. The patient’s treatment was delayed several weeks from the time of admission until his weight decreased enough to safely undergo CT imaging in the operating room, developing complications throughout the course of his stay. This paper highlights the identified barriers of care and potential solutions to ensure improvement in the quality of care of patients with severe obesity, in order to reduce preventable complications.

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Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3023 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael L James ◽

Julian P Yand ◽

Maria Grau-Sepulveda ◽

DaiWai M Olson ◽

Deepak L Bhatt ◽

...

Keyword(s):

Quality Of Care ◽

Length Of Stay ◽

Intracerebral Hemorrhage ◽

Reference Group ◽

Private Insurance ◽

Quality Measures ◽

Geographic Region ◽

Insurance Status ◽

Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

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Chest tube removal after cardiac surgery

Critical Care Nurse ◽

10.4037/ccn1997.17.1.34 ◽

1997 ◽

Vol 17 (1) ◽

pp. 34-38 ◽

Cited By ~ 6

Author(s):

SC Thomson ◽

S Wells ◽

M Maxwell

Keyword(s):

Cardiac Surgery ◽

Quality Of Care ◽

Length Of Stay ◽

Chest Tube ◽

Chest Tubes ◽

Tube Removal ◽

Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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A Statistically Significant Reduction in Length of Stay and Hospital Costs with Equivalent Quality of Care Metrics for ERCPs Performed During the Weekend Versus Postponed to Weekdays: A 6-Year Study of 533 ERCPs at Four Teaching Hospitals

Digestive Diseases and Sciences ◽

10.1007/s10620-020-06066-z ◽

2020 ◽

Vol 65 (11) ◽

pp. 3132-3142 ◽

Cited By ~ 1

Author(s):

Seifeldin Hakim ◽

Andrew M. Aneese ◽

Ahmed Edhi ◽

Christienne Shams ◽

Treta Purohit ◽

...

Keyword(s):

Quality Of Care ◽

Length Of Stay ◽

Hospital Costs ◽

Teaching Hospitals

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Current Use of Intravenous (IV) Long Acting Antibiotic (LAA) Therapy in the Aetna Health Plan among Patients with Acute Bacterial Skin and Skin Structure Infection (ABSSSI)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.808 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S339-S340

Author(s):

Rajesh Mehta ◽

Alison Edwards ◽

Katelyn R Keyloun ◽

Nicole Bonine ◽

Iver Juster

Keyword(s):

Sensitivity Analysis ◽

Quality Of Care ◽

Cost Savings ◽

Potential Cost ◽

Treatment Pathways ◽

Inpatient Management ◽

Inpatient Population ◽

Long Acting ◽

Potential Opportunity

Abstract Background In an effort to lower costs and improve quality of care, there is potential to change the treatment landscape for low-risk (i.e., less severe) ABSSSI patients who historically required inpatient management, a costly option. Outpatient IV treatment pathways have been shown to be a cost-saving option for hospitals and insurers. The objective was to quantify the potential opportunity for reducing cost of ABSSSI treatment in an insured Commercial and Medicare Aetna population. Methods Adult patients between January 2013 and July 2016 were identified with a primary ABSSSI claim (Table 1) in the Aetna fully-insured Commercial and Medicare insurance claims database. ABSSSI encounters were identified with insurance eligibility for the 7 months prior to and no evidence of ABSSSI in the 30 days prior to the ABSSSI claim. Demographic and clinical data were described, including length of stay (LOS) and allowed cost for inpatient encounters with data. Inpatient encounters without evidence of severity (e.g., codes for major complications or comorbidities) were considered potential candidates for an outpatient LAA pathway. A sensitivity analysis for LOS and cost was run including all ABSSSI patients with LAA dispenses through 2016 (i.e., inclusion/exclusion criteria did not need to be met). Results 194,023 ABSSSI encounters were identified, most receiving non-IV treatment (90%). 18,603 received IV treatment, where 83% initially presented to the emergency room and the majority were admitted (97%). Of the 28 encounters with LAA use, 7 were inpatient. Of all current inpatient encounters (N = 9,019 after Jan 1, 2015), the majority (N = 7,005; 78%) where considered potential LAA pathway candidates. Comparing inpatient encounters with vs. without LAA use, mean LOS and cost differed (Table 2: 4.1 days and $14,295 vs. 9.0 days and $23,194, respectively). A sensitivity analysis supported similar mean LOS and cost for all inpatient LAA dispenses. Conclusion Current use of LAA in an inpatient population is limited but resulted in potential cost-savings. Most of the inpatient population was identified as potential candidates for an outpatient LAA pathway. Research on utilization and quality of care for outpatient IV treatment pathways with LAA is warranted. Disclosures K. R. Keyloun, Allergan: Employee, Salary N. Bonine, Allergan: Employee, Salary

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