scholarly journals Management of Patients With Sepsis in Canadian Community Emergency Departments: A Retrospective Multicenter Observational Study

2020 ◽  
Vol 7 ◽  
pp. 233339282092008
Author(s):  
Victor C. K. Lo ◽  
Haitong Su ◽  
Yuet Ming Lam ◽  
Kathleen Willis ◽  
Virginia Pullar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Observational Study ◽  
Hospital Mortality ◽  
Emergency Departments ◽  
Lactate Concentration ◽  
Admission Rate ◽  
Multicenter Observational Study ◽  
Icu Admission ◽  
Physician Assessment ◽  
Assessment Time

Background: Sepsis is a life-threatening syndrome and a leading cause of morbidity and mortality representing significant financial burden on the health-care system. Early identification and intervention is crucial to maximizing positive outcomes. We studied a quality improvement initiative with the aim of reviewing the initial management of patients with sepsis in Canadian community emergency departments, to identify areas for improving the delivery of sepsis care. We present a retrospective, multicenter, observational study during 2011 to 2015 in the community setting. Methods: We collected data on baseline characteristics, clinical management metrics (triage-to-physician-assessment time, triage-to-lactate-drawn time, triage-to-antibiotic time, and volume of fluids administered within the first 6 hours of triage), and outcomes (intensive care unit [ICU] admission, in-hospital mortality) from a regional database. Results: A total of 2056 patients were analyzed. The median triage-to-physician-assessment time was 50 minutes (interquartile range [IQR]: 25-104), triage-to-lactate-drawn time was 50 minutes (IQR: 63-94), and triage-to-antibiotics time was 129 minutes (IQR: 70-221). The median total amount of fluid administered within 6 hours of triage was 2.0 L (IQR: 1.5-3.0). The ICU admission rate was 36% and in-hospital mortality was 25%. We also observed a higher ICU admission rate (51% vs 24%) and in-hospital mortality (44% vs 14%) in those with higher lactate concentration (≥4 vs ≤2 mmol/L), independent of other sepsis-related parameters. Conclusion: Time-to-physician-assessment, time-to-lactate-drawn, time-to-antibiotics, and fluid resuscitation in community emergency departments could be improved. Future quality improvement interventions are required to optimize management of patients with sepsis. Elevated lactate concentration was also independently associated with ICU admission rate and in-hospital mortality rate.

scholarly journals Predicted quality benefits of achievable performance benchmarks of chronic heart failure care in China: results from a nationwide observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036786
Author(s):  
Chang Yin ◽  
Xi Li ◽  
Chao Wang ◽  
Jingkun Li ◽  
Xiaoqiang Bao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Improvement ◽  
Chronic Heart Failure ◽  
Observational Study ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Patient Survey ◽  
Primary Outcome Measure ◽  
Adherence Rate ◽  
Independent Variables

ObjectivesThis study aimed to set a data-driven achievable performance benchmark, explore the process–outcome association and speculate about the net gain in quality improvement with benchmarking.DesignObservational study.SettingPatient survey conducted at 466 secondary and tertiary hospitals across 31 provinces, autonomous regions and municipalities in China.Participants183 334 patients diagnosed with chronic heart failure (CHF) who were treated at 466 Chinese hospitals from January 2011 through May 2017.Primary independent variablesHospital process composite performance (HPCP).Secondary independent variablesPatient-level and hospital-level characteristics.Primary outcome measurePatients getting better or recovered after treatment, in-hospital mortality, length of hospital stay (LOS) and medical cost.MethodsHPCP was calculated using denominator-based weights. Mixed random-intercept models were used to evaluate the contributions of HPCP on patient outcomes and to speculate quality improvement after adjusting HPCP to benchmark level.ResultsWhen all hospitals were to operate at the benchmark level, the proportion of patients getting better or recovered after treatment would increase in most hospitals, particularly those with low baseline rates. However, there was no evidence for lowering in-hospital mortality, significant savings in cost or shortening LOS.ConclusionsIncreasing the adherence rate of CHF care and closing the gap in HPCP between hospitals have important implications for improving patient condition.

Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015

2019 ◽  
Vol 73 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Roger Daglius Dias ◽  
Jacson Venancio de Barros
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Older People ◽  
Health System ◽  
Hospital Admissions ◽  
Public Health System ◽  
Average Length ◽  
Admission Rate ◽  
Older Population ◽  
Icu Admission

BackgroundThe world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.MethodsUsing the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.ResultsA total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.ConclusionThese findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.

scholarly journals Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission

2014 ◽  
Vol 40 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Denise Rossato Silva ◽  
Larissa Pozzebon da Silva ◽  
Paulo de Tarso Roth Dalcin
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Admission Rate ◽  
Hospitalized Patients ◽  
Tuberculosis Treatment ◽  
Medical Attention ◽  
Considerable Proportion ◽  
Sputum Smear ◽  
Icu Admission

Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment.

scholarly journals Clinical and Biological Predictors of Plasma Levels of Soluble RAGE in Critically Ill Patients: Secondary Analysis of a Prospective Multicenter Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Thibaut Pranal ◽  
Bruno Pereira ◽  
Pauline Berthelin ◽  
Laurence Roszyk ◽  
Thomas Godet ◽  
...  
Keyword(s):  
Observational Study ◽  
Plasma Levels ◽  
Patient Characteristics ◽  
Biological Parameters ◽  
Multicenter Observational Study ◽  
Icu Admission ◽  
Biological Indices ◽  
Ancillary Study ◽  
Soluble Rage ◽  
Circulating Levels

Rationale. Although soluble forms of the receptor for advanced glycation end products (RAGE) have been recently proposed as biomarkers in multiple acute or chronic diseases, few studies evaluated the influence of usual clinical and biological parameters, or of patient characteristics and comorbidities, on circulating levels of soluble RAGE in the intensive care unit (ICU) setting. Objectives. To determine, among clinical and biological parameters that are usually recorded upon ICU admission, which variables, if any, could be associated with plasma levels of soluble RAGE. Methods. Data for this ancillary study were prospectively obtained from adult patients with at least one ARDS risk factor upon ICU admission enrolled in a large multicenter observational study. At ICU admission, plasma levels of total soluble RAGE (sRAGE) and endogenous secretory (es)RAGE were measured by duplicate ELISA and baseline patient characteristics, comorbidities, and usual clinical and biological indices were recorded. After univariate analyses, significant variables were used in multivariate, multidimensional analyses. Measurements and Main Results. 294 patients were included in this ancillary study, among whom 62% were admitted for medical reasons, including septic shock (11%), coma (11%), and pneumonia (6%). Although some variables were associated with plasma levels of RAGE soluble forms in univariate analysis, multidimensional analyses showed no significant association between admission parameters and baseline plasma sRAGE or esRAGE. Conclusions. We found no obvious association between circulating levels of soluble RAGE and clinical and biological indices that are usually recorded upon ICU admission. This trial is registered with NCT02070536.

scholarly journals Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

2020 ◽  
Author(s):  
Esther Park ◽  
Hyejeong Park ◽  
Danbee Kang ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
...  
Keyword(s):  
Health Disparities ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Household Income ◽  
Pediatric Patients ◽  
Admission Rate ◽  
National Database ◽  
Critically Ill Children ◽  
Icu Admission ◽  
Icu Discharge

Abstract Background: There is a lack of nationwide studies on health disparity of critically ill patients under the National Health Insurance (NHI) System. We aim to evaluate health disparities in intensive care unit (ICU) admission, outcomes, and readmission after ICU discharge in an impoverished pediatric population.Methods: We conducted a retrospective cohort study using a national database of claims submitted to the Korean NHI and Medical Aid Program (MAP). MAP provides support for the population whose household income is lower than 40% of the median Korean household income, and we defined poverty as being a MAP beneficiary. Patients between 28 days and 18 years old who were admitted to the ICU between August 1, 2010 and September 30, 2013, were included. Demographic characteristics, procedures, admission rates, and clinical outcomes were compared between the poverty and reference groups. Logistic regression model used to analyze hospital mortality and readmission with adjustment for patient characteristics, hospital type, and management procedures.Results: Out of 17,893 patients, 1,153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There were more deaths among impoverished patients who were admitted to the ICU (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group had a similar risk of adjusted in-hospital mortality to those not in the poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42).Conclusion: Pediatric patients in poverty were more likely to die in association with ICU admission. A high ICU admission rate rather than the high in-hospital mortality rate may cause the disparity in deaths. Further policies and studies are required to improve the health status of pediatric patients in poverty to decrease ICU admission.Trial registration: retrospectively registered

scholarly journals Effect of Timely Lactate Measurement on In-hospital Mortality among Adults with Hypotension and Hyperlactatemia: An Observational Study on Two Cohorts

2020 ◽  
Author(s):  
Hui Chen ◽  
Xiebing Bao ◽  
Ying Xu ◽  
Yanxia Guo ◽  
Mingqin Zhou ◽  
...  
Keyword(s):  
Observational Study ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Lower Risk ◽  
Mediation Effect ◽  
Research Database ◽  
Icu Admission ◽  
Causal Mediation ◽  
Lactate Measurement ◽  
Mimic Iii

Abstract Background: Whether patients presented with hypotension and hyperlactatemia can benefit from timely lactate measurement and further lactate-guide resuscitation were not fully understood.Methods: This was a retrospective observational study based on the data from the Medical Information Mart for Intensive Care (MIMIC)-III Database and the eICU Collaborative Research Database (eICU). Patients with hypotension (defined as a minimal systolic blood pressure ≤90 mm Hg or minimal mean arterial pressure ≤65 mm Hg or requiring any vasopressors support during the first 24 h after ICU admission) and hyperlactatemia (defined as an initial lactate level > 2.0 mmol/L after ICU admission) were eligible.The primary exposure was the timely lactate measurement, which was defined as an initial lactate level measured within 1 h after ICU admission. The primary outcome was in-hospital mortality. The statistical approaches included multivariate regression, propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) and causal mediation analysis (CMA) were utilized to elucidate the relationship between timely lactate measurement and in-hospital mortality. Results: A total of 9978 patients were identified, of which 4257 in MIMIC-III and 5721 in eICU. Timely lactate measurement was associated with lower risk-adjusted in-hospital mortality both in MIMIC (OR 0.70 (95%CI 0.58-0.85; p<0.001)) and eICU (OR 0.75 (95%CI 0.64-0.88; p<0.001)). Time to initial intravenous fluid (IVF) in MIMIC mediated 6.7% (95%CI 1.4%-38%; p<0.001) of the beneficial effect of timely lactate measurement (p<0.001 for average causal mediation effect (ACME)) in terms of in-hospital mortality. Finally, delayed initial lactate measurements are also associated an increased in-hospital mortality in MIMIC and eICU.Conclusions: Timely lactate measurement is associated with a lower risk-adjusted in-hospital mortality among patients with hypotension and hyperlactatemia, which was proportional mediated through shortening the time to IVF. Delay in initial lactate measurement showed a positive association with in-hospital mortality.

scholarly journals Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

2020 ◽  
Author(s):  
Hyun Jeong Kim ◽  
Jinhyun Kim ◽  
Jung Hun Ohn ◽  
Nak-Hyun Kim
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Waiting Time ◽  
Admission Rate ◽  
Care Hospital ◽  
Care Model ◽  
Medical Unit ◽  
Icu Admission ◽  
Medical Needs ◽  
Acute Medical Unit

Abstract BACKGROUND: The present study aimed to assess a newly introduced, hospitalist-run, acute medical unit (AMU) model in Korea. The AMU in our institution started in October 2015. Four hospitalists managed patients with acute medical needs that were admitted through the emergency department (ED). STUDY DESIGN: We conducted a retrospective cohort study of all medical inpatients admitted through the ED from June 1, 2016 to May 31, 2017, at a tertiary care hospital. We evaluated 6391 patients whether the hospitalist care in the AMU improved patient outcomes compared to standard non-hospitalist care. METHODS: We created multivariate analysis models to compare the clinical outcomes of patients cared for by hospitalists with the outcomes of patients cared for by non-hospitalists. RESULTS: In the adjusted models, compared to the non-hospitalist group, the AMU hospitalist group had a lower in-hospital mortality (OR: 0.46, P <0.001), a lower intensive care unit (ICU) admission rate (OR: 0.39, P <0 .001), a shorter hospital length of stay (coefficient: -1.349, SE: 0.217; P <0.001), and a shorter ED waiting time (coefficient: -3.021, SE: 0.256; P <0.001). There were no significant differences in the 10-day or 30-day re-admission rates (P = 0.493, P = 0.201; respectively). CONCLUSIONS: The AMU hospitalist care model was associated with reductions in in-hospital mortality, ICU admission rate, length of hospital stay, and ED waiting time. These findings suggested that this AMU hospitalist care model might be adaptable to other healthcare systems to improve care for patients with acute medical needs.

Mo1415 – Hospital Mortality in Pancreatic Surgery – Results of a Multicenter Observational Study

2019 ◽  
Vol 156 (6) ◽  
pp. S-1466
Author(s):  
Frank Meyer ◽  
Ingo Gastinger ◽  
Henry Ptok ◽  
Hans Lippert ◽  
Henning Dralle
Keyword(s):  
Observational Study ◽  
Hospital Mortality ◽  
Pancreatic Surgery ◽  
Multicenter Observational Study

scholarly journals Intensive Care Unit and Hospital Outcomes of Patients Admitted with Blastomycosis: A 14-Year Retrospective Study

2021 ◽  
Author(s):  
Yahya Almodallal ◽  
Adham K Alkurashi ◽  
Hasan Ahmad Hasan Albitar ◽  
Hussam Jenad ◽  
Suartcha Prueksaritanond ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Clinical Presentation ◽  
Admission Rate ◽  
Icu Admission ◽  
Life Threatening

Abstract Introduction: Blastomycosis is an uncommon; potentially life threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients admitted with blastomycosis. Methods: All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.Results: A total of 84 Patients were identified with 93 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1-65, range: 6-85) years and 56 (66.7%) were male. The most frequent comorbidities incl­uded hypertension (n=28, 33.3%); immunosuppressed state (n=25, 29.8%) and diabetes mellitus (n=21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases. A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (n=21, 25%), acute respiratory distress syndrome (ARDS) (n=13, 15.5%), tracheostomy (n=9, 10.7%), renal replacement therapy (n=8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (n=4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (P=0.0255).Conclusions: Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. Renal replacement therapy was associated with in-hospital mortality.

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