Screening for older inpatients at risk for long length of stay: which clinical tool to use?

AbstractSchizophrenia is among the most debilitating neuropsychiatric disorders. However, clear neurophysiological markers that would identify at-risk individuals represent still an unknown. The aim of this study was to investigate possible alterations in the resting alpha oscillatory activity in normal population high on schizotypy trait, a physiological condition known to be severely altered in patients with schizophrenia. Direct comparison of resting-state EEG oscillatory activity between Low and High Schizotypy Group (LSG and HSG) has revealed a clear right hemisphere alteration in alpha activity of the HSG. Specifically, HSG shows a significant slowing down of right hemisphere posterior alpha frequency and an altered distribution of its amplitude, with a tendency towards a reduction in the right hemisphere in comparison to LSG. Furthermore, altered and reduced connectivity in the right fronto-parietal network within the alpha range was found in the HSG. Crucially, a trained pattern classifier based on these indices of alpha activity was able to successfully differentiate HSG from LSG on tested participants further confirming the specific importance of right hemispheric alpha activity and intrahemispheric functional connectivity. By combining alpha activity and connectivity measures with a machine learning predictive model optimized in a nested stratified cross-validation loop, current research offers a promising clinical tool able to identify individuals at-risk of developing psychosis (i.e., high schizotypy individuals).

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Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

International Journal for Population Data Science ◽

10.23889/ijpds.v4i1.461 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Lynn Robertson ◽

Dolapo Ayansina ◽

Marjorie Johnston ◽

Angharad Marks ◽

Corri Black

Keyword(s):

At Risk ◽

Length Of Stay ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Resource Planning ◽

Kappa Statistics ◽

Data Systems ◽

Hospital Episode ◽

Hospitalised Patients ◽

Poor Outcomes

IntroductionMultimorbidity is a complex and growing health challenge. There is no accepted “gold standard” multimorbidity measure for hospital resource planning, and few studies have compared measures in hospitalised patients. AimTo evaluate operationalisation of two multimorbidity measures in routine hospital episode data in NHS Grampian, Scotland. MethodsLinked hospital episode data (Scottish Morbidity Record (SMR)) for the years 2009-2016 were used. Adults admitted to hospital as a general/acute inpatient during 2014 were included. Conditions (ICD-10) were identified from general/acute (SMR01) and psychiatric (SMR04) admissions during the five years prior to first admission in 2014. Two count-based multimorbidity measures were used (Charlson Comorbidity Index and Tonelli et al.), and multimorbidity was defined as ≥2 conditions. Kappa statistics assessed agreement. The association between multimorbidity and length of stay, readmission and mortality was assessed using logistic and negative binomial regression as appropriate. ResultsIn 41,545 adults (median age 62 years, 52.6% female), multimorbidity prevalence was 15.1% (95% CI 14.8%, 15.5%) using Charlson and 27.4% (27.0%, 27.8%) using Tonelli – agreement 85.1% (Kappa 0.57). Multimorbidity prevalence, using both measures, increased with age. Multimorbidity was higher in males (16.5%) than females (13.9%) using the Charlson measure, but similar across genders when measured with Tonelli. After adjusting for covariates, multimorbidity remained associated with longer length of stay (Charlson IRR 1.1 (1.0, 1.2); Tonelli IRR 1.1 (1.0, 1.2)) and readmission (Charlson OR 2.1 (1.9, 2.2); Tonelli OR 2.1 (2.0, 2.2)). Multimorbidity had a stronger association with mortality when measured using Charlson (OR 2.7 (2.5, 2.9)), than using Tonelli (OR (1.8 (1.7, 2.0)). ConclusionsMultimorbidity measures operationalised in hospital episode data identified those at risk of poor outcomes and such operationalised tools will be useful for future multimorbidity research and use in secondary care data systems. Multimorbidity measures are not interchangeable, and the choice of measure should depend on the purpose. Hightlights Operationalisation of two count-based multimorbidity measures using linked electronic hospitalepisode data was evaluated (Charlson and Tonelli). First study to compare the Tonelli measure with another measure for investigating multimor-bidity in hospitalised patients. Multimorbidity prevalence differed depending on measure used, but both multimorbidity mea-sures identified those at risk of poor outcomes. Operationalised multimorbidity tools have uses for future multimorbidity research and use insecondary care data systems. Multimorbidity measures are not interchangeable, and choice of measure should depend onpurpose.

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Economics of implementing an early deterioration detection solution for general care patients at a US hospital

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2021-0222 ◽

2021 ◽

Author(s):

Belinda A Mohr ◽

Diane Bartos ◽

Stephen Dickson ◽

Libby Bucsi ◽

Mariska Vente ◽

...

Keyword(s):

At Risk ◽

Length Of Stay ◽

Hospital Mortality ◽

Database Analysis ◽

Patients At Risk ◽

Retrospective Database Analysis ◽

General Care ◽

Retrospective Database ◽

Discharge Length

Aim: This study estimates the costs and outcomes pre- versus post-implementation of an early deterioration detection solution (EDDS), which assists in identifying patients at risk of clinical decline. Materials & methods: A retrospective database analysis was conducted to assess average costs per discharge, length of stay (LOS), complications, in-hospital mortality and 30-day all-cause re-admissions pre- versus post-implementation of an EDDS. Results: Average costs per discharge were significantly reduced by 18% (US$16,201 vs $13,304; p = 0.007). Average LOS was also significantly reduced (6 vs 5 days; p = 0.033), driven by a reduction in general care LOS of 1 day (p = 0.042). Complications, in-hospital mortality and 30-day all-cause re-admissions were similar. Conclusion: Costs and LOS were lower after implementation of an EDDS for general care patients.

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Distribution of indications for blood transfusion among the patients of Faridpur, Bangladesh

Bangladesh Medical Journal ◽

10.3329/bmj.v45i2.28981 ◽

2016 ◽

Vol 45 (2) ◽

pp. 85-89

Author(s):

Tonmoy Biswas ◽

Sunil Kumar Biswas ◽

Md Rassell ◽

Md Abdul Alim

Keyword(s):

At Risk ◽

Blood Transfusion ◽

Length Of Stay ◽

Middle Age ◽

Post Partum ◽

Descriptive Study ◽

Blood Transfusions ◽

Age Group ◽

Cross Sectional ◽

Hematological Cancer

For more than a century, blood transfusion is recognized as an important contributor to patients outcome. This study was focused on frequent indications of reported blood transfusions. This cross-sectional type of descriptive study was conducted in Faridpur, Bangladesh among the 719 patients from April, 2013 to July 2013. 30% had non-hemorrhagic anemia, 21% had intra or post-partum hemorrhage, 7% were undergoing haemodialysis, 6% had thalassemia, 4% had trauma, 2% had non-hematological cancer, 1% had leukemia and the rest had other causes. Middle age group and female patients required more transfusions. Moreover, conservative managements required more blood transfusion rather than surgical. However, Patients receiving a blood transfusion are at risk of increased morbidity, mortality, length of stay in hospital & ICU.Bangladesh Med J. 2016 May; 45 (2): 85-89

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49 Rooming-In to Treat Neonatal Abstinence Syndrome

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.048 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e20-e21

Author(s):

Shalea Piteau ◽

Meera Vyas ◽

Peter Papadakos

Keyword(s):

At Risk ◽

Length Of Stay ◽

Breast Feeding ◽

Hospital Cost ◽

Community Hospital ◽

Neonatal Abstinence Syndrome ◽

Total Hospital Cost ◽

Abstinence Syndrome ◽

Feeding Rates ◽

Total Hospital

Abstract Background Ontario has been facing a steady rise in the number of individuals abusing narcotics. Newly implemented rooming-in programs in Ontario have allowed infants of opioid-dependent mothers to stay in the same room as their mother while the infant continues to be monitored for signs of neonatal abstinence syndrome (NAS). Objectives To retroactively review the impact of a rooming-in program for babies at risk of NAS on the need for pharmacologic treatment and length of stay in one community hospital site in Belleville, Ontario. Design/Methods Belleville General Hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Prior to its inception, the standard of care was to admit these infants to the special care nursery for monitoring and treatment. Charts were reviewed to collect data on infants born to mothers using opioids in the 24 months prior to (July 2013 – June 2015) and after (July 2015 – June 2017) the implementation of our program. The two groups were compared for the primary outcomes studied, including the number of babies started on morphine and length of stay in hospital. Secondary outcomes were also examined, including breast feeding rates, resource intensity weight, and total hospital cost. Results Rooming-in is associated with a reduction in the need for treatment with morphine, shorter length of stay in hospital, improved breast feeding rates, and lower total hospital cost. Conclusion Our study demonstrates that rooming-in programs for babies born to mothers using opioids have benefits in terms of quality of care and health care resource utilization. These findings add to the existing literature on NAS that rooming-in can be successfully implemented in a community hospital.

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A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay

BMC Medical Informatics and Decision Making ◽

10.1186/1472-6947-10-27 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 45

Author(s):

Andrew A Kramer ◽

Jack E Zimmerman

Keyword(s):

Intensive Care Unit ◽

At Risk ◽

Intensive Care ◽

Length Of Stay ◽

Predictive Model ◽

Early Identification ◽

Unit Length ◽

Intensive Care Unit Length ◽

Patients At Risk

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PENGARUH HASIL SKRINING BERDASARKAN METODE MNA (MINI NUTRITIONAL ASSESTMENT) TERHADAP LAMA RAWAT INAP DAN STATUS PULANG PASIEN LANJUT USIA DI RSUP DR. SARDJITO YOGYAKARTA

Berkala Kedokteran ◽

10.20527/jbk.v13i1.3442 ◽

2017 ◽

Vol 13 (1) ◽

pp. 69

Author(s):

Wahyu Hardi Prasetyo ◽

I Dewa Putu Pramantara ◽

R. Dwi Budiningsari

Keyword(s):

At Risk ◽

Length Of Stay ◽

Elderly Patients ◽

Elderly People ◽

The Elderly ◽

Nutrition Status ◽

Inpatient Ward ◽

Discharge Status ◽

Initial Hospitalization ◽

Nutrition Problem

Abstract: The number of elderly people (over 60 years old) is growing rapidly in this 21th century, reaching as many as 425 millions (+ 6,8%) worldwide in 2000. This figure is estimated almost twice in 2025. In Indonesia, percentage the elderly people in 1995 was as much as 7.5%. In line with the increasing of live expectancy the number of the elderly will grow bigger. This is related to greater need of health service for the elderly. In older people, nutrition problem is closely associated with disease. One factor that causes nutrition problem in the elderly is the increase of morbidity. Increased risk for disease and nutrition problem in the elderly requires early identification of risk for malnutrition in the elderly. Routine assessment of preliminary nutrition status of patients being hospitalized is essential in order to get an overview of nutrition status patients at a time, detect high risk patients and help to identify nutrition treatment specifically for each patient so that appropriate nutrition support can be given to improve nutrition status of patient. The study aimed to identify impact of result screening nutrition based on MNA method to length of stay and discharge status of elderly patients at inpatient ward of internal medicine and neurology of Dr Sardjito Hospital Yogyakarta. The study was observational that used prospective cohort design and was undertaken at inpatient ward of internal in medicine and neurology of Dr. Sardjito, Yogyakarta in August-November 2009. Data were collected by the researcher with the help of an enumerator, i.e. nutritionist at inpatient ward. The result of study showed that impact of result screening during initial hospitalization to length of stay of elderly patients based on MNA method was RR 1.63. This indicated that malnourished patients were at risk for being hospitalized > 7 days 1.63 times longer than those not malnourished. Impact of result screening during initial hospitalization to discharge status of elderly patients based on MNA method was RR 1.29. This indicated that malnourished patient were at risk for uncovered discharged as much as 1.29 greater than those not malnourished. There was impact of result screening in admission to length of stay. There was impact of nutrition status to length of discharged status. Keywords: discharge home, length of stay, nutritional status in initial admission Abstrak: Pertumbuhan penduduk lanjut usia (umur ≥60 tahun) meningkat secara cepat pada abad 21 ini, yang pada 2000 di seluruh dunia telah mencapai 425 juta jiwa (± 6,8%). Jumlah ini diperkirakan akanmengalami peningkatan hampir dua kali lipat pada 2025. Di Indonesia, persentase lanjut usia pada 1995 mencapai 7,5%. Dengan meningkatnya angka harapan hidup, jumlah lanjut usia pun akan bertambah banyak. Hal ini terkait dengan perlunya peningkatan pelayanan kesehatan lanjut usia. Pada lanjut usia, masalah gizi erat kaitannya dengan penyakit. Salah satu faktor yang menyebabkan lanjut usia menjadi rawan gizi yaitu peningkatan morbiditas penyakit (Darmojo, 2006). Dengan meningkatnya risiko penyakit dan disertai gangguan nutrisi pada lanjut usia, sehingga perlu dilakukan identifikasi risiko malnutrisi pada lanjut usia sedini mungkin. Penilaian status gizi awal pasien masuk rumah sakit sangat penting dilakukan secara rutin karena dapat menggambarkan status gizi pasien saat itu, mendeteksi pasien-pasien yang beresiko tinggi dan membantu mengidentifikasi perawatan gizi secara spesifik pada masing-masing pasien sehingga dukungan nutrisi yang tepat dapat diterapkan untuk meningkatan status gizi pasien. Untuk mengetahui pengaruh hasil skrining awal berdasarkan metode MNA (Mini Nutritional Assessment) terhadap lama rawat inap dan status pulang pasien lanjut pada ruang rawat inap penyakit dalam dan saraf di RSUP Dr.Sardjito Yogyakarta. Jenis penelitian ini adalah penelitian observasional dengan menggunakan rancangan kohort prospektif. Penelitian ini dilakukan di ruang rawat inap penyakit dalam dan saraf pada pasien lanjut usia di Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta. Penelitian dilaksanakan pada bulan Agustus-November 2009. Pengumpulan data dilakukan oleh peneliti dengan bantuan enumerator yaitu ahli gizi yang bertugas di ruang rawat inap. Berdasarkan hasil skrining dengan metode MNA pada pasien lanjut usia terhadap lama rawat inap, maka diketahui bahwa nilai RR=1,63. Hal ini menunjukkan bahwa pasien yang terpapar (malnutrisi) berisiko dirawat selama ≥ 7 hari adalah 1,63 kali lebih besar daripada pasien yang tidak terpapar (tidak malnutrisi). Berdasarkan hasil regresi logistik tidak ada pengaruh antara hasil skrining dengan lama rawat inap. Ada pengaruh secara statistik antara usia, jenis penyakit dan kelas perawatan terhadap lama rawat inap. Berdasarkan hasil regresi logistik, jenis penyakit memiliki pengaruh yang paling dominan dengan nilai RR 3,88 terhadap lama rawat inap.Berdasarkan hasil skrining awal masuk rumah sakit terhadap status pulang pasien lanjut usia berdasarkan metode MNA, maka diketahui nilai RR=1,29. Hal ini menunjukkan bahwa pasien yang terpapar (malnutrisi) berisiko keluar dalam keadaan tidak sembuh sebesar 1,29 kali lebih besar daripada pasien yang tidak terpapar (tidak malnutrisi). Berdasarkan hasil uji regresi logistik ada pengaruh antara hasil skrining dengan status pulang dengan nilai OR 9,21. Demikian pula ada pengaruh antara usia dan jenis kelamin dengan status pulang (p< 0,05). Tidak ada pengaruh antara hasil skrining dengan lama rawat inap. Ada pengaruh antara usia, jenis penyakit dan kelas perawatan terhadap lama rawat inap. Ada pengaruh antara hasil skrining dengan status pulang. Kata-kata kunci: skrining, lama rawat inap, status pulang pasien

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Hubungan karakteristik dengan kejadian depresi pada lansia

Jurnal Keperawatan Jiwa ◽

10.26714/jkj.7.2.2019.185-192 ◽

2019 ◽

Vol 7 (2) ◽

pp. 183

Author(s):

Novi Herawati ◽

Deharnita Deharnita

Keyword(s):

At Risk ◽

Length Of Stay ◽

Sex Education ◽

Sampling Technique ◽

The Elderly ◽

Education Level ◽

Bivariate Analysis ◽

Chi Square ◽

Cross Sectional ◽

Loved One

Depresi merupakan gangguan psikiatrik yang sangat sering terjadi pada lanjut usia. Faktor penyebab depresi lansia antara lain ditinggal oleh semua anak, tidak lagi bekerja, tidak mempunyai kegiatan, kematian orang yang dicintai. Tujuan penelitian untuk mengetahui hubungan karakteristik dengan tingkat depresi pada lansia di panti sosial tresna werdha Sicincin tahun 2018. Penelitian ini merupakan studi analisis dengan pendekatan cross sectional. Variabel penelitian yaitu umur, jenis kelamin, pendidikan dan lama tinggal, serta tingkat depresi. Populasinya seluruh lansia di PSTW, jumlah 110 orang. Teknik sampling secara total sampling. Analisa bivariat dengan uji chi square. Hasil penelitian didapatkan bahwa sebagian besar lansia mengalami depresi, berusia beresiko yaitu > 65 tahun, mayoritas lansia berjenis kelamin laki-laki, tingkat pendidikan lansia mayoritas rendah, lama tinggal lansia di panti sebagian besar beresiko ≥ 4 tahun. Uji bivariatnya tidak ada hubungan umur, jenis kelamin dan lama tinggal dengan depresi serta ada hubungan tingkat pendidikan dengan depresi. Kata kunci: depresi, karakteristik lansia RELATIONSHIP CHARACTERISTICS WITH INCIDENCE OF DEPRESSION IN THE ELDERLY ABSTRACTDepression is a psychiatric disorder that is very common in the elderly. Factors causing depression in the elderly include being abandoned by all children, no longer working, no activity, death of a loved one. The purpose of this study was to determine the relationship of characteristics with the level of depression in the elderly in the social home of Vesna Sicincin in 2018. This study was an analytical study with a cross sectional approach. The research variables are age, sex, education and length of stay, and the level of depression. The population is all elderly in PSTW, the number of 110 people. Sampling technique in total sampling. Bivariate analysis with chi square test. The results showed that most of the elderly are depressed, aged at risk that is> 65 years, the majority of the elderly are male, the majority of the elderly's education level is low, the length of stay of the elderly at home is mostly at risk ≥ 4 years. The bivariate test had no relationship with age, sex and length of stay with depression and there was a relationship between education level and depression. Keywords: depression, characteristics of the elderly

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765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care

British Journal of Surgery ◽

10.1093/bjs/znab134.484 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Sambhwani ◽

A Kandiah ◽

F Rayan ◽

A Wazir ◽

N Sheikh

Keyword(s):

At Risk ◽

Quality Improvement ◽

Length Of Stay ◽

Positive Impact ◽

Care Pathway ◽

Quality Improvement Project ◽

Time Data ◽

Neck Of Femur ◽

Improvement Project ◽

Operative Care

Abstract Introduction A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway. Method The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI) Results 150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days. Conclusions Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.

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