scholarly journals The association between hospital length of stay before rapid response system activation and clinical outcomes: a retrospective multicenter cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jimyung Park ◽  
Yeon Joo Lee ◽  
Sang-Bum Hong ◽  
Kyeongman Jeon ◽  
Jae Young Moon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Clinical Outcomes ◽  
Hospital Length ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Confounding Factors ◽  
Rapid Response System ◽  
Response System ◽  
Deterioration Group

Abstract Background Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes. Methods Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS < 5 days) and late deterioration (LOS ≥ 5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors. Results Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44–1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45–1.91). Conclusions Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

scholarly journals Longer Hospital Length of Stay After Admission Before Rapid Response System Activation is Associated with Worse Clinical Outcome: A Retrospective Multicenter Cohort Study

2020 ◽  
Author(s):  
Jimyung Park ◽  
Yeon Joo Lee ◽  
Sang-Bum Hong ◽  
Kyeongman Jeon ◽  
Jae Young Moon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Clinical Outcomes ◽  
Hospital Length ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Confounding Factors ◽  
Rapid Response System ◽  
Response System ◽  
Deterioration Group

Abstract Background: Rapid response system (RRS) has been increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes.Methods: Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS <5 days) and late deterioration (LOS ≥5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors.Results: Among 11,612 patients, 5,779 and 5,883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44–1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45–1.91).Conclusions: Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

scholarly journals Mortality and Length of Stay Trends Following Implementation of a Rapid Response System and Real-Time Automated Clinical Deterioration Alerts

2016 ◽  
Vol 32 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Marin H. Kollef ◽  
Kevin Heard ◽  
Yixin Chen ◽  
Chenyang Lu ◽  
Nelda Martin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Real Time ◽  
General Medicine ◽  
Hospital Length ◽  
Rapid Response ◽  
Clinical Deterioration ◽  
Hospital Length Of Stay ◽  
Rapid Response System ◽  
Response System ◽  
Lengths Of Stay

A study was performed to determine the potential influence of a rapid response system (RRS) employing real-time clinical deterioration alerts (RTCDAs) on patient outcomes involving 8 general medicine units. Introduction of the RRS occurred in 2006 with staged addition of the RTCDAs in 2009. Statistically significant year-to-year decreases in mortality were observed through 2014 ( r = −.794; P = .002). Similarly, year-to-year decreases in the number of cardiopulmonary arrests (CPAs; r = −.792; P = .006) and median lengths of stay ( r = −.841; P = .001) were observed. There was a statistically significant year-to-year increase in the number of RRS activations for these units ( r = .939; P < .001) that was inversely correlated with the occurrence of CPAs ( r = −.784; P = .007). In this single-institution retrospective study, introduction of a RRS employing RTCDAs was associated with lower hospital mortality, CPAs, and hospital length of stay.

Medical Comorbidity in Psychiatric Inpatients: Relation to Clinical Outcomes and Hospital Length of Stay

2002 ◽  
Vol 43 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Constantine G. Lyketsos ◽  
Gary Dunn ◽  
Michael J. Kaminsky ◽  
William R. Breakey
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Psychiatric Inpatients ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medical Comorbidity

scholarly journals No associations between physical activity and clinical outcomes among hospitalized patients with severe COVID-19

2020 ◽  
Author(s):  
Ana J. Pinto ◽  
Karla F. Goessler ◽  
Alan L. Fernandes ◽  
Igor H. Murai ◽  
Lucas P. Sales ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Hospital Length ◽  
Sao Paulo ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Activity Levels ◽  
Physical Activity Levels

AbstractPurposeThis small-scale, prospective cohort study nested within a randomized controlled trial aimed to investigate the possible associations between physical activity levels and clinical outcomes among hospitalized patients with severe COVID-19.MethodsHospitalized patients with severe COVID-19 were recruited from Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital), and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. Physical activity levels were assessed by Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were: mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsMean hospital length of stay was 8.5 ± 7.1 days; 3.3% of patients died, 13.8% were admitted to ICU, and 8.6% required mechanical ventilation. Linear regression models showed that physical activity indexes were not associated with hospital length of stay (work index: β=-0.57 [95%CI: −1.80 to 0.65], p=0.355; sport index: β=0.43 [95%CI: −0.94 to 1.80], p=0.536; leisure-time index: β=1.18 [95%CI: −0.22 to 2.59], p=0.099; total activity index: β=0.20 [95%CI: −0.48 to 0.87], p=0.563. Physical activity indexes were not associated with mortality, admission to ICU and mechanical ventilation requirement (all p>0.05).ConclusionsAmong hospitalized patients with COVID-19, physical activity did not associate with hospital length of stay or any other clinically-relevant outcomes. These findings suggest that previous physical activity levels may not change the prognosis of severe COVID-19.

scholarly journals Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

2020 ◽  
Vol 18 (6) ◽  
pp. 747-754 ◽  
Author(s):  
Daniel E. Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard A. Newcomb ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Functional Status ◽  
Clinical Outcomes ◽  
Advanced Cancer ◽  
Functional Impairment ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Hospital Length Of Stay

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

Association Between Rapid Response Algorithms and Clinical Outcomes of Hospitalized Children

2021 ◽  
Vol 11 (12) ◽  
pp. 1385-1394
Author(s):  
Jonathan G. Sawicki ◽  
Dana Tower ◽  
Elizabeth Vukin ◽  
Jennifer K. Workman ◽  
Gregory J. Stoddard ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Pathways ◽  
Rapid Response ◽  
Future Research ◽  
Hospitalized Children ◽  
Rapid Response System ◽  
Response System ◽  
Algorithm Implementation ◽  
The Impact ◽  
Over Time

OBJECTIVES To evaluate whether the implementation of clinical pathways, known as pediatric rapid response algorithms, within an existing rapid response system was associated with an improvement in clinical outcomes of hospitalized children. METHODS We retrospectively identified patients admitted to the PICU as unplanned transfers from the general medical and surgical floors at a single, freestanding children’s hospital between July 1, 2017, and January 31, 2020. We examined the impact of the algorithms on the rate of critical deterioration events. We used multivariable Poisson regression and an interrupted time series analysis to measure 2 possible types of change: an immediate implementation effect and an outcome trajectory over time. RESULTS We identified 892 patients (median age: 4 [interquartile range: 1–12] years): 615 in the preimplementation group, and 277 in the postimplementation group. Algorithm implementation was not associated with an immediate change in the rate of critical deterioration events but was associated with a downward rate trajectory over time and a postimplementation trajectory that was significantly less than the preimplementation trajectory (trajectory difference of −0.28 events per 1000 non-ICU patient days per month; 95% confidence interval −0.40 to −0.16; P &lt; .001). CONCLUSIONS Algorithm implementation was associated with a decrease in the rate of critical deterioration events. Because of the study’s observational nature, this association may have been driven by unmeasured confounding factors and the chosen implementation point. Nevertheless, the results are a promising start for future research into how clinical pathways within a rapid response system can improve care of hospitalized patients.

Abstract 282: Dabigatran Etexilate is Associated with Shorter Hospital Length of Stay Compared to Warfarin in Patients with Nonvalvular Atrial Fibrillation

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Eileen Fonseca ◽  
David R Walker ◽  
Jerrold Hill ◽  
Gregory P Hess
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Propensity Score ◽  
Dabigatran Etexilate ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Diagnosis ◽  
Newly Diagnosed ◽  
Nonvalvular Atrial Fibrillation ◽  
Matched Samples

Background: Warfarin and dabigatran etexilate (DE) are oral anticoagulants used to reduce the risk of stroke among patients with nonvalvular atrial fibrillation (NVAF). This study examined whether hospital length of stay (LOS) differed for the two therapies. Methods: LOS was evaluated for patients hospitalized with a primary or secondary discharge diagnosis of atrial fibrillation (AF) between 1/1-3/31/2011, with DE or warfarin administered during hospitalization, and excluding patients with a valvular procedure. Patients were identified from a hospital Charge Detail Masters database, consisting of 184 hospitals. Differences in LOS by therapy were estimated using propensity score-matched samples selected by nearest neighbor matching within a caliper of 0.20 standard deviations of the logit, without replacement and a 2:1 match. Covariates used to estimate the propensity score included age, gender, CHADS 2 score, comorbid conditions and hospital attributes. LOS was also analyzed in patient subgroups identified by use of specific bridging agents (low-molecular weight heparin, unfractionated heparin, combination of the heparins, or no bridging agent) and a subset categorized as newly diagnosed NVAF. Results: Matched samples included 2,372 warfarin and 1,186 DE patients selected from 19,725 warfarin and 1,190 DE patients. Covariates used for the propensity score were not significantly different in the matched samples. LOS was 1.06 days shorter for DE compared to warfarin (DE: 6.16 days vs. warfarin: 7.22 days, p<0.01). In the 4 subgroups identified by choice of bridging agent, LOS was significantly shorter for DE in 3 (0.8 to 1.4 days, p<0.011), but not the fourth (0.9 day, p=0.3). In the subset of newly diagnosed NVAF, LOS was not significantly shorter for DE when AF was the primary discharge diagnosis (0.5 day, p=0.15), but was 2.47 days shorter for DE patients (p<0.01) when AF was a secondary discharge diagnosis. Limitations of the study were small sample sizes in some subgroups and potential of residual confounding. Conclusions: Among hospitalized patients with NVAF receiving an oral anticoagualant, patients receiving DE had a shorter length of stay compared to patients receiving warfarin.

scholarly journals Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals

2020 ◽  
Vol 27 (1) ◽  
pp. e100109 ◽  
Author(s):  
Hoyt Burdick ◽  
Eduardo Pino ◽  
Denise Gabel-Comeau ◽  
Andrea McCoy ◽  
Carol Gu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Real World ◽  
Learning Algorithm ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Machine Learning Algorithm

BackgroundSevere sepsis and septic shock are among the leading causes of death in the USA. While early prediction of severe sepsis can reduce adverse patient outcomes, sepsis remains one of the most expensive conditions to diagnose and treat.ObjectiveThe purpose of this study was to evaluate the effect of a machine learning algorithm for severe sepsis prediction on in-hospital mortality, hospital length of stay and 30-day readmission.DesignProspective clinical outcomes evaluation.SettingEvaluation was performed on a multiyear, multicentre clinical data set of real-world data containing 75 147 patient encounters from nine hospitals across the continental USA, ranging from community hospitals to large academic medical centres.ParticipantsAnalyses were performed for 17 758 adult patients who met two or more systemic inflammatory response syndrome criteria at any point during their stay (‘sepsis-related’ patients).InterventionsMachine learning algorithm for severe sepsis prediction.Outcome measuresIn-hospital mortality, length of stay and 30-day readmission rates.ResultsHospitals saw an average 39.5% reduction of in-hospital mortality, a 32.3% reduction in hospital length of stay and a 22.7% reduction in 30-day readmission rate for sepsis-related patient stays when using the machine learning algorithm in clinical outcomes analysis.ConclusionsReductions of in-hospital mortality, hospital length of stay and 30-day readmissions were observed in real-world clinical use of the machine learning-based algorithm. The predictive algorithm may be successfully used to improve sepsis-related outcomes in live clinical settings.Trial registration numberNCT03960203

scholarly journals Inpatient Mortality and Length of Stay Among Direct-Acting Oral Anticoagulant (DOAC) and Warfarin Users Presenting with Major Hemorrhage

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2538-2538
Author(s):  
Walter Bialkowski ◽  
Sylvia Tan ◽  
Alan E. Mast ◽  
Joseph Kiss ◽  
Daryl J. Kor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Head Injuries ◽  
Traumatic Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Major Hemorrhage ◽  
All Cause Mortality ◽  
Traumatic Head ◽  
Direct Acting

Abstract Background: Use of direct-acting oral anticoagulants (DOAC) is increasingly common among patients with atrial fibrillation and venous thromboembolic disease. Differences in the mechanisms of action as compared to warfarin could impact transfusion patterns and clinical outcomes in patients, especially for those presenting with major hemorrhage. The management of patients taking these newer medications and corresponding outcomes are relevant to optimizing clinical decision making in situations of major hemorrhage. Methods: We tested the hypothesis that inpatient all-cause mortality among patients presenting with major hemorrhage differs based on the home-administered anticoagulant medication class (DOAC versus warfarin). A cohort of patients presenting to twelve US hospitals from 2013 to 2016 was identified using the Recipient Epidemiology and Donor Evaluation Study (REDS)-III Recipient Database. Primary ICD diagnosis codes, issued blood products, laboratory data, and early mortality events were used in the application of the International Society on Thrombosis and Hemostasis definition of major hemorrhage. Exposure status was defined as a record of home-administered DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban; exposed) or warfarin (non-exposed). Patients with multiple encounters and those transferred into or out of network were excluded from the analysis. Proportional hazards regression was used to compare all-cause mortality and hospital length of stay. We then repeated the analysis using a cohort matched on propensity scores to account for confounding by age, gender, concurrent aspirin and anti-platelet use, liver and renal dysfunction, cancer, CHA2DS2-VASc score, traumatic injury, and hospital. We then repeated the propensity score matched analysis stratified by anatomic location of bleed and traumatic injury. Results: More than 1.5 million hospitalizations were screened for eligibility. Exclusion of minors, outpatients, hospitalizations without a medication of interest, absence of major hemorrhage, multiple hospitalizations, and hospital transfers resulted in 3,731 patients available for the unadjusted analysis. Inpatient all-cause mortality was lower among DOAC users when the entire cohort was considered (HR = 0.60, 95%CI 0.45 - 0.80, p=0.0005). Implementation of propensity score matching to account for confounding abrogated this difference (HR=0.84, 95%CI 0.58 - 1.22, p=0.36). Time to hospital discharge was shorter for DOAC users (HR = 1.17, 95%CI 1.05 - 1.30, p=0.0034). Transfusion patterns were similar by medication, except for plasma transfusion occurring in 42% of warfarin encounters and 11% of DOAC encounters. Vitamin K was administered in 63% of warfarin encounters, whereas specific DOAC reversal agents were largely unavailable during the analysis period [used in 5 (1%) DOAC encounters]. There were no statistically significant differences in inpatient all-cause mortality in the stratified analysis (warfarin as reference): HR = 0.69 (95%CI 0.31 - 1.55) for traumatic head injuries; HR = 1.10 (95%CI 0.62 - 1.95) for non-traumatic head injuries; HR = 0.62 (95%CI 0.20 - 1.94) for traumatic, non-head injuries; and HR = 0.69 (95%CI 0.29 - 1.63) for non-traumatic, non-head injuries. Conclusions: Analysis of a population taking oral anticoagulation and presenting with major hemorrhage showed that transfusion of plasma was more commonly employed to treat major hemorrhage among warfarin users than DOAC users. Inpatient all-cause mortality was lower among DOAC users in the overall cohort; however, accounting for potential confounding factors using propensity score matching abrogated this difference. Hospital length of stay was shorter for DOAC users compared to warfarin users. Stratification by location of bleed and traumatic injury did not alter these findings. Less plasma use and a shorter length of hospitalization in this study, combined with no observable difference in inpatient all-cause mortality, suggests that outcomes following major hemorrhage are at least no different for DOAC users as compared to warfarin users. Disclosures Mast: Novo Nordisk: Research Funding. Kor:NIH: Consultancy; NIH: Research Funding; UpToDate: Patents & Royalties; CSL Behring: Honoraria.

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