scholarly journals The association between hallway boarding in internal wards, readmission and mortality rates: a comparative, retrospective analysis, following a policy change

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Assaf Ben Shoham ◽  
Gabriel Munter
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Policy Change ◽  
Medical Center ◽  
Linear Regression Analysis ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Before And After ◽  
Full Capacity ◽  
Bed Capacity

Abstract Background Emergency department overcrowding is associated with adverse clinical outcomes and poor patients and staff experience. Full capacity protocols enabling hallway boarding in internal wards are instituted to relieve emergency room overcrowding. The effect of hallway boarding on the clinical outcomes of all inpatients in the internal wards has not been studied. Early in 2016, a decision to enable hallway boarding in the internal wing in our medical center came into effect, comprising an abrupt change to the medical center’s policy. The objective of this study is to examine the effect of hallway boarding on patients who were hospitalized in the internal wards. Methods General linear regression analysis, based on administrative data about admissions of patients, from January 2013 through September 2019, is used to compare in-hospital mortality, 30-day readmission and 30-day mortality rates, of inpatients hospitalized in two internal departments in our medical center, before and after the policy change. Results Eight thousand five hundred eighty-three patients and 11,962 patients were admitted to internal departments A and B, before and after the policy change, respectively. Adjusted in-hospital mortality was lower after the policy change (OR 0.76, [CI, 0.65 to 0.90]), 30-day readmission was mildly higher (OR, 1.18 [CI, 1.00 to 1.40]) and no change in 30-day mortality was observed (OR 1.16 [CI, 0.88 to 1.53]). The results emanate from corresponding changes in department A. No apparent change was observed in the length of hospital stay in department A, while a shorter length of stay was observed in department B. Conclusion Enabling inpatient boarding in our medical center, effectively, had increased bed capacity and generated an increase in the volume of patients. It was associated with lower in-hospital mortality and an increased 30-day readmission, without increasing 30-day mortality. Since this is an observational study, conducted in a single center, further research is necessary to confirm and qualify these observations.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

2021 ◽  
Author(s):  
Neima Briggs ◽  
Michael V Gormally ◽  
Fangyong Li ◽  
Sabrina L Browning ◽  
Miriam M Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research Question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study Design and Methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P=0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P=0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P=0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P=0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

scholarly journals Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

2021 ◽  
Vol 50 (5) ◽  
pp. E4
Author(s):  
Rafael De la Garza Ramos ◽  
Christine Park ◽  
Edwin McCray ◽  
Meghan Price ◽  
Timothy Y. Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Surgical Intervention ◽  
Mortality Rates ◽  
Cord Compression ◽  
Interhospital Transfer ◽  
Clinical Presentations ◽  
Transferred Patients

OBJECTIVE In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD. METHODS The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes. RESULTS Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18–1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16–1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46–1.98, p < 0.001), with no significant difference in inpatient mortality rates. CONCLUSIONS Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.

Abstract 3531: Clinical Outcomes Following Endovascular Stroke Treatment Facilitated via Telestroke Evaluation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Stacie Demel ◽  
Amin Aghaebrahim ◽  
Vivek Reddy ◽  
Maxim Hammer ◽  
Lori Massaro ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Mortality Rates ◽  
Favorable Outcome ◽  
Multivariate Logistic Regression Model ◽  
Small Community ◽  
Stroke Treatment ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BACKGROUND: Most stroke patients present to small community hospitals without established stroke pathways or interventional stroke treatment capability. The advent of 2 way audiovisual telestroke systems gives such patients the opportunity to be assessed rapidly by stroke neurologists. Patients who are not candidates for systemic IV tPA or have failed thrombolytic treatment can be identified and transferred to a comprehensive stroke center for potential endovascular treatment. We compared the clinical outcomes of patients undergoing endovascular stroke treatment at University of Pittsburgh Medical Center triaged either through telestroke or non-telestroke means. METHODS: Prospective data including demographics, co-morbidities, baseline Alberta Stroke Program Early CT (ASPECT) and National Institute of Health Stroke Scale (NIHSS) score, intervention modality (pharmacological, mechanical or both), time to treatment, clinical outcome, and hemorrhage and mortality rates were compared. Favorable outcome was defined as modified rankin score (mRS) of 2 or less. RESULTS: Between 3/2007 and 5/2011, thirty four patients underwent endovascular stroke treatment following telestroke evaluation versus 354 patients who were triaged through other means. Baseline characteristics were similar between the groups. Time to endovascular treatment (595 vs. 767 minutes; p = 0.5), pretreatment with systemic tPA (51.6 vs. 56.9%, p=0.6), recanalization (TIMI ≥ 2; 91.2% vs. 84.8%; p = 0.31), favorable outcome (modified rankin score ≤ 2; 50% vs. 40.4%; p = 0.29) and mortality rates (28.1% vs. 34.9%, p=0.44) were comparable. Multivariate logistic regression model identified young age (OR 0.91, CI 0.88-0.95, p<0.01), successful recanalization (OR 3.3, CI 1.8-6.2, p<0.01), and baseline ASPECT score (OR 6.5, CI 2.4-17.4, p<0.01) as predictors of favorable outcome. CONCLUSION: The results of this study suggest that telestroke guided endovascular stroke treatment is feasible and the outcomes are similar to those patients who were triaged by traditional means. Future randomized studies which specifically compare triage via telemedicine vs. telephone or direct emergency department presentation are needed to substantiate these findings.

Abstract 17235: Comparision of Outcomes in Patients Undergoing Catheter versus Surgical Ablation for Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Krunalkumar Patel ◽  
Kirtenkumar Patel ◽  
Jay Shah ◽  
Rajkumar Doshi ◽  
Amitkumar Patel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Cardiac Complications ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Surgical Ablation

Introduction: There is a lack of research comparing outcomes of Surgical Ablation (SA) and Catheter Ablation (CA) among Atrial Fibrillation(AF) patients with heart failure with Preserved Ejection Fraction (HFpEF) and . Hypothesis: The main objective is to compare short-term clinical outcomes of SA and CA in AF patients with HFpEF. Methods: We used the national inpatient sample to identify patients over 18 years with HFpEF hospitalization and AF, and undergoing SA and CA from 2016 - 2017. The clinical outcomes of SA versus CA in AF stratified as non-paroxysmal and paroxysmal were analyzed. Results: 1,530 HFpEF hospitalizations with AF who underwent SA and 1,045 HFpEF hospitalizations with AF who underwent CA were included in the analysis. Patients undergoing CA had higher baseline comorbidity. The in-hospital mortality between HFpEF with AF undergoing SA as compared to CA was similar (1.9% versus 1.4%, adjusted P-value 0.04). Patients undergoing SA had a significantly longer length of hospital stay, a higher percentage of post-procedural, and cardiac complications. In HFpEF patients with non-paroxysmal AF, SA as opposed to CA was associated with a higher percentage of in-hospital mortality (2.7% versus 0%, adjusted P-value=0.23), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. Conclusions: In conclusion, CA is associated with lower in-hospital outcomes as compared to SA among AF with HFpEF patients. Further research with freedom from AF is needed between this group with long-term out c omes.

scholarly journals The analysis for time of referral to a medical center among patients with diabetic foot infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng-Wei Lin ◽  
Hui-Mei Yang ◽  
Shih-Yuan Hung ◽  
I-Wen Chen ◽  
Yu-Yao Huang
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Poor Prognosis ◽  
Medical Center ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Diabetic Foot Infection ◽  
The Impact

Abstract Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.

scholarly journals 557. Trends in Remdesivir Treatment Over the Course of the COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S380-S381
Author(s):  
J Xin Liao ◽  
Vrishali Lopes ◽  
Aisling Caffrey
Keyword(s):  
Intensive Care ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Inpatient Mortality ◽  
Real World Data ◽  
Pcr Test ◽  
Research Grant

Abstract Background Remdesivir is approved for use in the United States for treatment of COVID-19 requiring hospitalization. Real-world data on trends in remdesivir use may elucidate its benefits and place in therapy. Methods Hospitalized Veterans with a positive SARS-CoV-2 polymerase chain reaction (PCR) test that were treated with remdesivir at a Veterans Affairs Medical Center from May 2020 to April 2021 were included. Monthly trends in remdesivir treatment, as well as patient characteristics and clinical outcomes among patients treated with remdesivir, were assessed with joinpoint regression to calculate average monthly percent change and corresponding 95% confidence intervals (CI). Results A total of 30,333 Veterans were hospitalized with a positive PCR test over the study period, and 13,639 were treated with remdesivir (45%). Throughout the study period, the proportion of Veterans treated with remdesivir increased significantly (4.5% per month, 95% CI 0.5%-8.6%) and median time to remdesivir initiation decreased significantly (12% per month, 95% CI -15.8% to -8.0%). Though demographic characteristics of Veterans treated with remdesivir remained stable, including age, race, and obesity, improvement in clinical outcomes were observed, including median length of hospital stay which decreased by 6.5% per month (95% CI -9.1% to -3.8%), intensive care admissions which decreased by 4.6% per month (95% CI -6.3% to -2.8%) and inpatient mortality which decreased by 6.3% per month (95% CI -9.4% to -3.1%). By April 2021, most patients initiated remdesivir on the day of admission, and the inpatient mortality rate decreased to 7.9% from 19.2% in May 2020. Conclusion Over the course of the COVID-19 pandemic, utilization of remdesivir increased while initiation of remdesivir occurred earlier in the hospital admission, with concurrent reductions in length of hospital stay, intensive care admissions, and inpatient mortality. Disclosures Aisling Caffrey, PhD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)Shionogi, Inc (Research Grant or Support)

scholarly journals Comparative Evaluation of the Prognosis of Septic Shock Patients from before to after the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

2022 ◽  
Vol 12 (1) ◽  
pp. 103
Author(s):  
Jae Hwan Kim ◽  
Chiwon Ahn ◽  
Myeong Namgung
Keyword(s):  
Septic Shock ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Mortality Rates ◽  
Clinical Analysis ◽  
Simplified Acute Physiology Score ◽  
Before And After ◽  
System Data ◽  
The Difference ◽  
National Emergency

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic.

scholarly journals Early experience of a regional trauma center in Gangwon province: First step toward organizing a regional trauma system

2019 ◽  
Vol 27 (4) ◽  
pp. 202-210
Author(s):  
Kwangmin Kim ◽  
Hongjin Shim ◽  
Pil Young Jung ◽  
Seongyup Kim ◽  
Hui-Jae Bang ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
Mortality Rates ◽  
Trauma Patients ◽  
Before And After ◽  
The Impact

Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015. Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center. Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified. Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 ± 26.1) than in the before trauma center group (84.7 ± 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment. Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.

scholarly journals Extended-Infusion versus Standard-Infusion Piperacillin-Tazobactam for Sepsis Syndromes at a Tertiary Medical Center

2014 ◽  
Vol 58 (8) ◽  
pp. 4470-4475 ◽  
Author(s):  
Scott R. Cutro ◽  
Robert Holzman ◽  
Yanina Dubrovskaya ◽  
Xian Jie Cindy Chen ◽  
Tania Ahuja ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Cost Savings ◽  
Mortality Rates ◽  
Failure Rates ◽  
Clinical Failure ◽  
Inpatient Mortality ◽  
Group 5 ◽  
Abdominal Infections ◽  
Extended Infusion

ABSTRACTPiperacillin-tazobactam (PTZ) is frequently used as empirical and targeted therapy for Gram-negative sepsis. Time-dependent killing properties of PTZ support the use of extended-infusion (EI) dosing; however, studies have shown inconsistent benefits of EI PTZ treatment on clinical outcomes. We performed a retrospective cohort study of adult patients who received EI PTZ treatment and historical controls who received standard-infusion (SI) PTZ treatment for presumed sepsis syndromes. Data on mortality rates, clinical outcomes, length of stay (LOS), and disease severity were obtained. A total of 843 patients (662 with EI treatment and 181 with SI treatment) were available for analysis. Baseline characteristics of the two groups were similar, except for fewer female patients receiving EI treatment. No significant differences between the EI and SI groups in inpatient mortality rates (10.9% versus 13.8%;P= 0.282), overall LOS (10 versus 12 days;P= 0.171), intensive care unit (ICU) LOS (7 versus 6 days;P= 0.061), or clinical failure rates (18.4% versus 19.9%;P= 0.756) were observed. However, the duration of PTZ therapy was shorter in the EI group (5 versus 6 days;P< 0.001). Among ICU patients, no significant differences in outcomes between the EI and SI groups were observed. Patients with urinary or intra-abdominal infections had lower mortality and clinical failure rates when receiving EI PTZ treatment. We did not observe significant differences in inpatient mortality rates, overall LOS, ICU LOS, or clinical failure rates between patients receiving EI PTZ treatment and patients receiving SI PTZ treatment. Patients receiving EI PTZ treatment had a shorter duration of PTZ therapy than did patients receiving SI treatment, and EI dosing may provide cost savings to hospitals.

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