Emergency department (ED) utilization and hospital admission rates among oncology patients at a large academic center and the need for improved urgent care access.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 19-19 ◽  
Author(s):  
Kerin B. Adelson ◽  
Vanna Dest ◽  
Salimah Velji ◽  
Richard Lisitano ◽  
Rogerio Lilenbaum
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
New Haven ◽  
Oncology Patients ◽  
Prolonged Length ◽  
Palliative Care Consultation ◽  
Ambulatory Oncology

19 Background: In the US, 30% of the total cancer expenditure is spent in the last year of life and 55% of this is spent on inpatient care. For patients with advanced cancer, most hospitalizations arise from expected disease progression. With the ultimate goal reducing hospital admissions at the Smilow Cancer Hospital at Yale New Haven, we sought to understand our patterns of ED referral, hospital admission, and length-of-stay. Methods: An analysis of all oncology patients coming to the Yale New Haven Hospital (YNHH) ED was performed by executing reports through our EPIC electronic medical record. We looked at a 5-month time frame from January 1, 2014, through May 31, 2014. Results: A total of 391 oncology patients from each of our disease groups presented to the ED and 90% were admitted. Mean length of stay (LOS) was 6.74 days. 62% of patients arrived during the hours of 9:00AM-5:00PM. The average daily cost per admission was $1886 per day/ $12,711.64 for the mean hospitalization (largely spent on nursing, pharmacy, and laboratory). At least 50% of these presentations could have been addressed in the ambulatory setting including but not limited to dehydration, abdominal pain and failure-to-thrive. Conclusions: Despite a 6-day/wk ambulatory oncology practice, our patients are presenting to the ED during standard daytime hours resulting in admission and prolonged length-of-stay. We will launch a same-day visit program with access to urgent palliative care consultation, pharmacy and infusion chairs. We will treat dehydration, nausea, vomiting, pain, DVT, and other urgent presentations. This cultural change will require education of physicians, nurses, staff, patients and caregivers. We estimate that a 50% reduction in admissions would yield a cost savings of approximately $6 million annually. [Table: see text]

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9592-9592
Author(s):  
A. H. Kamal ◽  
K. M. Swetz ◽  
H. Liu ◽  
S. R. Ruegg ◽  
E. C. Carey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Median Time ◽  
Mayo Clinic ◽  
Hospital Admissions ◽  
Cox Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Plan ◽  
Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

scholarly journals Inpatient hypoglycaemia in older people is associated with a doubling in the increased length of stay compared with the younger population

2020 ◽  
Author(s):  
Yue Ruan ◽  
Zuzana Moysova ◽  
Garry D Tan ◽  
Alistair Lumb ◽  
Jim Davies ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Age Groups ◽  
University Hospitals ◽  
Clinical Consequences ◽  
Level 1 ◽  
Poor Outcomes ◽  
Level 2

Abstract Background Hypoglycaemia during hospital admission is associated with poor outcomes including increased length of stay. In this study, we compared the incidence of inpatient hypoglycaemia and length of stays among people of three age groups: ≤65 years, 65–80 years and &gt;80 years old. Methods The study was conducted using a 4-year electronic patient record dataset from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for people with diabetes. We analysed the blood glucose (BG) measurements and identified all level 1 (BG &lt;4 mmol/l) and level 2 (BG &lt;3 mmol/l) hypoglycaemic episodes. We compared the length of stays between different age groups and with different levels of hypoglycaemia. Results We analysed data obtained from 17,658 inpatients with diabetes who underwent 32,758 hospital admissions. The length of stays for admissions with no hypoglycaemia were 3[1,6], 3[1,8] and 4[2,11] (median[interquartile range]) days for age groups ≤65 years, 65–80 years and &gt;80 years, respectively. These were statistically significantly lower (P &lt; 0.01 for all pairwise comparisons) than the length of stays for admissions with level 1 hypoglycaemia, which were 6[3,13], 10[5,20] and 12[6,22] days, and level 2 hypoglycaemia, which were 7[3,14], 11[5,24] and 13[6,24] days. Conclusions In all age groups, admissions with either level 1 or level 2 hypoglycaemia were associated with an increased length of stay. However, in both the older groups, the length of stay increments were much higher (double) than the younger counterparts. The clinical consequences of hypoglycaemia were more severe in older people compared with the younger population.

scholarly journals Validity of the diagnosis of pneumonia in hospitalised patients with COPD

2019 ◽  
Vol 5 (2) ◽  
pp. 00031-2019 ◽  
Author(s):  
Lydia J. Finney ◽  
Vijay Padmanaban ◽  
Samuel Todd ◽  
Nadia Ahmed ◽  
Sarah L. Elkin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chest Radiograph ◽  
Hospital Admissions ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Prolonged Length ◽  
High Dependency ◽  
Copd Patients ◽  
Hospitalised Patients

RationaleExacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia are two of the most common reasons for acute hospital admissions. Acute exacerbations and pneumonia present with similar symptoms in COPD patients, representing a diagnostic challenge with a significant impact on patient outcomes. The objectives of this study were to compare the prevalence of radiographic consolidation with the discharge diagnoses of hospitalised COPD patients.MethodsCOPD patients admitted to three UK hospitals over a 3-year period were identified. Participants were included if they were admitted with an acute respiratory illness, COPD was confirmed by spirometry and a chest radiograph was performed within 24 h of admission. Pneumonia was defined as consolidation on chest radiograph reviewed by two independent observersResultsThere were 941 admissions in 621 patients included in the final analysis. In 235 admissions, consolidation was present on chest radiography and there were 706 admissions without consolidation. Of the 235 admissions with consolidation, only 42.9% had a discharge diagnosis of pneumonia; 90.7% of patients without consolidation had a discharge diagnosis of COPD exacerbation. The presence of consolidation was associated with increased rate of high-dependency care admission, increased mortality and prolonged length of stay. Inhaled corticosteroid use was associated with recurrent pneumonia.ConclusionsPneumonia is underdiagnosed in patients with COPD. Radiographic consolidation is associated with worse outcomes and prolonged length of stay. Incorrect diagnosis could result in inappropriate use of inhaled corticosteroids. Future guidelines should specifically address the diagnosis and management of pneumonia in COPD.

scholarly journals 850Description of total population hospital admissions for Craniosynostosis in Australia

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mohammed Junaid ◽  
Linda Slack-Smith ◽  
Helen Leonard ◽  
Kingsley Wong
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Total Population ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Average Length ◽  
Craniofacial Morphology ◽  
Outcome Variable ◽  
Diagnosis Codes ◽  
Hospital Separation

Abstract Background Craniosysnostosis (CS) is a condition ensuing from premature fusion of cranial sutures, resulting in altered craniofacial morphology, requiring early neurosurgical interventions to improve prognosis and outcomes. This study aimed to describe total population hospital admissions related to craniosynostosis in Australia over a 22-year period. Methods Population summary data for admissions to public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database (July 1996 to June 2018). The primary outcome variable was a hospital separation with the principal diagnosis of craniosynostosis, craniodysostosis or acrocephalosyndactyly (ICD9CM diagnosis codes 756.00 and 756.01 between July 1996– June 1998 and ICD10AM diagnosis codes Q75.0, Q75.1 and Q87.02 for July 1998 onwards). Trends in rates of hospital admission and length of stay by age, gender and type of craniosynostosis were investigated by negative binomial regression. Results A total of 8,115 admissions were identified between July 1996 to June 2018. Marginal decrease in hospital admission rates [-0.02 (95%CI 0.03, 0.001)] has been observed over a duration of 22 years. Admissions were higher for males, infants (&lt;1 year) and nonsyndromic cases of disease. Average length of stay at hospitals for CS was calculated to be 5.3 ± 1.3 days per year which were even lengthier with syndromic conditions. Conclusion This study has identified population level trends in hospital separation for craniosynostosis in Australia. Key Message Population administrative data, despite limitations provides useful information to inform research and practice.

scholarly journals Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

2019 ◽  
Vol 32 (6) ◽  
pp. 453
Author(s):  
João Gonçalves-Pereira ◽  
Filipe Froes ◽  
Fernanda Paula Santos ◽  
Helena Sofia Antão ◽  
João Paulo Guimarães
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Early Discharge ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ambulatory Setting ◽  
Skin Structure ◽  
Clinically Significant ◽  
Prolonged Hospital

Introduction: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections.Material and Methods: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015.Results: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 – 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively.Discussion: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections.Conclusion: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.

Predicting Hospital Admission and Prolonged Length of Stay in Older Adults in the Emergency Department: The PRO-AGE Scoring System

2020 ◽  
Vol 76 (3) ◽  
pp. 255-265 ◽  
Author(s):  
Pedro K. Curiati ◽  
Luiz A. Gil-Junior ◽  
Christian V. Morinaga ◽  
Fernando Ganem ◽  
Jose A.E. Curiati ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Scoring System ◽  
Prolonged Length

Length of Stay in Pediatric Neurology Hospital Admissions

2021 ◽  
pp. 088307382110208
Author(s):  
Annie Roliz ◽  
Yash D. Shah ◽  
Sanjeev Kothare ◽  
Kanwaljit Singh ◽  
Sushil Talreja
Keyword(s):  
Length Of Stay ◽  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Neurologic Disorder ◽  
Prolonged Length ◽  
Inpatient Hospital ◽  
Icu Admission ◽  
Unplanned Admissions ◽  
Pediatric Icu

Objective: To describe inpatient length of stay patterns, identify key drivers related to prolonged length of stay, and evaluate the relationship between length of stay and readmission in pediatric neurology Methods: This was a retrospective review of patients <19 years old admitted with a principal neurologic diagnosis to our hospital between January 2017 and July 2019. Scheduled admissions and hospital admissions lasting >30 days were excluded from analysis. Length of stay was obtained in addition to demographic characteristics, principal discharge diagnosis, multispecialty care, use of multiple antiseizure medications, inpatient hospital costs (ie, claims paid), and pediatric intensive care unit (ICU) admission for unplanned admissions and 7- and 30-day readmissions. Results: There were a total of 1579 unplanned admissions. The most common reasons for admission were seizure (n = 942), headache (n = 161), other neurologic diagnosis (n = 121), and psychiatric disorders/functional neurologic disorder (n = 60). Children admitted to the hospital for a neurologic condition have an average length of stay of 2.8±5.0 days for unplanned admissions, 4.5±7.4 days for 7-day readmissions, and 5.2±7.5 days for 30-day readmissions. Average inpatient hospital costs were $44 075±56 976 for unplanned admissions, $60 361±71 427 for 7-day readmissions, and $55 434±56 442 for 30-day readmissions. Prolonged length of stay and increased hospital costs were associated with pediatric ICU admission, multispecialty care, 7- and 30-day readmission, multiple antiseizure medications, and psychiatric disorders / functional neurologic disorders. Conclusions: Pediatric ICU admission, multispecialty care, readmission, multiple antiseizure medications, and psychiatric disorder / functional neurologic disorder prolong length of stay and increase hospital costs.

scholarly journals Common Diagnoses and Outcomes in Elderly Patients Who Present to the Emergency Department with Non-Specific Complaints

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Kathleen Quinn ◽  
Michael Herman ◽  
Daren Lin ◽  
Wendy Supapol ◽  
Andrew Worster
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Discharge Diagnosis ◽  
Median Length ◽  
Aged Patients ◽  
Life Threatening ◽  
Ischemic Attack

AbstractObjectiveElderly patients often present to the emergency department (ED) with non-specific complaints. Previous studies indicate that such patients are at greater risk for life-threatening illnesses than similarly aged patients with specific complaints. We evaluated the diagnoses and outcomes of elderly patients presenting with non-specific complaints.MethodsTwo trained data abstractors independently reviewed all records of patients over 70 years old presenting (to two academic EDs) with non-specific complaints, as defined by the Canadian Emergency Department Information System (CEDIS). Outcomes of interest were ED discharge diagnosis, hospital admission, length of stay, and ED revisit within 30 days.ResultsOf the 743 patients screened for the study, 265 were excluded because they had dizziness, vertigo, or a specific complaint recorded in the triage notes. 419 patients (87.7%) presented with weakness and 59 patients (12.3%) presented with general fatigue or unwellness. The most common diagnoses were urinary tract infection (UTI) (11.3%), transient ischemic attack (TIA) (10.0%), and dehydration (5.6%). There were 11 hospital admissions with median length of stay of five days. Eighty-one (16.9%) patients revisited the ED within 30 days of discharge. Regression analysis indicated that arrival to the ED by ambulance was independently associated with hospital admission.ConclusionsOur results suggest that elderly patients presenting to the ED with non-specific complaints are not at high risk for life-threatening illnesses. The most common diagnoses are UTI, TIA, and dehydration. Most patients can be discharged safely, although a relatively high proportion revisit the ED within 30 days.

scholarly journals Prevalence of Hospital Admissions for Low Back Pain: Protocol for a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Harrison J Lord ◽  
Danielle Coombs ◽  
Christopher Maher ◽  
Gustavo C Machado
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Low Back

Low back pain is the leading cause of years lived with disability in most countries and creates a huge burden for healthcare systems globally. Around the globe, 4.4% of all emergency department attendances are attributed to low back pain, and subsequent admissions to hospital seem to be common. These hospitalisations can result in unnecessary medical care, functional decline and high costs. There are no systematic reviews summarising the global prevalence of hospital admission for low back pain, identifying the sources of admissions or estimating hospital length of stay. This information would be valuable for health and medical researchers, front-line clinicians, and health planners aiming to improve and increase the value of their health services. The objectives of this study are to estimate the prevalence of hospital admission for low back pain from different healthcare facilities across the globe, including the emergency department, as well as investigate hospital length of stay and explore sources of heterogeneity when categorising studies according to low back pain definitions, sources of admission, study period, study setting and country’s region and income level.

scholarly journals Practice Transformation: Early Impact of the Oncology Care Model on Hospital Admissions

2018 ◽  
Vol 14 (12) ◽  
pp. e739-e745 ◽  
Author(s):  
Molly A. Mendenhall ◽  
Karyn Dyehouse ◽  
Jad Hayes ◽  
Joanie Manzo ◽  
Teresa Meyer-Smith ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Average Cost ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Urgent Care ◽  
Inpatient Cost ◽  
Care Model ◽  
Hospital Admission Rate ◽  
Oncology Care ◽  
Cost Per Admission

Purpose: The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives. Methods: Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care. Results: On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively). Conclusion: By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.

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