Redesigning care for frail older people: The impact of an elderly care pathway on admission avoidance, length of stay and readmission rates

2016 ◽  
Vol 05 (01) ◽  
Author(s):  
Zabien Nathaniel ◽  
Kawa Amin
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Care Pathway ◽  
Elderly Care ◽  
Frail Older People ◽  
Readmission Rates ◽  
The Impact

Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

2018 ◽  
Vol 53 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Mary-Haston Leary ◽  
Kathryn Morbitzer ◽  
Bobbi Jo Walston ◽  
Stephen Clark ◽  
Jenna Kaplan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Positive Impact ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Readmission Rates ◽  
A Value ◽  
Pharmacist Interventions ◽  
Semistructured Interviews ◽  
The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

Tensions and polarities in the autonomy of family carers in the context of the COVID-19 pandemic in France

2022 ◽  
Author(s):  
Olivier Giraud ◽  
Anne Petiau ◽  
Abdia Touahria-Gaillard ◽  
Barbara Rist ◽  
Arnaud Trenta
Keyword(s):  
Older People ◽  
Social Service ◽  
Long Term Care ◽  
Health Protection ◽  
Family Carers ◽  
Frail Older People ◽  
Term Care ◽  
Care Systems ◽  
The Impact

This article analyses the impact of the COVID-19 lockdown on ‘monetised’ family carers’ understanding of their own autonomy in a long-term care relation at home. The reduction or suspension of medico-social service deteriorated the situation of family carers of frail older people or people with disability. We develop and apply an analytical grid of 15 interviews of monetised family carers about the reorganisation of care systems and their situation as carers. We identify three types of understandings of autonomy among family carers in the context of the COVID-19 pandemic: preventive autonomy; health protection autonomy; and supported autonomy.

scholarly journals 17 Improving Frailty Identification and Comprehensive Geriatric Assessment (CGA) Completion on the Wards

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
D Verma ◽  
F Bonora ◽  
R Walker ◽  
M Kaneshamoorthy ◽  
L Bafadhel
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Elderly Care ◽  
Frail Older People ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Qualitative Feedback ◽  
Complicated Course ◽  
User Friendly

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is known to deliver substantial and measurable health improvements to frail older people, including increased independence and a reduction in mortality.1 The Clinical Frailty Scale (CFS) can detect older adults at higher risk of complicated course and longer hospital stay.2 Despite the known benefits, previous audits has shown poor documentation on geriatric wards at Southend Hospital. Therefore, we devised a Quality Improvement Project to improve the uptake of both these. Methods A total of two Plan Do Study Act (PDSA) cycles were completed where CGA completion and CFS documentation was audited. Each cycle lasted two weeks (25 patients). Qualitative feedback was obtained from the members of multidisciplinary team to aid improvements. The baseline audit was based on the introduction of a 2-page ward proforma for all new patients. The first intervention was an improved 2-page ward-proforma. The second intervention was a single page ward-proforma. Results Originally, 40% of new patients admitted onto the ward had a CGA assessment and CFS score. After the first intervention, 79% (19) patients had a CFS score and a CGA assessment. 21% had a full CGA completed and 58% had partial CGA. Feedback included wanting a single page proforma to increase uptake. Questions needed to be more unambiguous and more tick boxes. After the second intervention 100% (25) patients had a CFS score and a CGA assessment. 40% (10) had a full CGA completed and 60% (15) had a partial CGA. Feedback include incorporating the ward round documentation to avoid repetition. Conclusions The results show that by using a focused, concise and user-friendly proforma, uptake of the Comprehensive Geriatric Assessment and Clinical Frailty Scale can be significantly increased, bringing substantial and measurable health improvements to frail older people admitted to elderly care wards. References 1. Welsh TJ, Gordon AL, Gladman JR. Int J Clin Pract. 2014;68(3):290–293. 2. Juma S, Taabazuing MM, Montero-Odasso M. Can Geriatr J. 2016;19(2):34–39.

scholarly journals Implementation of a Spine-Centered Care Pathway at a Regional Academic Spine Center

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 36S-40S
Author(s):  
George M. Ghobrial ◽  
Jefferson Wilson ◽  
Daniel Franco ◽  
Kristen Vogl ◽  
Alexander R. Vaccaro ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Fusion ◽  
Multidisciplinary Team ◽  
Care Pathway ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Spine Care ◽  
Time Periods ◽  
The Impact ◽  
Anterior Posterior

Study Design: Retrospective case series. Objective: To describe the early implementation of an inpatient spinal surgery unit and measure the impact on cost and length of stay (LOS). Methods: A retrospective case review was performed for frequent spine-related diagnosis-related groups (DRGs) cared for by a dedicated multidisciplinary team: combined anterior/posterior (AP) spinal fusion with major complicating or comorbid condition (MCC), combined (AP) spinal fusion with CC, combined (AP) spinal fusion without complicating or comorbid (CC)/MCC, cervical spinal fusion with MCC, cervical spinal fusion with CC, and cervical spinal fusion without CC/MCC. Four time periods were compared: historical control, initial pathway implementation, full pathway implementation, and spine unit opening. Mean hospital LOS, mean and median total costs (USD), and ratio of costs-to-charges were analyzed. Results: The number of spine cases per interim ranged from 219 to 258. The mean overall hospital LOS and mean cost varied from 3.8 to 4.3 days for all DRGs across the time periods and was not significant. Cost also did not vary significantly throughout. Median variable cost per anterior/posterior spinal fusion procedure with a CC or MCC declined by 16 311, first with the institution of a spine pathway protocol by USD8738 and then USD7423 with the establishment of a spine care unit but did not reach significance. Conclusions: The use of a standardized, inpatient spine care pathway implemented by a multidisciplinary team may reduce the hospital length of stay and decrease overall costs.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P &lt; 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Readmission after robotic Ivor Lewis esophagectomy: Earlier discharge, increased readmissions?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 149-149
Author(s):  
Ahmed I. Salem ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
Kenneth Meredith
Keyword(s):  
Length Of Stay ◽  
Neoadjuvant Therapy ◽  
Statistical Tests ◽  
P Value ◽  
Readmission Rates ◽  
Historical Cohort ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

149 Background: Readmissions after esophagectomy are costly and incidence can be as high as 25%. The robotic assisted approach has potential benefits of earlier discharge compared to conventional techniques, however it is unclear what impact an earlier discharge will have on readmission rates. We sought to examine the impact of early discharge on readmission rates with robotic approaches. Methods: A retrospective review of all patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL) from 2009-2015 was conducted. Clinicopathologic factors and surgical outcomes were recorded and compared. We then compared outcomes to a historical cohort from the Surveillance, Epidemiology, and End Results-Medicare data (2002 to 2009). Length of stay, 30-day and 90-day readmissions, and mortality were determined. All statistical tests were two-sided and a p-value < 0.05 was considered statistically significant. Results: We identified 147 patients who underwent RAIL. There were 78.9% (116) male with an average age 66 ±10 years. Adenocarcinoma was the predominant histology in 86% (126) patients, 9.52% (14) patients had squamous cell histology, and 4.76% (7) patients had other histology. Neoadjuvant therapy was administered to 77.6% (114) patients. In the SEER database 1,744 patients with esophageal cancer underwent esophagectomy: 80% of patients (1,390) were male, with a mean age of 73 years; 71.8% of tumors (1,251) were adenocarcinomas, and 38% of patients (667) received neoadjuvant therapy. Median length of stay was 13 days, 30-day mortality was 8.8% (158 patients), and 90 day mortality was 17.9% (302) compared to median LOH of 9 days, 30-day mortality of 0.6% (1) and 90-day mortality of 1.4% (2)% in the robotic cohort, p < 0.0001, p = 0.007, and p < 0.0001. Readmission rates at 30 and 90 days were 18.6% (212) and 31.3% (356) in the SEER patients, and 3.4% (5) and 5.4% (8) in the robotic cohort p = 0.001 and p < 0.001. Conclusions: RAIL is a safe surgical technique that provides an alternative to conventional approaches to esophageal resection. Patients undergoing RAIL had lower mortality rates and LOH. Despite the lower LOH, RAIL was associated with lower 30 and 90-day readmissions.

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