Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time

Abstract Background It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions. Results Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values>0.05). Conclusions Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.

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Secular trends in emergency department encounters for concussion at US children's hospitals by age group (2008–2017)

Neurology ◽

10.1212/01.wnl.0000550679.93221.1a ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S22.2-S22

Author(s):

Amy Linabery ◽

Kara Seaton ◽

Alicia Zagel ◽

Alicen Spaulding ◽

Gretchen Cutler ◽

...

Keyword(s):

Emergency Department ◽

Public Awareness ◽

Weighted Least Squares ◽

Age Groups ◽

Secular Trends ◽

Medical Attention ◽

Age Group ◽

Admission Rates ◽

Pediatric Hospitals ◽

Over Time

BackgroundIncreased concussion rates in US youth have been documented since 2000. Concomitant rises in healthcare utilization for concussion are likely attributable to public health, media, and legislative initiatives aimed at increasing public awareness of the importance of seeking medical attention after injury. Utilization trends in young children have not been well-documented, however.ObjectiveTo characterize recent secular trends in pediatric emergency department (ED) encounters for concussion by 4-year age group.MethodsUsing Children's Hospital Association's Pediatric Health Information System data, we examined a retrospective cohort of patients aged 2–17 years with an ED encounter for concussion at 22 US pediatric hospitals with continuous data between 2008 and 2017. Average annual change in rates of ED visits for concussion and sports-/recreation-related concussion, imaging, and admissions were estimated via weighted least-squares regression.ResultsED encounters with a primary indication of concussion comprised 0.8% (n = 86,393) of all ED encounters in 2008–2017. Over time, ED concussion visits in 6–17-year-olds increased by 0.5–1.1 per 1,000 ED encounters per year (all Ptrend< 0.0001), while rates among 2-5-year-olds remained stable (Ptrend = 0.72). Rates for sports-/recreation-related concussions increased significantly across all age groups (<0.0001 ≤ Ptrend ≤ 0.01). Absolute number undergoing any imaging increased in all age groups; however, due to increased ED concussion encounters, the rate of imaging decreased overall (−29.7/1,000 ED concussion encounters/year; Ptrend < 0.0001) and across all age groups; the imaging rate decreased less for 2-5-year-olds (−19.6/1,000 encounters/year; Ptrend < 0.0001). Likewise, admission rates declined significantly over time overall (−10.1/1,000 encounters/y; Ptrend = 0.0006) and for all age groups.ConclusionsED concussion encounter rates in US youth aged 6–17 years continue to increase at pediatric hospitals, suggesting awareness efforts have been effective. Conversely, imaging and admission rates have decreased, indicating efforts to curtail unnecessary irradiation and intervention have also been successful. Trends in 2-5-year-olds were somewhat different from older youth and should be explored further.

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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 ◽

10.1093/qjmed/hcaa261 ◽

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 < 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.

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Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?

Journal of Intensive Care Medicine ◽

10.1177/0885066620956633 ◽

2020 ◽

pp. 088506662095663

Author(s):

Christopher F. Chesley ◽

Michael O. Harhay ◽

Dylan S. Small ◽

Asaf Hanish ◽

Hallie C. Prescott ◽

...

Keyword(s):

Critical Care ◽

Critical Illness ◽

Acute Care ◽

Hospital Readmission ◽

Critical Care Unit ◽

Readmission Rates ◽

Critical Care Units ◽

Icu Admission ◽

Over Time ◽

Post Acute Care

Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time. Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a critical care unit. The primary outcome was 30-day all cause hospital readmission. Secondary outcomes included post-acute care resource use and immediate readmission, defined as within 7 days of discharge. Results: Compared to patients discharged after an index hospitalization without critical illness, surviving patients following ICU admission were not more likely to be rehospitalized within 30 days (15.8 vs. 16.1%, p = 0.08). However, they were more likely to receive post-acute care services (45.3% vs. 70.9%, p < 0.001) as well as be rehospitalized within 7 days (5.2 vs. 6.0%, p < 0.001). Post-acute care use and 30-day readmission rates varied by ICU type, the latter ranging from 11.7% after admission in a cardiothoracic critical care unit to 23.1% after admission in a medical critical care unit. 30-day readmission after ICU admission did not decline between 2010 and 2015 (p = 0.38). Readmission rates declined over time for 2 of 4 targeted conditions (heart failure and chronic obstructive pulmonary disease), but only when the hospitalization did not include ICU admission. Conclusions: Rehospitalization for survivors following ICU admission is common across all specialty critical care units. Post-acute care use is also common for this population of patients. Overall trends for readmission rates after critical illness did not change over time, and readmission reductions for targeted conditions were limited to hospitalizations that did not include an ICU admission.

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Abstract 14971: Impact of Medicare Diagnosis Code Expansion and Inclusion of Outpatient Data on Risk-adjusted 30-day Mortality and Readmission Rates After Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.14971 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Lauren Gilstrap ◽

Rishi Wadhera ◽

Andrea Austin ◽

Stephen A Kearing ◽

Karen Joynt Maddox ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Adjustment ◽

Average Increase ◽

Diagnosis Code ◽

Readmission Rates ◽

Medicare Data ◽

Diagnosis Codes ◽

The Impact ◽

Over Time

Introduction: In January 2011, the Center for Medicare and Medicaid Services increased the number of billing codes allowed per admission from 9 to 25. This caused an artificial increase in comorbidity burdens. Some have argued including outpatient data mitigates this problem. The aim of this study was to explore the impact of diagnosis code expansion, using inpatient and inpatient+outpatient data and evaluate potential solutions for conducting longitudinal studies of 30-day risk-adjusted outcome rates after acute myocardial infarction (AMI). Hypothesis: Limiting diagnosis codes and including outpatient data would produce the most stable estimates of risk-adjusted outcomes over time. Methods: We used 100% Medicare data to create a cohort of beneficiaries with AMI between 2008 and 2013. We used 4 methods to calculate the hierarchical condition categories/patient (HCC/pt) necessary for risk adjustment: 1) inpatient-only data, limited codes after 2011; 2) inpatient-only data, unlimited codes; 3) inpatient+ outpatient data, limited codes; 4) inpatient+outpatient data, unlimited codes. Results: Using inpatient-only data, expanding diagnosis codes increased the average HCC/pt by +0.23 HCC/pt. Using inpatient+outpatient data, the average increase was only +0.11 HCC/pt. (relatively 109% less, Figure A ). Between 2009-2013, AMI mortality was flat while readmissions declined ( Figure B ). For mortality, all 4 methods produced estimates that were, on average, +0.7% higher than unadjusted (raw) rates. For readmission, the closest to unadjusted and most stable over time was inpatient+outpatient data with limited codes. Conclusion: For studies that span January 2011, diagnosis codes should be limited to 9 after 2011 when using inpatient or combined inpatient and outpatient data.

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Epidemiological trends in COVID-19 pandemic: prospective critical appraisal of observations from six countries in Europe and the USA

BMJ Open ◽

10.1136/bmjopen-2020-045782 ◽

2021 ◽

Vol 11 (4) ◽

pp. e045782

Author(s):

Maria Alexandra Velicu ◽

Luciano Furlanetti ◽

Josephine Jung ◽

Keyoumars Ashkan

Keyword(s):

Public Health ◽

Hospital Admissions ◽

Disease Prevalence ◽

Warning Signs ◽

Contributing Factors ◽

Admission Rates ◽

Health Measures ◽

The Usa ◽

Using Data ◽

Over Time

IntroductionEurope was the epicentre of the COVID-19 pandemic in March 2020, with the highest number of cases and deaths between March and April. In May, the infection numbers registered a fall followed by a second new rise, not proportionally reflected by an increase in the number of deaths. We aimed to investigate the relationship between disease prevalence and infection fatality rate (IFR), and the number of intensive care unit (ICU) and hospital admissions over time, to develop a predictive model, as well as appraising the potential contributing factors underpinning this complex relationship.MethodsA prospective epidemiological study using data from six countries collected between 10 March and 4 September 2020. Data on the number of daily hospital and ICU admissions with COVID-19 were gathered, and the IFR and the prevalence were calculated. Trends over time were analysed. A linear regression model was used to determine the association between the fatality rates and the number of admissions.FindingsThe prediction model confirmed the linear association between the fatality rates and the numbers of ICU and hospital admissions. The exception was during the peak of the COVID-19 pandemic when the model underestimated the fatalities indicating that a substantial number of deaths occurred outside of the hospitals. The fatality rates decreased in all countries from May until September regardless of the trends in prevalence, differences in healthcare systems or strategic variations in handling the pandemic.InterpretationThe observed gradual reduction in COVID-19 fatality rates over time despite varying disease prevalence and public health measures across multiple countries warrants search for a biological explanation. While our understanding of this novel virus grows, hospital and ICU admission rates remain effective predictors of patient outcomes which can be used as early warning signs for escalation of public health measures.

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THE INFLUENCE OF INCREASING SEVERITY OF ILLNESS ON ICU READMISSION RATES OVER TIME

Anesthesiology ◽

10.1097/00000542-2000090002-00003 ◽

2000 ◽

Vol 93 (3B) ◽

pp. B3-B3

Author(s):

Andrew L. Rosenberg ◽

Timothy P. Hofer ◽

Rodney A. Hayward ◽

Cathy Strachan ◽

Charles M. Watts

Keyword(s):

Severity Of Illness ◽

Readmission Rates ◽

Over Time

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1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.765 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Adnan ◽

S Sange ◽

M Ahmed ◽

S Kanchustambam

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Port Site ◽

Site Infection ◽

Surgical Team ◽

Readmission Rates ◽

Skin Preparation ◽

Local Skin ◽

Admission Rates ◽

Post Surgery

Abstract Introduction Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI). Method A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded. Results In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%). Conclusions The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.

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Abstract 248: Mortality and Readmission After Acute Myocardial Infarction in the Department of Veterans Affairs Health Care System

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.248 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Paul L Hess ◽

Elise C Gunzburger ◽

Chuan-Fen Liu ◽

Jacqueline Jones ◽

Daniel D Matlock ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Veterans Affairs ◽

Unplanned Readmission ◽

Level Variation ◽

Readmission Rates ◽

Acute Mi ◽

Over Time

Background: Little contemporary data about the performance of Veterans Affairs (VA) hospitals related to mortality and readmission rates after an acute myocardial infarction (MI) are available. Accordingly, we sought to characterize the rates of in-hospital and 30-day mortality and 30-day unplanned readmission after an acute MI as well as associated site-level variation. Methods: Using data from the External Peer Review Program, which abstracts data from the records of all patients admitted with an acute MI, linked with administrative data from the Corporate Data Warehouse, we performed an observational analysis of patients admitted with an acute MI from January 1, 2011, to February 28, 2014. Results: A total of 16,024 patients were admitted with an acute MI; 806 (5.0%) patients died during hospitalization, 1299 (8.1%) died within 30 days of admission, and 2529 (16.9%) had an unplanned hospital readmission. The annual risk-standardized in-hospital mortality rate (Hazard Ratio (HR) 0.90, 95% Credible Interval (CI) 0.83-0.98) and the 30-day mortality rate (HR 0.94, 95% CI 0.88-1.00) but not the unplanned readmission rate (HR 1.00, 95% CI 0.96-1.04) decreased over time ( Figure ). Individual hospital rates for in-hospital mortality, 30-day mortality, and 30-day unplanned readmission were comparable to the system-wide rates, with little variation between hospitals. Conclusions: In Veterans Affairs hospitals from 2011 to 2014, in-hospital and 30-day mortality but not 30-day unplanned readmissions rates declined over time. Little site-level variation in mortality or readmission rates was observed.

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Examining Trends in Sepsis and Sepsis Management by Non-Physician Clinicians in a Rural Ugandan Emergency Department Over a Decade.

10.21203/rs.3.rs-16484/v1 ◽

2020 ◽

Author(s):

Sal Calo ◽

Brian Travis Rice ◽

John Bosco Kamugisha ◽

Nicholas Kamara ◽

Stacey Chamberlain

Keyword(s):

Emergency Department ◽

Linear Regression ◽

Sub Saharan Africa ◽

Sepsis Management ◽

Suspected Infection ◽

Admission Rates ◽

Sub Saharan ◽

Qsofa Score ◽

The Impact ◽

Over Time

Abstract Background: There is a paucity of data from Sub-Saharan Africa regarding sepsis outcomes and the impact of sepsis care on those outcomes, including the impact of care provided by non-physician clinicians (NPCs). Methods: Data were retrospectively analyzed from a rural Ugandan emergency department staffed by NPCs using a quality assurance database of adult and pediatric patient visits with and without sepsis from 2010 through 2018. Sepsis was defined as suspected infection with a qSOFA score ≥ 2. Mortality, disposition, and NPC adherence to intravenous fluid and anti-infective therapy were analyzed using chi-squared and multivariable linear regression. Results: Sepsis criteria were met in 4,847 (11.0%) cases. Sepsis cases compared to non-sepsis cases were significantly older, and had higher rates of comorbid malaria, HIV, tuberculosis, and pneumonia. They had higher admission rates (86.8% versus 66.3%), were more likely to still be admitted at three days (40.2% versus 26.2%), and had higher mortality at three days (7.8% versus 2.5%). The incidence of sepsis significantly declined over time from 16.3% in 2010 to 3.1% in 2018 while the proportion of sepsis cases with qSOFA score of ≥ 3 increased significantly over time. The decrease in incidence was largely due to a precipitous drop in malaria smear-positive sepsis. Utilizing a multivariable linear regression model, annual three-day sepsis mortality did not significantly change over time, though adherence to administration of both fluids and anti-infectives increased significantly from 12.3% in 2010 to 35.0% in 2018. Conclusions: Sepsis incidence, especially malaria smear-positive sepsis, decreased over time, while annual mortality did not change despite increased adherence to administration of anti-infectives and intravenous fluids in an NPC-staffed emergency department. Further studies are needed to investigate the contextualized use of anti-infectives and fluid resuscitation.

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