Medications Reconciled at Discharge Versus Admission Among Inpatients at a Children’s Hospital

2021 ◽  
Author(s):  
Abby Emdin ◽  
Marina Strzelecki ◽  
Winnie Seto ◽  
James Feinstein ◽  
Orly Bogler ◽  
...  
Keyword(s):  
Chronic Condition ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Prescription Practices ◽  
Relative Risks ◽  
Younger Age ◽  
Nonopioid Analgesics ◽  
Sick Children ◽  
Nonsurgical Patients ◽  
Discharge Prescription

BACKGROUND AND OBJECTIVES Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. METHODS Electronic medication reconciliation data were extracted for inpatient admissions at The Hospital for Sick Children from January 1, 2016, to December 31, 2017 (n = 22 058). Relative changes in the number of medications and relative risks (RRs) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by the following: sex, age group, diagnosis of a complex chronic condition, surgery, or ICU (PICU) admission. Micronutrient supplements, nonopioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. RESULTS Medication counts at discharge were 1.27-fold (95% confidence interval [CI]: 1.25–1.29) greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a complex chronic condition, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Postsurgical patients had higher RRs of opioid prescriptions at discharge (versus admission; RR: 13.3 [95% CI: 11.5–15.3]) compared with nonsurgical patients (RR: 2.38 [95% CI: 2.22–2.56]). CONCLUSIONS Pediatric inpatients were discharged from the hospital with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in postsurgical patients is a priority target for educational and clinical decision support interventions.

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

2021 ◽  
pp. 70-72
Author(s):  
Gaurav Santosh Nemade ◽  
Sumit Nitin Dhus ◽  
Arushi Ramesh Shetty ◽  
Neha Dhananjay Firake
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary Tuberculosis ◽  
Younger Age ◽  
Tobacco Addiction ◽  
History Of ◽  
Early Case ◽  
Male To Female ◽  
Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2451-2453
Author(s):  
Shahid Iqbal ◽  
Muhammad Fareed Khan ◽  
Raja Imtiaz Ahmed ◽  
Shahab Saidullah ◽  
Nisar Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Congenital Heart ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Hospital ◽  
Younger Age ◽  
History Of ◽  
Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

scholarly journals Parental stress: a neglected entity

2019 ◽  
Vol 6 (6) ◽  
pp. 2357
Author(s):  
Nusrat R. Inamdar ◽  
Anvesh S. Tamboli ◽  
Anupama V. Mauskar ◽  
Suchit Tamboli
Keyword(s):  
Socioeconomic Status ◽  
Parental Stress ◽  
Tertiary Care ◽  
Stress Factors ◽  
Chi Square ◽  
College Hospital ◽  
Cross Sectional ◽  
Number Of Children ◽  
Monitor Alarms ◽  
Sick Children

Background: Parents feel very stressed when their child is sick and in Intensive care unit. Objectives of study were to identify common parental stressors during their child’s critical illness and to examine its relationship with demographic variables.Methods: It’s a Cross-sectional questionnaire based study done in PICU & NICU of a tertiary care medical college hospital in Mumbai, 62 parents of children admitted to PICU and NICU for at least 24 hours were interviewed using the Parental Stress Scale. The demographic variables were also recorded.The data analyzed using Cluster Analysis, Kruskal Wallis test, Chi- square test and spearman correlation.Results: The main cause of parental stress was to witness the child’s sufferings (unresponsiveness/pain, procedures, tubes, monitors around child) (median of standardized score = 3.9, IQR = 0.5, p <0.005). The median of standardised stress score due to hospital environmental factors (monitor alarms, nurses, doctors around baby, other sick children) was 3.7 (IQR = 0.5) and that due to lack of intimacy with child was 3.6 (IQR =0.4). Age of parent inversely correlated with the level of stress (r = -0.638) and parents of infants were more stressed (p = 0.005). Number of children, socioeconomic status didn’t affect the stress levels.Conclusions: Young parents and parents of infants were more stressful. Socioeconomic status, residential area and parental sex didn’t affect stress. Few stress factors need remedial steps to meet parental needs. The clinician’s awareness about these stressors, may help to provide optimized family-directed care.

scholarly journals Examining Workflow in a Pediatric Emergency Department to Develop a Clinical Decision Support for an Antimicrobial Stewardship Program

2018 ◽  
Vol 09 (02) ◽  
pp. 248-260 ◽  
Author(s):  
Mustafa Ozkaynak ◽  
Danny Wu ◽  
Katia Hannah ◽  
Peter Dayan ◽  
Rakesh Mistry
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Antimicrobial Stewardship ◽  
Time Allocation ◽  
Care Delivery ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Design And Implementation ◽  
Decision Points ◽  
Stewardship Program

Background Clinical decision support (CDS) embedded into the electronic health record (EHR), is a potentially powerful tool for institution of antimicrobial stewardship programs (ASPs) in emergency departments (EDs). However, design and implementation of CDS systems should be informed by the existing workflow to ensure its congruence with ED practice, which is characterized by erratic workflow, intermittent computer interactions, and variable timing of antibiotic prescription. Objective This article aims to characterize ED workflow for four provider types, to guide future design and implementation of an ED-based ASP using the EHR. Methods Workflow was systematically examined in a single, tertiary-care academic children's hospital ED. Clinicians with four roles (attending, nurse practitioner, physician assistant, resident) were observed over a 3-month period using a tablet computer-based data collection tool. Structural observations were recorded by investigators, and classified using a predetermined set of activities. Clinicians were queried regarding timing of diagnosis and disposition decision points. Results A total of 23 providers were observed for 90 hours. Sixty-four different activities were captured for a total of 6,060 times. Among these activities, nine were conducted at different frequency or time allocation across four roles. Moreover, we identified differences in sequential patterns across roles. Decision points, whereby clinicians then proceeded with treatment, were identified 127 times. The most common decision points identified were: (1) after/during examining or talking to patient or relative; (2) after talking to a specialist; and (3) after diagnostic test/image was resulted and discussed with patient/family. Conclusion The design and implementation of CDS for ASP should support clinicians in various provider roles, despite having different workflow patterns. The clinicians make their decisions about treatment at different points of overall care delivery practice; likewise, the CDS should also support decisions at different points of care.

A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement

2004 ◽  
Vol 24 (5) ◽  
pp. 460-465 ◽  
Author(s):  
David W. Johnson ◽  
David W. Mudge ◽  
Sophie Blizzard ◽  
Mary Arndt ◽  
Amanda O'Shea ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Glucose Measurement ◽  
Altman Analysis ◽  
Princess Alexandra Hospital ◽  
Peritoneal Equilibration Test ◽  
Bland Altman Analysis ◽  
Peritoneal Transport

Objective The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. Design Prospective observational study of an incident PD cohort at a single center. Setting Tertiary-care institutional dialysis center. Participants The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. Main Measurements Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. Results When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0 glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. Conclusions Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.

scholarly journals Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation

2019 ◽  
Vol 28 (9) ◽  
pp. 762-768 ◽  
Author(s):  
Norman Lance Downing ◽  
Joshua Rolnick ◽  
Sarah F Poole ◽  
Evan Hall ◽  
Alexander J Wessels ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Health Record ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Electronic Health

BackgroundSepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions.ObjectivesTo determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis.DesignPatient-level randomisation, single blinded.SettingMedical and surgical inpatient units of an academic, tertiary care medical centre.Patients1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015.InterventionsPatients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders.Measurements and main resultsThere was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids.ConclusionsAn EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.

Endoscopic Retrograde Cholangiopancreatography in General Surgery: How Much are We Outsourcing?

2009 ◽  
Vol 75 (11) ◽  
pp. 1050-1053
Author(s):  
Wesley B. Jones ◽  
Richard H. Roettger ◽  
William S. Cobb ◽  
Alfredo M. Carbonell
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Surgical Patients ◽  
Time Interval ◽  
Endoscopic Retrograde ◽  
Care Surgery ◽  
Surgery Department ◽  
Nonsurgical Patients

Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.

scholarly journals Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 486-493
Author(s):  
Garrick Mok ◽  
Hailey Newton ◽  
Lisa Thurgur ◽  
Marie-Joe Nemnom ◽  
Ian G. Stiell
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Prescription Data ◽  
Care Hospital ◽  
Total Dosage ◽  
Opioid Prescription ◽  
Prescription Practices ◽  
Ed Visits

ABSTRACTBackgroundOpioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures.MethodsWe conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016–April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis.ResultsWe enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1–120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15–36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88–10.35)] had a significantly higher likelihood of opioid prescriptions.ConclusionsThe majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.

Haematological and coagulation disorders and anaesthesia

2017 ◽  
Author(s):  
Herman G. D. Hendriks ◽  
Joost T. M. de Wolf
Keyword(s):  
Clinical Decision Making ◽  
Haemoglobin Concentration ◽  
Perioperative Period ◽  
Clinical Decision ◽  
Red Blood Cell Transfusion ◽  
Coagulation Management ◽  
Coagulation Activity ◽  
Relative Risks ◽  
Coagulation Tests ◽  
Surgical Bleeding

This chapter covers the principal haematological disorders and their implications for anaesthesia. Haemoglobin concentration is the main determinant of oxygen delivery to the tissues making anaemia a potential concern for the anaesthetist. In deciding whether to correct anaemia with a red blood cell transfusion, the anaesthetist must consider the nature of the surgery and the underling cause of the anaemia as well as the haemoglobin concentration. Techniques to limit the need for blood transfusion and the complications of transfusion are discussed. Perfect haemostasis means control of bleeding without the occurrence of thrombotic events. Coagulation management requires an understanding of this balance and the knowledge that altered coagulation activity may result in clinically relevant bleeding or, in contrast, thrombosis. Therefore, the key in haemostasis is an understanding that every anticoagulant action enhances the risk of bleeding and every procoagulant action enhances the risk of thrombosis. If a specific defect in the haemostatic system is known, treatment is tailored to restore this defect. However, tests to predict surgical bleeding do not exist, as it is for test to predict thrombotic events. The strengths and limitations of coagulation tests should be appreciated before they are used to assist clinical decision-making in the perioperative period. An excellent coagulation test is the clinical field (i.e. the surgical wound). If there are abnormalities in the coagulation tests without clinical bleeding, a correction is hardly necessary. In patients taking anticoagulant medication, consideration must be given on an individual patient basis, to the relative risks of continuing (bleeding) or stopping (thrombotic events) the medication.

Delivery (organization and outcome)

2016 ◽  
Author(s):  
Caroline A. Brand ◽  
Ilana N. Ackerman
Keyword(s):  
Chronic Condition ◽  
Tertiary Care ◽  
Risk Behaviour ◽  
Theoretical Models ◽  
Models Of Care ◽  
Current Evidence ◽  
Delivery Of Care ◽  
Care Community ◽  
Research Designs ◽  
Future Challenges

This chapter considers the organization and delivery of care for osteoarthritis (OA) within the broader context of chronic condition management, and with a specific focus on the current OA literature. It describes factors that have influenced healthcare reforms for people with chronic conditions such as OA, and the development and characteristics of chronic condition models of care. The chapter also examines existing models of care for OA, which are commonly multidisciplinary in nature and situated within primary care, community care, or secondary/tertiary care settings. It summarizes current evidence for the effectiveness and cost-effectiveness of OA models of care, acknowledging that limited data are available regarding access and efficiency outcomes. Barriers to the successful development, implementation, and sustainability of OA models of care are discussed, as well as enablers that could facilitate the success of models of care. The chapter also presents points to consider when planning the implementation and evaluation of models of care, such as the development of a program logic, use of theoretical models or frameworks, and careful selection of appropriate research designs (including mixed-methods approaches). Finally, it considers future challenges for OA models of care, particularly the rise of multi-morbidity among patient populations that will necessitate integrated chronic condition management rather than stand-alone OA services. Future models of care may require the design of specific OA modules that can be integrated with generic chronic condition models that address risk behaviour modification and optimize self-management and mental health outcomes.

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