scholarly journals Mobile stroke unit in the UK healthcare system: avoidance of unnecessary accident and emergency admissions

2021 ◽  
Vol 5 (4) ◽  
pp. 64-64
Author(s):  
Daniel Phillips ◽  
Iris Q. Grunwald ◽  
Silke Walter ◽  
Klaus Faßbender
Keyword(s):  
Hospital Admission ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
Catheter Laboratory ◽  
Uk National Health Service ◽  
The Uk

<sec id="s1"> Aims: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. </sec> <sec id="s2"> Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service was conducted. Emergency patients categorised as code stroke and headache were included from 5 June to 18 December 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward and stroke management metrics were assessed. </sec> <sec id="s3"> Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to eight of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, one patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 mins (interquartile range, 40‐60). </sec> <sec id="s4"> Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments. </sec>

scholarly journals Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions

2020 ◽  
Vol 49 (4) ◽  
pp. 388-395
Author(s):  
Iris Q. Grunwald ◽  
Daniel J. Phillips ◽  
David Sexby ◽  
Viola Wagner ◽  
Martin Lesmeister ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
The Uk

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&amp;E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&amp;E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&amp;E departments.

scholarly journals Change in Admission Rates Among Patients Presenting to Emergency Departments with VTE and Low Risk of Complications: A Retrospective Cohort Study from 11 Community Hospitals

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4694-4694
Author(s):  
William Rhoades ◽  
Rasha Khatib ◽  
Kara Nitti ◽  
Marc McDowell ◽  
Rick Szymialis ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Health Research ◽  
Clinical Guidelines ◽  
Research Funding ◽  
Hospital Admissions ◽  
Low Risk ◽  
Hospital Treatment ◽  
Community Hospitals ◽  
Study Results ◽  
Before And After

Background: Venous thromboembolism (VTE) is often diagnosed in the emergency department (ED), but adherence to clinical guidelines in the management of VTE in the ED may be low. The 2016 update of the American College of Chest Physicians (CHEST) guidelines has recommended home management or early discharge instead of in-hospital treatment for patients with low risk VTE. Gaps in clinical practice and clinical guideline recommendations need to be identified to improve VTE management in the ED. Objectives: To investigate changes in management of patients with low-risk VTE who received a diagnosis in the ED before and after the February 2016 update of CHEST guidelines on antithrombotic therapy for VTE. Methods: This retrospective analysis examined patient electronic medical records from January 1, 2013 to December 31, 2018 from a large healthcare system in Illinois. Data were collected on patients presenting in 11 EDs in community hospitals who were given a primary diagnosis or discharge diagnosis of VTE based on International Classification of Diseases, Ninth Revision or Tenth Revision. VTE was categorized as low-risk if diagnosis was either lower-extremity DVT or PE and a pulmonary embolism score index (PESI) lower than 85. A multivariable logistic regression model was constructed to measure the adjusted odds of hospital admissions among patients with low-risk VTE before and after the update of the CHEST guidelines. The model was adjusted for patient demographics and clinical characteristics, type of anticoagulant administered, preexisting comorbidities, and hospital characteristics. Results: Among 2,193,965 ED visits over the 6-year period, 15,543 visits representing 14,530 patients who received diagnoses of DVT (55%) or PE (45%) were included in the analysis. The mean age was 65.0 ± 17.4 years, with 46% being male and 63% Caucasian. A total of 83% of patients with DVT were considered low risk based on DVT location and 49% of patients with PE were low risk based on PESI. The rates of hospital admission for management of low-risk VTE declined from 81% in 2013 to 73% in 2018. In the adjusted model, patients visiting EDs between 2016 and 2018 (post-update of guidelines) were equally likely to be admitted compared with patients visiting EDs between 2013 and 2015 (pre-update of guidelines; odds ratio [OR]=0.91; 95% confidence interval [CI]: 0.81, 1.02). Patients who received a diagnosis of PE compared with DVT (OR=4.90; 95% CI: 4.26, 5.64) and patients who received vitamin K antagonists compared with direct oral anticoagulants (OR=1.74; 95% CI: 1.54, 1.96) had higher odds of hospital admission. However, the presence of a pharmacist was associated with lower odds of hospital admission (OR=0.68; 95% CI: 0.55, 0.85). Conclusions: Our study results indicate that most patients receiving a diagnosis of low-risk VTE in EDs were admitted for in-hospital management despite clinical guidelines recommending otherwise. The 2016 update of CHEST guidelines recommending outpatient management had minimal effects on decreasing the rate of admissions of patients with low-risk VTE. More effort in real-world practices is needed to adopt guideline recommendations and integrate clinical evidence on new and existing treatment advances. Disclosures Rhoades: Bristol-Meyers Squibb: Research Funding. Khatib:National Institutes of Health: Research Funding; Bristol-Meyers Squibb: Research Funding; Takeda: Research Funding. Nitti:Takeda: Research Funding; Bristol-Meyers Squibb: Research Funding. McDowell:Bristol-Meyers Squibb: Research Funding. Szymialis:Bristol-Meyers Squibb: Employment. Blair:Takeda: Research Funding; Bristol-Meyers Squibb: Research Funding; National Institutes of Health: Research Funding.

Abstract 3: Early Recanalization of Large Vessel Occlusions by tPA on the Mobile Stroke Unit

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexandra L Czap ◽  
James C Grotta ◽  
Mengxi Wang ◽  
Stephanie Parker ◽  
Patti Bratina ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Stroke Unit ◽  
Arterial Occlusion ◽  
Large Vessel ◽  
Secondary Outcome ◽  
Hospital Treatment ◽  
Endovascular Thrombectomy ◽  
Wilcoxon Rank Sum Test ◽  
Mobile Stroke Unit ◽  
Derived Data

Introduction: The benefit of intravenous tPA in acute ischemic stroke patients with large vessel occlusions (LVOs) is limited but time dependent. We evaluated pre-hospital treatment with tPA on the Mobile Stroke Unit (MSU) to explore the recanalization rate in patients with LVOs and its effect on clinical improvement upon ED arrival. Methods: Prospectively derived data were analyzed from patients on the Houston MSU who were treated with tPA and had LVOs identified by hyperdense artery on MSU CT or arterial occlusion on MSU CTA. The primary outcome was early recanalization, categorized as resolution of LVO on repeat vascular imaging in the ED or on emergent angiography versus no recanalization. Secondary outcome was change in baseline NIHSS at 24 hours. Differences in NIHSS were evaluated using Wilcoxon rank sum test with continuity correction. Results: Seventy-one patients received tPA and had proximal LVOs both in the anterior and posterior circulation. Eleven had recanalization on CTA upon ED arrival (15.5%), while 7 had recanalization on emergent angiography (9.9%). The total early recanalization rate with tPA was 25.4%. Forty-seven patients with persistent LVOs on ED arrival (66.2%) underwent endovascular thrombectomy (EVT). Time from symptom onset (last known normal) to tPA bolus did not differ significantly between the early recanalization vs non-early recanalization groups (64.5 minutes [IQR 43.0-78.5] vs 64.0 minutes [52.5-92.0]; p = 0.41). Early recanalization resulted in greater improvement in baseline to ED arrival NIHSS (median NIHSS change 4.0 [0-11.8] vs 0 [0-3.5]; p = 0.01). There were no differences in ED arrival to 24 hour NIHSS between the early recanalization versus non-early recanalization groups irrespective of EVT. Conclusions: Recanalization by ED arrival occurs in 25% of LVO patients with tPA treatment on a MSU and was associated with early clinical improvement. Subsequent EVT did not “make up” for the clinical benefit of early recanalization.

scholarly journals Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
L. Goodwin ◽  
D. Leightley ◽  
Z. E. Chui ◽  
S. Landau ◽  
P. McCrone ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Alcohol Use ◽  
Hospital Admission ◽  
Military Personnel ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Phase 2 ◽  
Physical And Mental Health ◽  
The Uk

Abstract Background Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without. Methods Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014. Results The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16–1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32–2.40)) and in current smokers (HR 1.35 (95% CI 1.12–1.64) compared to those without the disorder, and non-smokers, respectively. Conclusions Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.

scholarly journals Costs for in hospital treatment of urinary lithiasis in the Brazilian public health system

2011 ◽  
Vol 9 (4) ◽  
pp. 518-522 ◽  
Author(s):  
Fernando Korkes ◽  
Jarques Lúcio da Silva II ◽  
Ita Pfeferman Heilberg
Keyword(s):  
Public Health ◽  
Hospital Admission ◽  
Health System ◽  
Hospital Admissions ◽  
Public Health System ◽  
Epidemiological Data ◽  
Hospital Treatment ◽  
The Public ◽  
Urinary Lithiasis ◽  
Mean Cost

ABSTRACT Objective: To estimate costs associated to hospital treatment of urinary lithiasis in the Brazilian public health system as well as to evaluate demographic and epidemiological data referred to hospital admissions in the Brazilian public health system (or unified health care system). Methods: Data from the Informatic Department of Brazilian public health system were obtained as referred to costs in hospital admissions for urinary lithiasis during 2010 and also epidemiological data from 1996 through 2010. Results: There were 69,039 hospital admissions for urinary lithiasis, totaling 0.61% of all hospital admissions in the Brazilian public health system. The mean cost of each of these hospital admissions was US$ 240,23 or R$ 423.42 having as result an overall cost of US$ 16,240,378.00 or R$ 29.232.682,56. Hospital admissions for urinary lithiasis in the Brazilian public health system increased 69% from 1996 to 2010 (43,176 versus 69,309; p < 0.001; OR = 1.69). The number of hospital admissions was 5% greater between December and March as compared to the period between June and September (35,290 versus 33,749; p < 0.001; OR = 1.10). For Caucasian patients the hospital admission was 75% greater as compared to black patients (63.2% versus 35.8%; p = 0.02; OR = 1,75). Conclusion: Hospital admission for urinary liyhiasis has an elevated impact on the public health system with a cost of US$ 16,2 or R$ 29.2 million per year. The number of hospital admissions was greater in hotter months than in cold ones and also in the last decade, mainly in Caucasian population. These data may be helpful for the organization and optimization of health programs in the public health system as referred to prevention and treatment of urinary lithiasis in Brazil.

scholarly journals The relationship between alcohol-related hospital admission and specialist alcohol treatment provision across local authorities in England since passage of the Health and Social Care Act 2012

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Emmert Roberts ◽  
Matthew Hotopf ◽  
Colin Drummond
Keyword(s):  
Hospital Admission ◽  
Social Care ◽  
Local Authority ◽  
Hospital Admissions ◽  
Alcohol Treatment ◽  
Data Sets ◽  
Treatment Provision ◽  
Health And Social Care ◽  
High Prevalence ◽  
The Uk

Summary To our knowledge no previous studies have been conducted at the local authority level assessing relationships between alcohol-related hospital admission, specialist alcohol treatment provision and socioeconomic deprivation since the UK government passed the Health and Social Care Act in 2012. Our results, using publicly available national data-sets, suggest that the local authority areas in England most in need of adequately funded specialist alcohol treatment, because of high prevalence of alcohol dependence and deprivation, are not receiving targeted increased funding, and that the national rise in alcohol-related hospital admissions may be fuelled by local authority funding cuts to specialist alcohol treatment.

010 The melbourne mobile stroke unit substantially improves thrombolysis times and pre-hospital triage

2018 ◽  
Vol 89 (6) ◽  
pp. A5.2-A5
Author(s):  
Henry Zhao ◽  
Skye Coote ◽  
Lauren Pesavento ◽  
Francesca Langenberg ◽  
Patricia Desmond ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Stroke Unit ◽  
Life Support ◽  
Hospital Treatment ◽  
Future Research ◽  
Stroke Patients ◽  
Time Saving ◽  
Royal Melbourne Hospital ◽  
Stroke Treatment ◽  
Mobile Stroke Unit

IntroductionThe Melbourne mobile stroke unit (MSU) project is the first Australian pre-hospital stroke service that delivers on-scene imaging, treatment and triage. The MSU vehicle consists of a Mercedes Sprinter-5 chassis with on-board CereTom 8-slice portable CT scanner and telemedicine capabilities. On-board crew consists of a neurologist/telemedicine, nurse, radiographer and two paramedics (advanced-life-support and mobile-intensive-care). The MSU service is co-dispatched within 20 km of Royal Melbourne Hospital. We describe the service activity since project launch.MethodsData are sourced from the Melbourne MSU registry, an ongoing prospectively collected database of all MSU dispatched cases since November 2017.ResultsIn the first 50 operational days, there were a total of n=255 dispatches (5.1/day), of which 47% of patients received on-scene attendance. On-scene CT was performed on 52% of all attendances. Of n=29 suspected ischaemic stroke cases<6 hours of symptom onset (24% of attended), n=10 (34%) received pre-hospital thrombolysis and n=6 (21%) were directed for endovascular thrombectomy. 30% of patients were thrombolysed within 90 min of symptom onset. A total of n=7 (14% of all stroke) patients were recommended to bypass the closest hospital to a specialist centre for endovascular, neurosurgical or other services. The median scene-to-thrombolysis time of 36.5 min was substantially better than Australian in-hospital averages and represented an estimated 30–45 min time saving compared to in-hospital treatment.DiscussionThe Melbourne MSU project shows that pre-hospital diagnosis and treatment of stroke patients is feasible and associated with substantial time saving in providing acute stroke treatment and triage. Future research will focus on optimising MSU dispatch and cost-effectiveness analysis.

scholarly journals The Cost of Ignoring Acute Cholecystectomy

2009 ◽  
Vol 91 (1) ◽  
pp. 39-42 ◽  
Author(s):  
JP Garner ◽  
SK Sood ◽  
J Robinson ◽  
W Barber ◽  
K Ravi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Waiting Times ◽  
Hospital Costs ◽  
Cost Savings ◽  
The Uk ◽  
Elective Cholecystectomy ◽  
First Admission

INTRODUCTION Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. PATIENTS AND METHODS The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. RESULTS In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over £40,000. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. CONCLUSIONS Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

Entitlement to hospital treatment in the UK: qualifiers, challenges and comment

2011 ◽  
Vol 72 (3) ◽  
pp. 156-160
Author(s):  
Simon W Dubrey ◽  
Paresh A Mehta ◽  
Ritu Sharma ◽  
Sheila Shah
Keyword(s):  
Hospital Treatment ◽  
The Uk
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