Predictors of Mortality among Inter-Hospital Transferred Patients in a Middle-Income Country: a Retrospective Cohort Study

Objective: To identify predictors for hospital mortality among inter-hospital transferred patients in low-resource settings of rural hospitals in Thailand.Methods: We conducted a retrospective cohort study of patients transferred from emergency room(ER) of a community hospital to its designated tertiary care hospital in a western province of Thailand. During March 2018 and February 2019, medical records of 412 patients were reviewed and extracted for potential predictor variables and outcomes. We defined deaths within 72 hrs after a transfer as primary outcome and overall hospital mortality as secondary outcome. Multivariate logistic regression analysis was performed to identify predictors of the outcomes adjusted for potential confounders.Results: Out of 412 patients, a total of 37 patients (9.0%) died during the stay in receiving hospital and 18 (4.4%) of them died within 72 hrs after transfer. Top ten primary diagnostic categories included road traffic injuries (19.7%), acute appendicitis (9.7%), and acute myocardial infarction (5.1%). Univariate analysis revealed early mortality (<72 hrs) was associated with NEWS2, Emergency Severity Index (ESI), cardiac arrest prior to transfer, use of vasoactive agents, endotracheal intubation and admitting service. Using multiple logistic regression model adjusted for the predictors identified by univariate analysis, we found early mortality was independently associated with NEWS2 ≥ 9 (compared to NEWS2 0-6) with OR= 17.51(95%CI 3.16-97.00) and vasoactive medication use (OR= 5.46, 95%CI 1.39-21.46). Similarly, overall mortality was also independently associated with NEWS2 ≥ 9(OR= 4.76, 95%CI 1.31–17.36) and vasoactive medication use (OR= 7.51,95%CI 2.76–20.45).Conclusion: This study identified predictors of early (<72 hrs) hospital mortality and overall hospital mortality among ER patients transferred from a rural community hospital to its designated tertiary care hospital in Thailand, a middle-income country with universal healthcare coverage. The findings might be helpful to inform decision-making dealing with the inter-hospital transfer of ER patients in resource-poor rural settings with similar case-mix.

Download Full-text

How to improve patient experience of compassion through nursing: Development of an on-job mentorship programme in a tertiary care hospital, Pakistan

10.21203/rs.3.rs-122995/v1 ◽

2020 ◽

Author(s):

Alma Arshad ◽

Naureen Lalani ◽

Noureen Sultan ◽

Aly Zubairi ◽

Ayesha Hussain ◽

...

Keyword(s):

Nursing Education ◽

Patient Experience ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Theory Of Change ◽

Pediatric Care ◽

Care Hospital ◽

Intervention Package ◽

Middle Income ◽

Experience Of Care

Abstract Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships and energize the workplace environments but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited owing to human and financial constraints. Objective The current study describes the development of a feasible an on-job nursing mentorship program using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience from a tertiary care hospital in Pakistan. Methods The intervention package was built by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps that were based on the principles of implementation science, a) identification of a framework, b) creating a working group and c) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme. Results The intermediate outcome was to have nurses demonstrate skills of compassion with the eventual outcome of improving the patient's experience of compassion. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, precision of compassionate experience definition, creation of a compassionate culture and development of competent head nurses as supervisor. In order to ensure the pre-conditions, various interventions were planned and some were implemented through the course of designing. These involved, creation of space to talk about compassionate skills with staff, provide trainings and on-job coaching, revising career ladder of supervisors, inclusion of pediatric compassion specific nursing education service orientation program, recognition of efforts and promotion of compassionate values in numerous communication platforms, arrangement of training workshops, creation of checklists and development of dashboards. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme through strengthening routine supervision leading to improved patient experience of care in the pediatric service.

Download Full-text

FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i3.23496 ◽

2018 ◽

Vol 11 (3) ◽

pp. 272

Author(s):

Melissa Sherrel Pereira ◽

Chandrashekar Udyavara Kudru ◽

Sreedharan Nair ◽

Girish Thunga ◽

Vijayanarayana Kunhikatta ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Univariate Analysis ◽

Tertiary Care ◽

Elevated Serum ◽

Hospital Setting ◽

Severity Of Illness ◽

Southern India ◽

Severe Dengue ◽

Care Hospital ◽

Factors Associated

Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue.Methods: A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue.Conclusion: This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

Download Full-text

Frequency and Cause of Readmissions in Sepsis Patients Presenting to a Tertiary Care Hospital in a Low Middle Income Country

Critical Care Explorations ◽

10.1097/cce.0000000000000080 ◽

2020 ◽

Vol 2 (2) ◽

pp. e0080

Author(s):

Ainan Arshad ◽

Ahmed Ayaz ◽

Mian Arsam Haroon ◽

Bushra Jamil ◽

Erfan Hussain

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Middle Income Country ◽

Income Country ◽

Care Hospital ◽

Middle Income

Download Full-text

Factors predicting in‐hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan

The Clinical Respiratory Journal ◽

10.1111/crj.13137 ◽

2020 ◽

Vol 14 (4) ◽

pp. 328-334

Author(s):

Nousheen Iqbal ◽

Muhammad Irfan ◽

Faraz Siddique ◽

Verda Arshad ◽

Ali Bin Sarwar Zubairi

Keyword(s):

Hospital Mortality ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Community Acquired Pneumonia ◽

Care Hospital

Download Full-text

Patient-related factors associated with severe heat-related illnesses in Karachi: A hospital perspective

Journal of the Pakistan Medical Association ◽

10.47391/jpma.10-1016 ◽

2020 ◽

pp. 1-8

Author(s):

Saima Kanwal ◽

Sara Sajid ◽

Noreen Nasir ◽

Syed Ahsan ◽

Aysha Almas

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Tertiary Care Hospital ◽

Heat Stroke ◽

Tertiary Care ◽

Case Series ◽

Care Hospital ◽

Related Factors ◽

Hospital Perspective ◽

The Mean

Abstract In 2015, Karachi saw its first ever epidemic of severe heat-related illnesses that resulted in an extraordinary number of hospital admissions, especially in the intensive care, for fatal heat stroke within-hospital mortality of 3.7%.We conducted this study to elucidate the patient-related factors that lead to an increase in hospital admissions with heat-related illnesses in a tertiary care hospital. It was a descriptive case series conducted in the department of medicine at the Aga Khan University in June 2015. A total of 134 patients were admitted with heat-related illnesses of which 76(56.7%) were males. The mean age of the patients was 66 ±14.5 years. Heatstroke was present in 86 (64.2%) patients, followed by heat exhaustion in 48 (35.8%) and in-hospital mortality from heat-related illnesses was 5(3.7%). Continuous...

Download Full-text

Trend in the use of neo-adjuvant chemotherapy for the management of muscle invasive bladder cancer at a major tertiary care hospital in Pakistan.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16033 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16033-e16033

Author(s):

Adnan Abdul Jabbar ◽

Muhammad Asad Maqbool ◽

Muhammad Bilal Mirza

Keyword(s):

Bladder Cancer ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Standard Of Care ◽

Invasive Bladder Cancer ◽

Care Hospital ◽

Muscle Invasive Bladder Cancer ◽

Middle Income ◽

Middle Income Countries ◽

Muscle Invasive

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

Download Full-text

Identification of Risk Factors for Typhoid Fever in Children Admitted in a Tertiary Care Hospital

Journal of Health and Medical Sciences ◽

10.31014/aior.1994.04.02.168 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Soma Halder ◽

◽

Md. Ekhlasur Rahman ◽

Mst Mukta Sarker ◽

Fabia Hannan Mone ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Enteric Fever ◽

Tertiary Care Hospital ◽

Systemic Disease ◽

Univariate Analysis ◽

Tertiary Care ◽

Control Group ◽

Major Public Health Problem ◽

Care Hospital

Enteric fever remains a major public health problem in developing countries like Bangladesh. Improvement in the health facility, vaccination, and health-related awareness program the incidence of enteric fever among children is not decreased. The study aimed to find out the risk factors for enteric fever in hospitalized children in a tertiary care hospital. Methodology: We conducted a hospital-based case-control study to identify the risk factors in children residing in Dhaka city. We enrolled 50 enteric fever cases as a case group and 50 age-matched febrile patients as a control group. Result: Out of 50 cases, 2 patients were below one year and most of them were pre-school aged 26(52%). Univariate analysis showed that enteric fever is more who take food with the help of the mother and caregiver (OR=7.1); 95% CI= 26.7 -61.3) and never or rarely wash hands before preparing food and before feeding (OR= 5.7; 95% CI= 23.2 -52.8). Cases were eating outdoors at the mobile food vendors and consuming ice-cream regularly (OR=2.28; 95% CI=1- 39) whereas the control group also took street food but less frequently. Conclusion: Enteric fever is an exclusive food and water-borne systemic disease and one of the major public health problems in Bangladesh. Not only overcrowding, unsafe drinking water are the common risk factors but also hand washing both children and caregiver, poor food habit is the important risk factors. So, health education to children and food handlers may reduce the incidence of enteric fever in children.

Download Full-text