scholarly journals A Retrospective Cohort Study of the Impact of Nurse Practitioners on Hospitalized Patient Outcomes

2021 ◽  
Vol 11 (1) ◽  
pp. 28-35
Author(s):  
Manish S. Patel ◽  
Lauren C. Hogshire ◽  
Helaine Noveck ◽  
Michael B. Steinberg ◽  
Donald R. Hoover ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geometric Mean ◽  
Care Level ◽  
The Impact

The role of advanced practice providers has expanded in the hospital setting. However, little data exist examining the impact of these providers. Our purpose was to determine the effect of adding nurse practitioners in a complementary role on the quality and efficiency of care of hospitalized patients. A retrospective cohort study evaluated adult patients admitted by private physicians (without house staff or non-physician providers) to a general medical-surgical unit in an academic medical center. The admissions department allocated patients as beds became available and nurse practitioners were assigned to patients until their caseload was reached. Outcomes included length of hospital stay, in-hospital mortality, admission costs, 30-day readmissions, transfer to a more intensive care level, and discharge order time. Of the 382 patients included in this study, 263 were assigned to the nurse practitioner group. Hospital mortality was lower in the nurse practitioner group [OR 0.11 (95% CI 0.02–0.51)] as was transfer to more intensive care level [OR 0.39 (95% CI 0.20–0.75)]; however, the nurse practitioner group had longer length of stay (geometric mean = 5.80 days for nurse practitioners, 3.63 days for no nurse practitioners; p < 0.0001) and higher cost per patient (geometric mean = USD 6631 vs. USD 5121; p = 0.005). The results were unchanged when models were adjusted for potential confounders. Adding nurse practitioners can yield improved clinical outcomes (lower hospital mortality and fewer transfers to intensive care), but with a potential economic expense (longer hospital stays and higher costs).

scholarly journals Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study

2020 ◽  
Vol 5 (1) ◽  
pp. e000534
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Naoki Sakoda ◽  
Toshiki Sato ◽  
Keiji Sakurai ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Trauma ◽  
Balloon Occlusion ◽  
Trauma Management ◽  
The Impact ◽  
Endovascular Balloon Occlusion

BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III.

scholarly journals Age is the Main Determinant of COVID-19 Related in-Hospital Mortality with Minimal Impact of Pre-Existing Comorbidities: A Retrospective Cohort Study.

2021 ◽  
Author(s):  
M.T.H.M. Henkens ◽  
A.G. Raafs ◽  
J.A.J. Verdonschot ◽  
M. Linschoten ◽  
M. van Smeden ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mediation Effect ◽  
Main Determinant ◽  
Minimal Impact ◽  
Female Sex ◽  
The Impact ◽  
Related Mortality

Abstract Background: Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown. Methods: In this multicenter retrospective cohort study of 45 Dutch hospitals, 4,806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69 [58-77] years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with in-hospital mortality. The effect of comorbidities on the relation of age with in-hospital mortality was evaluated using mediation analysis.Results: In-hospital COVID-19 related mortality occurred in 1,108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively; both p<0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome.Conclusions: Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities.Trial registration: CAPACITY-COVID (NCT04325412).

scholarly journals Performance in mortality prediction of SAPS 3 And MPM-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: a retrospective cohort study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12332
Author(s):  
Nadeem Kassam ◽  
Eric Aghan ◽  
Samina Somji ◽  
Omar Aziz ◽  
James Orwa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Goodness Of Fit ◽  
Tertiary Referral ◽  
Goodness Of Fit Test ◽  
Saps 3

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non–survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Results A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844–0.935]) and 0.90 (95% CI [0.864–0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P–Value > 0.05. Conclusion Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania.

Association Between Afterhours Discharge From the Intensive Care Unit and Hospital Mortality: A Multi-Center Retrospective Cohort Study

2021 ◽  
pp. 088506662098190
Author(s):  
Adam Hall ◽  
Xioaming Wang ◽  
Danny J. Zuege ◽  
Dawn Opgenorth ◽  
Damon C. Scales ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mixed Effect ◽  
Icu Discharge

Background: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. Methods: We performed a multi-center retrospective cohort study of 10,463 adults discharged from 9 mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a 2-stage modeling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. Results: Of 10,463 patients, 23.7% (n = 2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. A greater average SOFA score in the 72 hours prior to ICU discharge was not associated with afterhours discharge. However, a greater average SOFA score was associated with hospital mortality (adjusted-odds ratio [OR], 1.23; 95% CI, 1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR, 1.19; 95% CI, 1.01-1.39), increased hospital stay (adjusted-risk ratio [RR], 1.10; 95% CI, 1.09-1.11) and increased post-ICU stay (adjusted-RR, 1.16; 95% CI, 1.14-1.17) when compared with workhours discharge. Conclusions: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.

scholarly journals Association between diarrhea quantity and in-hospital mortality in intensive care unit patients: A retrospective cohort study

2021 ◽  
Author(s):  
Ryohei Yamamoto ◽  
Hajime Yamazaki ◽  
Shungo Yamamoto ◽  
Yuna Ueta ◽  
Ryo Ueno ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Medical Center ◽  
Icu Patients ◽  
Failure Assessment ◽  
Comorbidity Index

Abstract Background Previous studies have shown that diarrhea is associated with increased mortality of patients in intensive care units (ICUs). However, these studies used dichotomized cutoff values, even if diarrhea was a continuous condition. This study aimed to assess the association between diarrhea quantity and mortality in ICU patients with newly developed diarrhea. Methods We conducted this single-center retrospective cohort study at the Kameda Medical Center ICU. We consecutively included all adult ICU patients with newly developed diarrhea in the ICU between January 2017 and December 2018. Newly developed diarrhea was defined based on a Bristol stool chart scale ≥ 6 and frequency of diarrhea ≥ 3 times per day. We excluded patients who already had diarrhea on the day of ICU admission among other criteria. We collected data on the quantity of diarrhea on the day when patients newly developed diarrhea. The primary outcome was in-hospital mortality. The risk ratio (RR) and 95% confidence interval (CI) for the association between the quantity of diarrhea and mortality were estimated using multivariable-modified Poisson regression models adjusted for the Charlson Comorbidity Index, sequential organ failure assessment score, and serum albumin levels. Results Among 231 participants, 68.4% (158/231) were men; the median age of the patients was 72 years. The median quantity of diarrhea was 401 g (interquartile range [IQR] 230‒645 g), and in-hospital mortality was 22.9% (53/231). More diarrhea at baseline was associated with higher in-hospital mortality; the unadjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.19). This association remained in the multivariable-adjusted analysis; the adjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.20). Conclusions A greater quantity of diarrhea was an independent risk factor for in-hospital mortality. The quantity of diarrhea may be an indicator of disease severity in ICU patients.

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