scholarly journals A “Reverse July Effect”: Association Between Timing of Admission, Medical Team Workload, and 30-Day Readmission Rate

2014 ◽  
Vol 6 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Yelena Averbukh ◽  
William Southern
Keyword(s):  
Patient Outcomes ◽  
Readmission Rate ◽  
Primary Outcome ◽  
Readmission Rates ◽  
Increased Risk ◽  
July Effect ◽  
Teaching Team ◽  
Independent Association ◽  
Time Of Year ◽  
Academic Year

Abstract Background High teaching team workload has been associated with poor supervision and worse patient outcomes, yet it is unclear whether this association is more pronounced during the early months of the academic year when the residents are less experienced. Objective We examined the associations between teaching team workload, timing of admission, and the 30-day readmission rate. Methods In this retrospective observational study, all admissions to an urban internal medicine teaching service over a 16-month period were divided into 2 groups based on admission date: early in the academic year (July–September) or late (October–June) and further defined as being admitted to “busy” versus “less busy” teams based on number of monthly admissions. The primary outcome was 30-day readmission rate. Multivariate logistic regression was used to determine the independent association between teaching team workload and readmission rates, stratified by time of year of admission after adjustment for demographic and clinical characteristics. Results Of 12 118 admissions examined, 2352 (19.4%) were admitted early in the year, and 9766 (80.6%) were admitted later. After multivariate adjustment, we found that patients admitted to busy versus less busy teams in the first quarter had similar 30-day readmission rate (odds ratio [OR]adj  =  1.03 [0.82–1.30]). Later year admission to a busy team was associated with increased risk of readmission after adjustment (ORadj  =  1.16 [1.03–1.30]). Conclusions Admission to busy teams early in the year was not associated with increased odds of 30-day readmission, whereas admission later in the year to busy teams was associated with 16% increased odds of readmission.

scholarly journals Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

2020 ◽  
Author(s):  
Sun-Joo Jang ◽  
Ilhwan Yeo ◽  
Chanel Jonas ◽  
Parag Goyal ◽  
Jim W. Cheung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Takotsubo Syndrome ◽  
Database Analysis ◽  
Readmission Rates ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes

2011 ◽  
Vol 155 (5) ◽  
pp. 309 ◽  
Author(s):  
John Q. Young ◽  
Sumant R. Ranji ◽  
Robert M. Wachter ◽  
Connie M. Lee ◽  
Brian Niehaus ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
July Effect ◽  
Academic Year

scholarly journals Thirty-Day Readmission Rates after Takotsubo Syndrome with or without Malignancy: A Nationwide Readmissions Database Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3701
Author(s):  
Sun-Joo Jang ◽  
Ilhwan Yeo ◽  
Chanel Jonas ◽  
Parag Goyal ◽  
Jim W. Cheung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Takotsubo Syndrome ◽  
Database Analysis ◽  
Readmission Rates ◽  
Increased Risk ◽  
Common Causes

The association between malignancy and readmission after Takotsubo syndrome (TTS) hospitalization has not been fully described. We sought to examine the rates, cause, and cost of 30-day readmissions of TTS, with or without malignancy, by utilizing Nationwide Readmissions Databases from 2010 to 2014. We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy tended to be older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio (OR), 1.35; 95% confidence interval (CI), 1.18–1.56). Non-cardiac causes were the most common causes of readmission for TTS patients with malignancy versus without malignancy (75.5% vs. 68.1%, p < 0.001). The 30-day readmission rate due to recurrent TTS was very low in both groups (0.4% and 0.5%; p = 0.47). The total costs were higher by 25% (p < 0.001) in TTS patients with vs. without malignancy. In summary, among patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission and increased costs. These findings highlight the importance of optimized management for TTS patients with malignancy.

Outcomes of Overlapping Surgery in Otolaryngology

2019 ◽  
Vol 162 (2) ◽  
pp. 181-185
Author(s):  
Pedrom C. Sioshansi ◽  
Robert K. Jackler ◽  
Edward J. Damrose
Keyword(s):  
Patient Outcomes ◽  
Complication Rate ◽  
Odds Ratio ◽  
University Hospital ◽  
Complication Rates ◽  
Readmission Rates ◽  
Tertiary Referral Center ◽  
Increased Risk ◽  
Institutional Experience ◽  
Reoperation Rates

Objective To compare outcomes in otolaryngology between overlapping and nonoverlapping surgeries. Study Design Retrospective cohort study. Setting Tertiary referral center. Subjects and Methods All patients undergoing otolaryngologic procedures at Stanford University Hospital between January 2009 and June 2016 were included (n = 13,479). Cases were divided into 2 cohorts: overlapping (n = 1806, 13.4%) vs nonoverlapping (n = 11,673, 86.6%). Variables reviewed were type of operation performed, multidisciplinary team involvement, complications, reoperations, readmissions, and deaths. Results The total complication rate over 7.5 years studied was 3.3% (n = 450). Complication rates were lower for overlapping cases (0.77%) compared to nonoverlapping cases (3.73%) with an odds ratio of 0.2014, which was statistically significant ( P < .0001). When examined by subspecialty, the complication rate for rhinology and endoscopic skull base procedures was approximately 10 times lower when overlapping (0.30%) was compared to nonoverlapping (3.15%), with an odds ratio of 0.094 ( P = .0001). There was no difference in complication rates for other surgical subspecialties. There were no deaths associated with overlapping surgery. The rate of major complications requiring reoperation was similarly lower for overlapping procedures (0.276%) compared to nonoverlapping procedures (1.35%) with an odds ratio of 0.2023 ( P = .0004). Readmission rates were lower for overlapping cases (0.49%) when compared to nonoverlapping cases (1.09%), with an odds ratio of 0.4553 ( P = .0229). Conclusions Patients undergoing overlapping surgery had lower overall complication rates, lower reoperation rates, lower readmission rates, and no mortalities. The institutional experience presented provides evidence that with appropriate patient and case selection, otolaryngologists may safely perform overlapping surgery without increased risk of adverse patient outcomes.

scholarly journals The Impact of the Number of Admissions to the Inpatient Medical Teaching Team on Patient Safety Outcomes

2012 ◽  
Vol 4 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Yelena Averbukh ◽  
William Southern
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Charlson Score ◽  
Number Of Patients ◽  
Increased Risk ◽  
Safety Outcomes ◽  
Teaching Team ◽  
The Impact

Abstract Introduction The clinical work in academic internal medicine inpatient units is done by teaching teams. To date, few studies have investigated how team workload affects patient safety outcomes. Objective We examined the association between the number of patients seen by a teaching team, 30-day readmission, and 60-day mortality. Methods In this retrospective observational study we defined each team as “less busy” (total monthly admissions ≤49, the median for all teams) or “more busy” (total monthly admissions &gt;49). We compared patients in both groups' demographic characteristics, comorbidities (Charlson score), severity of illness (the Laboratory-based Acute Physiology Score [LAPS]), and length of stay using t tests, χ2 tests, and rank sum tests, as appropriate. Logistic regression models were constructed to determine whether there was an association between assignment to a busy team and readmission and mortality. Results Of 12 119 admissions examined, 6398 (52.8%) were assigned to the less busy teams and 5721 (47.2%) were assigned to busy teams. Mean length of stay was not statistically different between the groups (5.2 vs 5.3 days; P  =  .08). After adjustment for demographic and clinical characteristics (LAPS and Charlson score), care by a busy team was associated with greater 30-day readmission rate (odds ratio, 1.21; 95% confidence interval [CI], 1.10–1.34) but not with increased risk of mortality (odds ratio, 1.05; 95% CI, 0.88–1.27). There was a significant linear association between the number of monthly admissions to teams and the readmission rate. Conclusions Admission to a busier teaching team is associated with a 21% increase in the odds of 30-day readmission. Sixty-day mortality was not affected by the number of monthly admissions to the teaching team.

Wildfire Burn Patients: A Unique Population

2021 ◽  
Author(s):  
Sarah C Stokes ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri
Keyword(s):  
Wound Infection ◽  
Operating Room ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Burn Patients ◽  
The Past ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Time Of Presentation ◽  
Room Time

Abstract In the past ten years wildfires have burned an average of 6.8 million acres per year and this is expected to increase with climate change. Wildfire burn patient outcomes have not been previously well characterized. Wildfire burn patients from the Tubbs or Camp wildfires and non-wildfire burn matched controls were identified from the burn center database and outcomes were compared. The primary outcome was mortality. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, readmission and development of wound infections. Time of presentation and operating room use after wildfires was evaluated. Sixteen wildfire burn patients were identified and matched with 32 controls. Wildfire burn patients trended towards higher mortality (19% wildfire vs. 9% non-wildfire, p=0.386), longer LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), longer ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991), increased readmission (19% wildfire vs. 3% non-wildfire, p=0.080) and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.468). The majority of wildfire patients (88%) presented within 24 hours of the wildfire reaching a residential area. Operating room time within the first week was 13 hours 44 minutes for the Tubbs Fire and 19 hours 1 minute for the Camp Fire. Patients who sustain burns in wildfires are potentially at increased risk of mortality, prolonged LOS, wound infection and readmission.

scholarly journals Impact of Heart Failure Focused Follow-Up Care at the “Heart Success Clinic” on 30-Day Readmission Rates in Patients with Congestive Heart Failure

2020 ◽  
pp. 1-3
Author(s):  
Deepti Bhandare ◽  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Readmission Rate ◽  
The United States ◽  
Hospital Data ◽  
Readmission Rates ◽  
Medication Reviews ◽  
Improve Patient

Nearly 6.2 million people in the United states are affected by heart failure, it is predicted that this number will rise to 8.5 million by 2030 Significant effort has been made to prevent heart failure and its exacerbations. The Hospital Readmission Reduction Program (HRRP), a Medicaare based program, was established to link payment to quality of care. Payment is reduced to hospitals when patients are readmitted within 30 days for heart failure The “Heart Success Clinic” is an outpatient clinic started to improve patient outcomes and reduce readmission rates. Patients are provided with heart failure focused visits which includes detailed medication reviews, diet modification, weight loss, disease education, etc. During the six months prior to the opening of the clinic, the readmission rate was 15.27% at AdventHealth Sebring hospital which is a community-based hospital. Data was collected on the patients who attended the “Heart Success Clinic” for six months. Zero patients from the clinic were readmitted, bringing the readmission rate down from 15.27% to 0%. This pilot study gives promising initial results. Further studies can be conducted over a longer period time as to gather more patients. Overall, the study demonstrates that there is value in providing heart failure focused follow up visits in improving patient outcomes and readmission rates.

scholarly journals Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

2021 ◽  
Vol 10 (17) ◽  
pp. 3947
Author(s):  
Savanna SanFilippo ◽  
Veronique Michaud ◽  
Juanqin Wei ◽  
Ravil Bikmetov ◽  
Jacques Turgeon ◽  
...  
Keyword(s):  
Risk Score ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Primary Outcome ◽  
Elderly Care ◽  
The Elderly ◽  
Secondary Outcome ◽  
Medication Regimen ◽  
Increased Risk ◽  
Medication Risk

Existing risk tools that identify patients at high risk of medication-related iatrogenesis are not sufficient to holistically evaluate a patient’s entire medication regimen. This study used a novel medication risk score (MRS) which holistically evaluates medication regimens and provides actionable solutions. The main purpose of this study was to quantify adults ≥ 65 years with a high medication risk burden using the MRS and secondarily, appraise MRS association with hospital readmission. This retrospective cohort study included all consecutive patients in a 6-month period aged 65 years and older, admitted for at least 48 h, and prescribed at least five medications upon discharge. Out of 3017 patients screened, 1386 met all criteria. The primary outcome was the proportion of patients with a score of ≥20 and the secondary outcome was the 30-day readmission rate. In the overall population, 17% of patients had an MRS ≥ 20. For patients discharged home, there was a 19% readmission rate for a score ≥ 20 and 11% for <20 (p = 0.009). A score of ;≥20 was associated with a 1.8-fold increased risk of readmission in patients discharged home. Only 7% of patients met these criteria, which can help direct future use of the MRS at patients with the highest risk of medication-related iatrogenesis.

Influence of Psychotropic Medications on Readmission Rates of Patients Receiving a Pharmacist Discharge Medication Reconciliation

2020 ◽  
pp. 089719002090446
Author(s):  
Elika Hefazi ◽  
Danielle Boggie ◽  
Trina Huynh ◽  
Kelly C. Lee
Keyword(s):  
Psychotropic Medication ◽  
Primary Outcome ◽  
Psychotropic Medications ◽  
Readmission Rates ◽  
Medication Discrepancies ◽  
Discharge Medication ◽  
Pharmacist Interventions ◽  
Increased Risk ◽  
The Mean ◽  
The Impact

Background: Current literature suggests that patients with psychiatric disorders are at an increased risk for inpatient readmission. This study evaluated the impact of pharmacist-driven discharge medication reconcilliation (DMR) on readmission rates of patients discharged with one or more psychotropic medications. Methods: This study was a retrospective review of patients receiving a pharmacist-driven DMR. The primary outcome was to compare the prevalence of 30-day readmission rates among patients who had a pharmacist DMR between patients who had at least one psychotropic medication upon discharge versus those without psychotropic medications. Secondary objectives were to (1) compare the number of medication discrepancies and pharmacist interventions prior to discharge and (2) compare prevalence of medical comorbidities between patients who had at least one psychotropic medication upon discharge versus those without psychotropic medications. Results: A total of 151 subjects were included who had a DMR and either at least one psychotropic medication at discharge (n = 69) or no psychotropic medications at discharge (n = 82). The 30-day readmission rates were similar between both groups ( P = .609). The mean number of discrepancies ( P < .001) and number of pharmacist interventions ( P = .005) were significantly greater in patients who had at least one psychotropic medication upon discharge compared to those without psychotropic medication. Conclusions: The prevalence of 30-day readmissions was similar between the two groups; however, patients discharged with at least one psychotropic medication had a greater number of discrepancies requiring significantly more discharge interventions during a pharmacist DMR.

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