scholarly journals Can a perioperative physician improve care and reduce length of stay in a surgical emergency admission unit?

2015 ◽  
Vol 15 (Suppl 3) ◽  
pp. s22-s22
Author(s):  
Margaret Hammersley ◽  
Hywel Jones ◽  
Sudhir Singh ◽  
Irene Stratton ◽  
Michael Silva
Keyword(s):  
Length Of Stay ◽  
Emergency Admission ◽  
Surgical Emergency

Using Internet Cloud Platform To Characterize Neurosurgical Patients in an Emergency Hospital Admission Setting: Retrospective Observational Study (Preprint)

2021 ◽  
Author(s):  
Wei Chen ◽  
Xiangkui Li ◽  
Xiangkui Li
Keyword(s):  
Length Of Stay ◽  
Vascular Disease ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Emergency Admission ◽  
University Hospital ◽  
Cloud Platform ◽  
Non Profit ◽  
Neurosurgical Patients ◽  
Medical Big Data

BACKGROUND Neurosurgical patients are admitted to hospital via emergency department admissions is common; however, studies designed to describe their features are not available. OBJECTIVE This study aims to investigate the characteristics of patients admitted to the neurosurgery department in an emergency manner by using medical big data integration and application platform (internet cloud platform). METHODS We derived data from the internet cloud platform of West China Hospital, Sichuan University. The data of consecutive patients admitted to the department of neurosurgery as emergency admissions in a non-profit tertiary care university hospital was collected. Data on demographic information, clinical characteristics and outcomes were collected and evaluated through the platform. Patients were stratified into five disease groups (vascular disease, trauma, oncology, spine and others) according to their main diagnoses at the time of admission. RESULTS A total of 4,149 cases (median age 52 years, 54.5% male) were identified in this study. Vascular disease was the most common reason for emergency admission (73.5%). Significant differences were found among the five disease groups in sex (P<.001), age (P<.001), surgery (P<.001) and season (P=.009) but not in the length of stay (P=.784). Multivariate logistic regression analysis identified male sex, older age, short length of stay, surgery not performed and disease type (particularly trauma) as independently associated with in-hospital mortality. CONCLUSIONS By using internet cloud platform, we identified significant demographic and clinical differences among neurosurgical patients admitted to the neurosurgery department as an emergency. These findings may assist health care practitioners in shifting tasks and clinical resources toward those patients who may benefit from particular intervention approaches.

scholarly journals The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges

2013 ◽  
Vol 43 (1) ◽  
pp. 116-121 ◽  
Author(s):  
P. N. Wright ◽  
G. Tan ◽  
S. Iliffe ◽  
D. Lee
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Emergency Admission ◽  
The Impact

scholarly journals A ‘hot clinic’ for cold limbs: the benefit of urgent clinics for patients with critical limb ischaemia

2020 ◽  
Vol 102 (6) ◽  
pp. 412-417
Author(s):  
A Khan ◽  
M Hughes ◽  
M Ting ◽  
G Riding ◽  
J Simpson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Outcome Measures ◽  
Odds Ratio ◽  
Smoking Status ◽  
Emergency Admission ◽  
Major Amputation ◽  
Critical Limb Ischaemia ◽  
Secondary Outcome ◽  
Limb Ischaemia ◽  
Emergency General Surgery

Introduction The national reconfiguration of vascular surgery means that arterial centres serve larger populations with increased demand on resources. Emergency general surgery ambulatory clinics facilitate timely review and intervention, avoiding admission; a critical limb ischaemia (CLI) ‘hot clinic’ (HC) was implemented to achieve similar for vascular patients. The aim of the study was to determine HC efficacy. Methods This was a prospective cohort study comparing HC patients with emergency admission (EA) patients between 1 May and 1 December 2017. Age, sex, comorbidities, CLI severity and smoking status were noted. HC patients were provided with satisfaction surveys. Primary outcome measures were freedom from reintervention and major amputation. Secondary outcome measures included time to procedure, length of stay, returns to theatre and 30-day readmission. Results A total of 147 patients (72 HC, 75 EA) were enrolled in the study. No statistical difference was found in age, sex, smoking status, severity of CLI or prevalence of comorbidities between the groups except that diabetes was more prevalent in EA patients (p=0.028). The median length of stay for the HC cohort was shorter (3 days vs 17 days, p<0.001), with no difference between time to procedure, return to theatre or 30-day readmission. HC patients were nearly 6 times more likely to experience freedom from reintervention (odds ratio: 5.824, p<0.001) and 2.5 times less likely to undergo amputation (odds ratio: 2.616, p=0.043). HC utilisation saved a total of 441 bed days. Over 90% of attendees responded with 100% positive feedback. Conclusions A vascular HC facilitates urgent review and revascularisation. It provides comparable in-hospital outcomes and better long-term outcomes, with greater efficiency than hospital admission, demonstrating its value in treating CLI.

scholarly journals P.225 Factors Contributing to Prolonged Length of Stay in Adults Undergoing Spine Surgery: Results from a Quaternary Spinal Care Center

2021 ◽  
Vol 48 (s3) ◽  
pp. S85-S85
Author(s):  
MN Hindi ◽  
C Dandurand ◽  
S Paquette ◽  
B Kwon ◽  
T Ailon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Analyses ◽  
Care Center ◽  
Diagnostic Category ◽  
Emergency Admission ◽  
Operative Management ◽  
Care Quality ◽  
Prolonged Length ◽  
Factors Associated ◽  
Asia Score

Background: Prolonged length of stay (LOS) is associated with increased resource utilization and worse outcomes. The goal of this study is identifying patient, surgical and systemic factors associated with prolonged LOS overall and per diagnostic category for adults admitted to a quaternary spinal care center. Methods: We performed a retrospective analysis on 13,493 admissions from 2006 to 2019. Factors analyzed included patient age, sex, emergency vs elective admission, diagnostic category (degenerative, deformity, oncology, trauma), presence of neurological deficits in trauma patients, ASIA score, operative management and duration, blood loss, and adverse events (AEs). Univariate and multivariate analyses determined factors associated with prolonged LOS. Results: Overall mean LOS (±SD) was 15.80 (±34.03) days. Through multivariate analyses, predictors of prolonged LOS were advanced age (p<0.001), emergency admission (p<0.001), advanced ASIA score (p<0.001), operative management (p=0.043), and presence of AEs (p<0.001), including SSI (p=0.001), other infections (systemic and UTI) (p<0.001), delirium (p=0.006), and pneumonia (p<0.001). The effects of age, emergency admission, and AEs on LOS differed by diagnostic category. Conclusions: Understanding patient and disease factors that affect LOS provides opportunities for QI intervention and allows for an informed preoperative discussion with patients. Future interventions can be targeted to maximize patient outcomes, optimize care quality, and decrease costs.

scholarly journals SP3.1.10 Surgical Emergency Assessment Unit and Emergency Surgeon of the Week’ : A Paradigm shift to providing Emergency Surgical Care

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anang Pangeni ◽  
Hesham Mohamed ◽  
Mohammad Imtiaz ◽  
Ankur Shah ◽  
Roland Fernandes ◽  
...  
Keyword(s):  
Paradigm Shift ◽  
Surgical Care ◽  
Health Resources ◽  
Admission Rate ◽  
Emergency Admission ◽  
Positive Outcome ◽  
Safe Patient Care ◽  
Surgical Emergency ◽  
Assessment Unit ◽  
Full Complement

Abstract Aims Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system. Patients and Method Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team. Results SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others. Conclusions A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.

scholarly journals INNV-26. SERVICE RECONFIGURATION INTO AN URGENT ELECTIVE PATHWAY FOR THE MANAGEMENT OF GLIOBLASTOMA PATIENTS IMPROVES OUTCOMES, COSTS AND PATIENT EXPERIENCE AND ADJUNCT USE: A SINGLE CENTRE SIX YEAR REVIEW

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii122-ii122
Author(s):  
Rosa Sun ◽  
Shivam Sharma ◽  
Colin Watts ◽  
Victoria Wykes
Keyword(s):  
Length Of Stay ◽  
Cost Savings ◽  
Emergency Admission ◽  
Extent Of Resection ◽  
Single Centre ◽  
Elective Admission ◽  
Single Centre Experience ◽  
Admission Status ◽  
One Stop

Abstract BACKGROUND Glioblastomas (GB) are grade four gliomas, the most common form of neoplasms arising in the brain. GBs are known for their aggressiveness; despite widespread research, limited advances have been made to improve survival. Between 2014–2019, a service reconfiguration for suspected GB referrals within our centre has been achieved. We have gone from a predominantly emergency admission and surgery based service for GB, to an urgent elective admission pathway. This is backed by weekly MDTs, neuro-oncology specialist led clinics, with imaging and pre-assessment clinic as part of a one-stop-shop model. Improved planning through elective admissions has also helped us achieve increased use of intra-operative adjuncts, including neuro-monitoring and the use of 5-ALA. The aim of this study is to describe a single centre experience of improvements made across six years through a combination of service reconfiguration and an increase use of intra-operative adjuncts. METHODS Patients with histological confirmed, primarily diagnosed GBs between 01/01/2014 and 31/12/2019 were extracted from the pathology database. Information including survival, treatment (surgical, oncological) and use of adjunct, admission status, length of stay (LOS), extent of resection and surgical complications were extracted manually. Inpatient admission costs were estimated. RESULTS From 2014 to 2019, we achieved an increase in elective admissions (28.1% to 90.3%, p&lt; 0.001), which has led to a greater proportion of patients undergoing resective surgery (68.4% to 81.9%, p= 0.041), reduction in median length of stay (9 to 3 days, p &lt; 0.001) and deceased overall costs. An increased use of intra-operative adjuncts has improved the proportion of total and gross resections (p&lt; 0.001). CONCLUSIONS A switch from emergency to a MDT-based, urgent pathway with increased use of intra-operative adjuncts has resulted in improved technical outcomes and cost savings for the trust. This change has high potential to improve survival in patients on further follow-up.

Impact of socio-economic status and race on emergency hospital admission outcomes: Analysis from hospital admissions between 2001 and 2012

2021 ◽  
pp. 095148482110121
Author(s):  
Thomas Davidson ◽  
Farhaan Mirza ◽  
Mirza M Baig
Keyword(s):  
Length Of Stay ◽  
Health Outcomes ◽  
Death Rate ◽  
Hospital Admissions ◽  
Racial Bias ◽  
Ethnic Disparities ◽  
Emergency Admission ◽  
The United States ◽  
Emergency Hospital ◽  
Racial Ethnic

Socio-economic and racial/ethnic disparities in healthcare quality have been the point of huge discussion and debate. There is currently a public debate over healthcare legislation in the United States to eliminate the disparities in healthcare. We reviewed the literature and critically examined standard socio-economic and racial/ethnic measurement approaches. As a result of the literature review, we identified and discussed the limitations in existing quality assessment for identifying and addressing these disparities. The aim of this research was to investigate the difference between health outcomes based on patients’ ability to pay and ethnic status during a single emergency admission. We conducted a multifactorial analysis using the 11-year admissions data from a single hospital to test the bias in short-term health outcomes for length of stay and death rate, based on ‘payment type’ and ‘race’, for emergency hospital admissions. Inconclusive findings for racial bias in outcomes may be influenced by different insurance and demographic profiles by race. As a result, we found that the Self-Pay (no insurance) category has the shortest statistically significant length of stay. While the differences between Medicare, Private and Government are not significant, Self-Pay was significantly shorter. That ‘Whites’ have more Medicare (older) patients than ‘Blacks’ might possibly lead to a longer length of stay and higher death rate for the group.

scholarly journals Length of hospitalization is associated with selected biomarkers (albumin and lymphocytes) and with co-morbidities: study on 4000 patients

2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Antonio E. Pontiroli ◽  
Lara Loreggian ◽  
Marco P. L. Rovati ◽  
Elena De Patto ◽  
Laura Folini ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Large Scale ◽  
Correlation Method ◽  
Length Of Hospital Stay ◽  
Emergency Admission ◽  
Negative Influence ◽  
Blood Levels ◽  
Essential Information ◽  
Length Of Hospitalization

Abstract Background Low albumin levels and low lymphocyte counts are intra hospital conditions that exert a negative influence on prognosis, healing and length of hospitalization. The study aimed to analyze the correlation between low blood levels of albumin, low lymphocytes, and length of stay. The secondary aim was to identify other co-morbidities associated with prolonged hospital stay. Methods Retrospective pilot study was conducted by analyzing anamnestic and biochemical data, related to 4038 patients admitted to ten wards of Hospital San Paolo (Milan), collected from July 1st 2012 to December 31st 2012. A statistical analysis was carried out using the Correlation method, Multivariate Analysis and Regression. Lymphocyte count and co-morbidities were evaluated in the whole cohort, albumin levels in 1437 patients. Results In the whole sample, low albumin levels and low lymphocyte counts were directly correlated to longer hospitalizations. The stratification of the results by department and diagnosis suggests that there is a higher correlation in certain subpopulations, and albumin shows a greater correlation with length of stay than lymphocytes. Also advanced age, high platelets, type of diagnosis, male gender and emergency admission led to longer hospitalizations. Conclusions A routine check of albumin, lymphocytes and a spectrum of significant variables can provide precious information which can eventually lead to a shorter hospital stay. Knowledge of the general health status of a patient and the possibility to estimate his/her length of hospital stay are essential information for Clinical Governance, and for the improvement of internal services of hospitals on a large scale.

Admission day of the week impacts GI length of stay and charges

2001 ◽  
Vol 120 (5) ◽  
pp. A403-A404
Author(s):  
J HARRISON ◽  
J ROTH ◽  
R COHEN
Keyword(s):  
Length Of Stay ◽  
Day Of The Week
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