Sustainable Hospital Management by a Cross SWOT Analysis in a Medium-Sized Hospital

The medical working environment in small and medium-sized hospitals is becoming more intense, and the coronavirus epidemic has threatened the hospital management base in Japan. To establish the future sustainable management of hospitals using internal and external environmental data, a cross SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis may be a very useful tool. A cross SWOT analysis considers four strategies: an offensive strategy (SO), a confrontation strategy (ST), a strengthening strategy (WO) and a defense strategy (WT). Here, using a cross SWOT analysis, we consider the future direction of an older medium-sized hospital as one case. The most important issue is to balance the interests of hospital management with those of patients. As a sustainable strategy for this purpose, we forecast the medical situation in the Fukuoka-Itoshima Medical Area, including the Fukuoka-Nishi area in Japan, and the future profitability of a medium-sized hospital for the next 30 to 40 years. Based on the data, we used a cross SWOT analysis to analyze the current situation at the hospital and formulated measures to realize innovations at the hospital that respond to the needs of patients and the community. According to this analysis, for the future sustainable management as a hospital, we should plan to become a more community-based by increasing our capacity to treat elderly inpatients and outpatients with cardiovascular, gastrointestinal and respiratory diseases and to increase the number of beds dedicated to community comprehensive care. Furthermore, through close cooperation with highly specialized and advanced medical institutions, we need to create a new type of regional medical cooperation that can bridge the gap between regional medical care and advanced medical care. We also need to open a cardiovascular-rhythm center and a gastrointestinal endoscopy center and establish an appropriate working system for staff. The future direction for this older hospital should include plans for relocation and reconstruction, considering the balance between expected changes in income and expenses. In conclusion, we performed a cross SWOT analysis with SO, ST, WO and WT. The analysis can be a very useful tool for planning the future direction of hospitals using internal and external environmental data, and our older hospital should eventually be able to achieve sustainable developmental innovations by rebuilding while working on various strategies.

Analysis of Related Factors of Depression and Malnutrition in Elderly Hospitalized Patients v1

SUMMARY: BACKGROUND: Depression and malnutrition are very common among elderly hospitalized patients and may lead to undesirable consequences. OBJECTIVE: To explore the correlation between depression and malnutrition through statistical methods to provide a theoretical basis for preventing the occurrence of depression and malnutrition in elderly hospitalized patients so as to improve their quality of life. METHODS: This is a retrospective analysis of 179 elderly inpatients in the Cadre Ward Unit of the First Hospital of Jilin University. Relevant data of the participants required for the study were obtained from the electronic medical record system and comprehensive geriatric assessment (CGA) database of the First Hospital of Jilin University. The correlation between depression and malnutrition was determined using logistic regression analysis. RESULTS: The percentage of included elderly inpatients without depression was 64.8%（median age=78.4 ± 10.3 years）, while the percentage of patients with depression was 35.2%（median age of 81.8 ± 8.4 years） . The prevalence of depression among the participants in the study was 35.2%, and the highest prevalence of depression combined with malnutrition was 58.9%, followed by 42.4% prevalence of depression combined with risk of malnutrition. After controlling for other relevant factors, the Mini Nutritional Assessment(MNA)(P=0.008,OR=0.821), albumin (P=0.005,OR=0.834) and calf circumference (P=0.004,OR=0.790) were independently associated with depression. CONCLUSION: There is a correlation between depression and malnutrition, and MNA, albumin and calf circumference are independent protective factors for depression, respectively. KEYWORDS:depression;malnutrition;elderly

1467Interaction effects of multimorbidity and frailty on adverse health outcomes in elderly hospitalised patients

Background Multimorbidity and frailty are each known to be drivers of adverse outcomes, but their joint effects are less well known. Methods We used state-wide hospital and mortality data for persons aged ≥75 years, admitted during 2010-2012 in New South Wales, Australia, to ascertain multimorbidity, frailty risk and outcomes: prolonged length of stay (LOS), 30-day mortality and 30-day emergency readmission. We estimated the relative risk (RR) of each outcome using Poisson models with random intercept for hospital. Interactions on both additive and multiplicative scales were examined. Results Among 257,535 elderly inpatients, 33.6% had multimorbidity and elevated frailty risk, 14.7% had multimorbidity only, 19.9% had elevated frailty risk only and 31.8% had neither. Additive interactions were present for all outcomes, with a further multiplicative interaction for mortality and LOS. Mortality risk was 4.2 (95% CI 4.1 – 4.4), prolonged LOS 3.3 (95% CI 3.3 – 3.4) and readmission 1.8 (95% CI 1.7 – 1.9) times higher in patients with both factors present compared with patients with neither. Conclusions Multimorbidity and frailty coexist in older hospitalized patients and interact to increase the risk of adverse outcomes beyond the sum of their individual effects. Their joint effect should be considered in health outcomes research and when administering hospital resources. Key messages Multimorbidity and frailty coexist and interact to increase the risk of adverse outcomes in hospitalised patients. Research and health planners should consider their joint effects to ensure patients at the highest risk of adverse outcomes are identified.

Influences of Dysphagia on the Prognosis of Chinese Elderly Inpatients: a Prospective Cohort Study

The increasing incidence of dysphagia may pose threats to the health of older patients. The aim of this study was to investigate the adverse influences of dysphagia on the prognosis of older Chinese inpatients. A total of 290 older inpatients with different swallowing functions were involved in this study through group sampling from the geriatric centre of a 3A-level hospital in China. Among them, 125 patients (43.1%) had dysphagia at admission. Based on a cross-sectional investigation, a prospective cohort study was conducted to investigate the incidence of complications, readmission, and death during 6 months of follow-up. A total of 34 patients (11.7%) died, and the remaining 256 patients (88.3%) were investigated concerning their complications. There was a higher prevalence of death among the older patients with dysphagia (15.6% vs 7.9%, RR = 2.361). In terms of complications, older patients with dysphagia were more likely to develop malnutrition (29.8% vs 5.9%, RR = 6.747) and aspiration pneumonia (34.6% vs 11.2%, RR = 4.204). Furthermore, multi-factor analysis demonstrated that dysphagia was an independent predictor of malnutrition and aspiration pneumonia but not an independent predictor of death. In conclusion, dysphagia was proven to be an independent predictor of a poor outcome of Chinese elderly inpatients. Specific clinical management and nursing interventions are recommended to prevent the potential adverse influences of dysphagia.

PATTERN OF MEDICATION USE AMONG ELDERLY INPATIENTS IN A TERTIARY CARE HOSPITAL OF NORTHEAST INDIA

Objectives: The objective of the present study was to assess the pattern of medication use among elderly inpatients of internal Medicine Wards and to evaluate inappropriate prescribing with the help of Beers criteria 2019. Methods: It was a retrospective hospital data-based study. Data were obtained from treatment charts of elderly inpatients stored in the Medical Records Department. Total 236 treatment record charts of patients ≥60 years of either sex was obtained from the period of July 2015 to December 2015 and the information were noted in predesigned pro forma. Results: The mean±SD age of the patients was 69.07±7.72 years with male preponderance (58.5%). Maximum number of patients were having respiratory disorders (57.6%), followed by kidney diseases (20.8%), cardiovascular diseases (18.6%), and so on. A total of 2683 drugs were prescribed with average number of 10.68±4.74 drugs per prescription. Only 363 formulations were prescribed by their generic names and 29.1% drugs were prescribed as fixed dose combinations. Polypharmacy was seen in 91.5% and 39%, respectively, in hospital stay and during discharge. About 60.5% drugs were prescribed from the National list of essential medicine. Total 57 drugs were found to be potentially inappropriate. About 22% patients received at least one drug which was potentially inappropriate according to Beers criteria and around 14% drugs were prescribed inappropriately. Conclusion: This study suggests that use of potentially inappropriate medications is common in elderly patients, some of them associated with high degree of risk in terms of worsening of the co-morbidity or drug-drug interactions. There is a need for nationwide assessment and strategies that may reduce or overcome such high prevalence.

Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s influenza surveillance system.SettingPublic and private hospitals across Brazil.ParticipantsEligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.Main outcome measuresSevere COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20–59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.ResultsA sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose–response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).ConclusionsThe combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose–response association between degrees of obesity and death in adults.