A prospective cohort study comparing two predictor models for 30-day emergency readmission in the elderly.

Aim: To undertake a prospective study of the efficacy of two models (LACE and BOOST) in predicting unplanned hospital readmission. Methods: Data were collected from a single centre prospectively over a continuous 30-day period on all patients over 75 years old admitted to the acute medical unit. The primary outcome was the area under the curve for both models. Results: Area under the curve were calculated for both tools with BOOST score 0.667 (95% CI: 0.559-0.775, p=0.005) and C-statistic for LACE index 0.685 (95% CI: 0.579-0.792, p=0.002). Conclusion: In this prospective study, both the BOOST and LACE scores were found to be significant predictive models of hospital readmission. Recent hospitalisation was found to be the most significant contributing factor. Key Words: Elderly, prediction, readmission

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

BackgroundInpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.MethodsWe conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios.ResultsAfter adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients.ConclusionsHospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.

A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London

Background Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. Methods A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. Results Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33–1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35–2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. Conclusion Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.

Improving physician handover documentation process for patient transfer from paediatric intensive care unit to general ward

BackgroundInadequate handover communication is responsible for many adverse events during the transfer of care, which can be attributed to many factors, including incomplete documentation or lack of standardised documentation process. The quality improvement project aimed to standardise the handover documentation process during patient transfer from paediatric intensive care unit (PICU) to the general paediatric ward.MethodsData analysis revealed lack of proper handover documentation with the omission of vital information when transferring patients from PICU to general ward. The quality improvement team assessed the current handover documentation practice using a brainstorming technique during multiple meetings. The team evaluated the process for possible causes of incomplete handover documentation, framed the existing challenges, and proposed improvement interventions, including a standardised handover form and conducting education sessions for the new proposed process. The main quality measures included physician’s compliance with handover documentation elements, physician’s satisfaction and PICU emergency readmission rate within 48 hours.ResultsPhysician compliance to handover documentation improved from 29.5% to 95.5% before and after implanting the improvement interventions, respectively. The level of physician satisfaction with the quality of communicated information during the handover process improved from 47.5% to 84%, and the PICU emergency readmission rate declined from 3.8% to zero after all improvement interventions were implanted.ConclusionImplementation of standardised handover form is essential to improve physician compliance for clear handover documentation and to avoid data omission during the patient transfer process. Documented handover in patient’s medical record has positive impact on physician satisfaction when managing patients recently discharged from PICU.

Abstract 13726: Remote Cardiac Rehabilitation is a Good Alternative of Outpatient Cardiac Rehabilitation in the Covid-19 Era

Introduction: As the COVID-19 pandemic has rapidly spread throughout the world, people need to take social distance to protect from SARS-CoV-2 infection. In such a stressful situation, physical activity is obliged to be reduced, and the risk of cardiovascular events was elevated in patients with heart failure (HF). The remote cardiac rehabilitation (CR) might be an alternative of outpatient-CR program. Methods: We prospectively investigated patients hospitalized for HF with left ventricular ejection fraction < 50% from January 2019 to April 2020. For patients who participated in the remote-CR program, telephone support by a nurse specialized in HF and cardiologists was provided every two weeks for five months after discharge. Emergency readmission rate within 30 days after discharge was compared among outpatient-CR, remote-CR and non-CR groups, and EQ-5D score as an indicator for quality of life (QOL) was compared between outpatient-CR and remote-CR groups. Results: The participation rate of our remote-CR program for HF patients, which had been launched in 2019, was elevated during COVID-19 pandemic. As was observed in the outpatient-CR group (n=70), emergency readmission rate within 30 days after discharge was lower in remote-CR group (n=31) as compared with non-CR group (n=137) (p=0.02). EQ-5D score 30 days after discharge was higher in remote-CR group than outpatient-CR group (p=0.03). Conclusions: Remote-CR is as effective as outpatient-CR for the improvement in short-term prognosis after discharge in patients hospitalized for heart failure, suggesting that remote-CR program can be provided as a good alternative of outpatient-CR program.

Female cardiologists in Japan

In Japan, the heavy workload managed by cardiologists might make it difficult for female cardiologists to work comfortably, and some hospital managers hesitate to employ female cardiologists. Are the clinical outcomes of patients with cardiovascular diseases affected by the cardiologist’s gender? In our previous study, the risk of emergency readmission within 30 days after discharge was found to be significantly lower for patients treated by female cardiologists than for those treated by male cardiologists. Compared to male counterparts, female cardiologists were more likely to practice evidence-based and guideline-directed medicine and communicate with other experts, that is, they are better at solving complex problems in the attending doctors’ team. In addition, female cardiologists probably maintain more robust physician–patient communication and successfully provide more fine-tuned and patient-centered preventive care than male cardiologists. In Japan, the rate of female doctors 21.1% is the lowest among the rates for the Organization for Economic Co-operation and Development countries. Under such a situation, in our hospital, a representative teaching hospital where female cardiologists constitute larger than other hospitals in Japan, better clinical outcome was observed in the patients treated by female cardiologists over those treated by male cardiologists. Considering the preference of medical management by female cardiologists, an increase in the number of female cardiovascular medicine practitioners is necessary from the perspective of patients’ clinical outcomes.