Acute Care Hospitals Research Articles

Critical Care Nursing Response to the Maui Wildfire Disaster: Narrative Review and Case Study.

Climate change has increased the frequency and severity of natural disasters, including the 2023 wildfires in Maui, Hawai'i. The no-notice disaster affected hospital operations at the sole acute care hospital that serves the community, requiring immediate interventions and reallocation of resources. The purpose of this article is to explore the role that critical care nurses play in responding to wildfires. Literature related to the nursing role in managing wildfire injuries and the events on Maui are explored and a case study presented. Results are organized into themes: environmental limitations, disaster response and code triage activation, no-notice preparation for critical care nurses, preparation to increase patient capacity and maintain patient safety standards, hospital staffing and staff affected by the disaster, management of patient care and hospital system operations, and disaster medical tent. Preparation for no-notice events requires critical care nurse involvement to effectively facilitate care for patients affected by disasters.

The relationship between conference presentations and in-hospital mortality in patients admitted with acute myocardial infarction: A retrospective analysis using a Japanese administrative database.

Clinicians' research activities reportedly improve their healthcare performance. Presenting research at conferences may be related to improved patient care outcomes; however, few studies have investigated this relationship. Thus, we examined the association between presenting at conferences and the mortality of patients hospitalized for acute myocardial infarction. We analyzed an administrative database of acute care hospitals in Japan. The study compared patients admitted to hospitals in which physicians made at least one conference presentation during the patient's admission year (Presentation Group) with those admitted to hospitals with no conference presentations (Control group). We performed multivariable logistic regression analyses to estimate the risk of all-cause in-hospital mortality. Five models were fitted: a Crude model, unadjusted; Model 1, adjusted for personal factors, including sex, age, Killip classification, and so on; Model 2, adjusted for Model 1 plus hospital factors; Model 3 was a multilevel analysis clustered by hospital codes and adjusted for the same variables as Model 1; Model 4 was adjusted for Model 1 plus evidence-based practices through causal mediation analysis. After excluding 3,544 patients with missing Killip classification or ambulance use, data for 56,923 patients in 384 acute care hospitals were analyzed. Drug prescription in accordance with the evidence was significantly greater in the Presentation group than in the Control group. Moreover, conference presentation was significantly associated with lower in-hospital mortality in all models (Odds ratios (OR) = 0.68, 95% Confidence intervals (CIs): 0.65 to 0.72 in the Crude model; OR = 0.73, 95% CIs: 0.68 to 0.79 in Model 1; OR = 0.76, 95% CIs: 0.70 to 0.82 in Model 2; OR = 0.84, 95% CIs: 0.76 to 0.92 in Model 3; OR = 1.00, 95% CIs: 0.92 to 1.09 in Model 4). The promotion of scholarly activities such as conference presentations might improve patient outcomes through increased evidence-based practice.

"Hello… I'm Here!" A Co-Productive Qualitative Study Involving Older People With Vision Impairment and Their Experiences of Acute Hospital Care.

To understand the experience and care needs of older people living with vision impairment in the acute hospital setting. A qualitative study using co-productive user-based design. Seven older people living with vision impairment and six healthcare students collaborated in a series of six researcher facilitated co-productive workshops. Recorded data were analysed using thematic analysis. The needs of older people with vision impairment are often overlooked in the acute hospital setting. Four themes identified (1) Trauma and Loss; (2) Vulnerability and Feeling Invisible; (3) Being disabled, and (4) Feeling safe. Trauma associated with vision loss was acute, particularly if acquired during the hospital admission. The experience of vision impairment coupled with illness served to heighten feelings of vulnerability and needs were often overlooked creating a sense of invisibility. The hospital environment was experienced as disabling, and care needs were not always acknowledged. Supportive communications and access to own audio/supportive devices were vital in supporting a sense of safety. Our study is significant in highlighting the increasing global importance of vision aware care in the context of an ageing population. The study is also unique in illustrating the potential for inclusive and creative co-productive approaches which engage both older people with sight loss and healthcare students to promote vision aware practice. Supporting vision impaired older people through diagnosis, care and discharge is vital for promoting equitable positive health outcomes and quality of life. What problem did the study address? Despite a high prevalence of sight loss within the older patient population, it is unclear how the acute hospital setting supports people living with vision impairment. What were the main findings? The hospital environment and lack of vision aware care can impact negatively on the care experience resulting in poorer physical and psychosocial wellbeing. Where and whom will the research have an impact? This work will inform the development of vision aware care educational resources, policy, and practice. Vision aware care is vital for supporting quality of life and health outcomes for all older people. EQUATOR guidelines have been adhered to using the COREQ checklist. The charitable organisation Sheffield Royal Society of Blind (SRSB) was involved in the planning of the research to ensure that volunteer participants could take part and the conduct of the research was inclusive to their needs.

Obstetric Care Access at Rural and Urban Hospitals in the United States

This study quantifies losses and gains of obstetric care services at US rural and urban short-term acute care hospitals between 2010 and 2022.

Recruitment Feasibility for a Randomized Controlled Pilot Study of Animal-Assisted Intervention for Hospitalized Older Adults

This study evaluated the feasibility of recruiting hospitalized older adults into a randomized controlled trial (RCT) comparing an animal-assisted intervention (AAI) involving visits from therapy dogs with an active control (conversation with a volunteer) and treatment as usual (TU) for addressing health and mental health outcomes. Recruitment occurred on acute care hospital units and a long-term physical rehabilitation facility. Feasibility data included the number of recruitment contacts, recruitment rate, and reasons for non-enrollment. The recruitment pool included 1124 patients; the recruitment rate was 4.8% (n = 54). This study explored the difficulties inherent in recruiting medically ill, hospitalized older adults for an RCT of hospital-based therapy dog visits. We believe this is the first RCT of its kind to evaluate the feasibility of recruiting this population for an animal-assisted intervention. Although the intervention was well received, older adults’ illnesses presented significant barriers to study enrollment. Strategies for improving the recruitment of hospitalized older adults for RCTs are discussed.

Early predictors of unfavorable outcomes in pediatric acute respiratory failure

ObjectiveAcute respiratory failure is a leading cause of critical illness in children. However, patient outcomes and early predictors of unfavorable outcomes are not well understood. This study aimed to describe composite unfavorable outcomes, defined as in-hospital death or discharge with new comorbidities, and to identify early predictors in children with acute respiratory failure in acute care hospitals.DesignRetrospective cohort study using a national inpatient database in Japan.SettingAll acute care hospitals registered in the database.PatientsThis study included children under 20 years of age who were admitted with acute respiratory diseases between July 2010 and March 2022 and received ventilatory support within the first three days of hospitalization.InterventionNone.Measurements and main resultsAmong 29,362 eligible children, the median age was 1.2 (interquartile range, 0.3–3.7) years and 28.8% had underlying conditions. The highest level of ventilatory support within the first three days was invasive ventilation (69.4%), noninvasive ventilation (1.0%), and high-flow nasal cannula (29.7%). Respiratory diagnoses included pneumonia (58.6%), bronchiolitis (29.0%), and asthma (11.1%). Among these children, 669 (2.3%) died and 1994 (6.8%) were discharged with new comorbidities, resulting in 2663 (9.1%) children experiencing unfavorable outcomes. In the logistic regression model, older age, underlying conditions, pneumonia, and low hospital volume were associated with unfavorable outcomes after adjusting for covariates.ConclusionsA significant proportion of pediatric patients with acute respiratory failure experienced unfavorable outcomes, warranting future efforts to improve acute care services for at-risk children. Early predictors identified from national database analyses could inform risk stratification and optimize the provision of acute care services for vulnerable pediatric patients.

Development of nurses’ critical thinking skills: Implications for clinical practice

Critical thinking skills of registered nurses are important to improve patient safety through recognition of an adverse change in a patient’s condition and initiation of appropriate action. The purpose of this study was to determine whether participation in case scenario simulation exercises significantly increased the critical thinking skills of registered nurses. The study used a simulation program developed by the American Association of Critical Care Nurses. Sixty registered nurses in an acute care hospital participated in the study. Although the results failed to indicate a significant statistical difference in the critical thinking skills of the registered nurses following completion of the assigned modules, limitations of the study may have adversely affected findings. Additional research is warranted to further explore the potential of using case-based simulation exercises to promote critical thinking skills in registered nurses. Wider implications include promoting an environment of continual learning to strengthen the critical thinking skills of staff. Implementation of case scenario simulation exercises may be an effective way to develop critical thinking skills and reduce incidences of registered nurses failing to rescue a patient when intervention is required. The actionable findings of this research may generate further studies to enhance the practice of nursing, improve patient safety and reduce the number of adverse events involving hospitalised patients.

A survey of the Nutrition Care Process in Japanese acute care hospitals using a nationwide web-based questionnaire.

Study aim was to determine the levels and barriers of the Nutrition Care Process (NCP), a practical method of individualized nutrition support. Delegate of registered dietitians (RDs) from acute-care hospitals answered our nationwide web-based questionnaire (April-June, 2023) to determine the implementation status of screening, assessment, intervention (including planning), and monitoring (components of the NCP). Of 5,378 institutions contacted, 905 (16.8%) responded. For Screening, 80.0% screened all inpatients: primary personnel in charge were RDs (57.6%); the most used screening tool was Subjective Global Assessment (SGA) (49.2%). For Assessment, 66.1% assessed all inpatients: food intake (93.3%) was most evaluated whereas muscle mass and strength (13.0%, 8.8%) were least evaluated. For Intervention, 43.9% did so within 48h of hospital admission: oral nutritional supplement (92.9%) was the most common RDs intervention and parenteral nutrition (29.9%) was used less. For Monitoring, 18.5% of institutions had monitoring frequency of ≥ 3 times/week whilst 23.0% had monitoring less than once a week for severely malnourished patients. Energy and protein intake (93.7%, 84.3%) were most monitored and lipid intake (30.1%) was less monitored. Barriers of NCP included inefficient staffing systems and unsuitable tools in Screening, inaccurate patient targeting and lack of important evaluation items in Assessment, delayed timing and incomplete contents in Intervention, and inadequate fre-quency and lack of important evaluation items in Monitoring. An increase in RDs staffing in acute-care general wards, widespread NCP instruction manuals, and education about the tools and evaluation items utilized in nutritional management are possible solutions.

Treatment patterns and clinical outcomes of immunocompromised patients with COVID-19 receiving remdesivir in the inpatient setting in Japan.

Remdesivir (RDV) was approved in Japan for the treatment of coronavirus disease 2019 (COVID-19) in May 2020. However, large-scale research describing the characterized use of RDV in the inpatient setting in Japan is limited. This study aimed to describe the treatment patterns and clinical outcomes of immunocompromised patients with COVID-19 treated with RDV. We used a secondary nationwide administrative claims database of acute care hospitals in Japan. The study period was from October 19, 2020, to September 30, 2022. Patients with COVID-19 treated with RDV during hospitalization were included, and the proportion of patients with death and disease progression were calculated. The analysis included a total of 2,171 immunocompromised patients treated with RDV. The mean (standard deviation) age at index date was 75.1 (13.6) years. The median time to RDV initiation from hospitalization was 1.0 days (Q1-Q3: 1.0-2.0), and the median duration of RDV treatment was 5.0 days (Q1-Q3: 3.0-5.0). At RDV initiation, 53.02% (n=1,151) of patients required non-invasive positive pressure ventilation, nasal high-flow or low-flow oxygen, and 2.26% (n=49) required mechanical ventilation, extracorporeal membrane oxygenation, or intensive care unit admission. Inpatient mortality rate by day 28 was 8.98% (95% confidence interval, 7.81-10.26). By day 28, the rate of disease progression was 9.86% (n=214), and 76.83% (n=1,668) were discharged. This study presents practical information on outcomes and treatment patterns of RDV in immunocompromised inpatients diagnosed with COVID-19.

Time from Admission to the Onset of Methicillin-Resistant Staphylococcus aureus Bacteremia in a Single Acute Care Hospital in Japan.

The spread of antimicrobial resistant organisms (AROs) poses a major threat to animal and human health. In Japan, the estimated disability-adjusted life years (DALYs) due to ARO infections is 137.9 per 100,000 persons, with methicillin-resistant Staphylococcus aureus (MRSA) being the main contributor. Factors that can contribute to DALYs in Japan include younger age and a higher number of deaths in patients with MRSA bacteremia. Moreover, longer hospital stays may contribute to the higher rates of MRSA bacteremia in Japan than in western countries. We reviewed the diagnostic procedure combination data collected from January 1, 2016 to December 31, 2020, in an acute care hospital in Tokyo, Japan. We found that the median time from admission to MRSA bacteremia onset was 26 days, which is longer than that observed in western countries however similar to that in South Korea. Furthermore, our cohort was older than those in the United States and South Korea, potentially contributing to the higher number of years of life lost in Japan. These results underscore the need to develop strategies to reduce hospitalization rates in Japan. Larger multicenter studies are needed to comprehensively evaluate the economic and health burdens of MRSA bacteremia in Japan.

Antibiotic prescribing trends in German acute care hospitals from 2012/13 through 2021/22

An important prerequisite for ascertaining rational antibiotic prescribing is the availability and evaluation of antibiotic use data. In this study we report evolving trends of antibiotic use in German hospitals during the last decade.Using drug dispensing data from acute care hospital pharmacies, we calculated yearly antibiotic use density values for the period from 2012/13 through to 2021/22. Use density was expressed as daily doses per 100 patient days, using both hospital adapted doses of antibiotics ("recommended daily dose", RDD) as well as WHO-"defined daily doses" (DDD). The 2021/22 data were extrapolated to estimate the hospital consumption in DDD per 1000 population and day.The overall antibiotic use density remained stable during the observation period. It was 41.9 RDD/100 patient days (median, n=169 hospitals, interquartile range 35-48 RDD/100) in the year 2012/13 and 42.1 RDD/100 (median, n=329, interquartile range 35-48 RDD/100) in the year 2021/22, respectively. The estimated national use per population in 2021/22 was 1.85 DDD per 1000 inhabitants and day. The antibiotic use levels in university hospitals (54.0 RDD/100) were higher than in non-university hospitals that showed a similar use density across different hospital size categories (medians between 39.8 and 44.0 RDD/100). Overall, penicillin use increased over time (change in proportion +63%), while fluoroquinolones (- 54%) and first and second generation cephalosporins (- 41%) were prescribed less frequently. Antibiotic use density in intensive care units was approximately twice as high as in normal wards. High levels of antibiotic use were also observed in haematology-oncology divisions at teaching hospitals (median 96.8 RDD/100), in urology (medians between 65.1 and 70.5 RDD/100) and oto-rhino-laryngology (medians between 49.1 and 60.9 RDD/100) and urology divisions.During the last decade, there was no increasing use of antibiotics in German acute care hospitals. We observed shifts in selected drug classes, in particular an increasing use of penicillins. The estimated hospital antibiotic consumption per population was slightly above the European average.

Immunotherapy Following Anaplastic Lymphoma Kinase Inhibitor Therapy for Patients with Anaplastic Lymphoma Kinase‑Positive Non‑small Cell Lung Cancer in Japan.

Although anaplastic lymphoma kinase inhibitors (ALKis) are the effective initial treatment for patients with anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC), most patients experience resistance to ALKis, leading to the need for alternative therapies. Immune checkpoint inhibitors (ICIs) are a standard NSCLC treatment. On the other hand, their efficacy remains unclear for ALK-positive NSCLC. We aim to describe the treatment patterns and treatment outcomes for patients with ALK-positive NSCLC receiving later-line ICI treatment. This retrospective cohort study used claims data from Japanese acute care hospitals and included patients with lung cancer (International Classification of Diseases, 10th version (ICD-10), code: C34) diagnosed between 1 December 2015 and 31 January 2023. We extracted patients who received ALKis as first-line therapy and subsequent lines of treatment. Patient characteristics and treatment patterns and durations were descriptively summarized. Time to treatment discontinuation (TTD) for ICIs was examined using Kaplan-Meier estimates. Of 478 patients who received ALKi as first-line treatment, 30 received ICIs, 249 ALKis, and 154 non-ICI/ALKi therapy as second-line treatment. Most patient characteristics showed no differences among the groups. ICIs were more likely to be administered to patients who underwent shorter durations of ALKi treatment. The median TTD for ICIs was 66 days, with a 1 year TTD rate of 13%. Given the rarity of ALK-positive NSCLC, this study contributes to add evidence through an expanded database and increased sample size, supporting previous suggestions that ICIs have limited effectiveness in patients positive for ALK.

Guideline concordance of electronic health record order sets for hospital-based treatment of alcohol withdrawal syndrome.

Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care. We examined variation in AWS order sets across hospital organizations and their concordance with AWS guidelines. We conducted a cross-sectional study of hospital organization user-created EHR order sets for AWS extracted from the December 2021 Epic® userweb community library. Hospital organizations with an acute care hospital and 1 AWS order set were included. We measured the proportion of guideline-concordant care practices within four categories: (1) laboratory assessment, (2) risk assessment for severe AWS and associated management changes, (3) symptom assessment and treatment of AWS, and identification and management of complications and (4) screening, diagnosis, and treatment of unhealthy alcohol use and AUD including medications for alcohol use disorder (MAUD). Ninety-five organizations with 289 order sets were included. The proportion of organizations with guideline-concordant laboratory assessments included testing of electrolytes (83%), hepatic function (75%), substance use (83%), and screening for infections (33%). Guidance for assessing risk of severe AWS (34%) and indications for care escalation (63%) used inconsistent definitions. Use of guideline-concordant medications for AWS (99%) and AWS symptom scores (91%) were nearly universal. MAUD was included by two organizations (2%). A common templated order set was used by 26% of organizations in EHR order sets. We observed frequent organizational inclusion of guideline-concordant medications and symptom scores but rare and/or poorly defined guidance for evaluating risk of severe AWS, escalation of care, and MAUD.

Managers' Experience of the Response of the Health System to the Covid-19 Pandemic for Inpatient Geriatric Care: Lessons About Organisation and Resilience.

Effective management of crises is a major challenge for healthcare organisations and their managers. Research suggests that to respond to evolving and unpredictable crises, such as the Covid-19 pandemic, an organisation needs the capability to continually adapt to the changing situation using relevant knowledge. However, there are few empirical studies using an organisational resilience perspective to understand how a health system responds to this type of crisis. This study aimed to describe managers' perspectives on what influenced the response to the Covid-19 pandemic in the Region Stockholm healthcare system for older people. Data collection was conducted through in-depth semi-structured interviews with assistant managers (n=3) and managers of inpatient geriatric services outside of acute care hospitals (n=8), managers of three acute care hospitals (n=3); and the crisis management team for geriatric services (n=3). Data was analysed using qualitative content analysis. Crisis management of geriatric care in the Stockholm healthcare system during the Covid-19 pandemic's first 15months was influenced by a combination of service specific aspects, 'Internal flexible responses', collaborative aspects, 'Coordination within the system', and governance aspects 'Adaptive steering'. This study contributes to empirical knowledge about organisational resilience. Managers' responses are facilitated when the governance allow them more flexibility in their internal responses and enable their cross-organisational collaboration. A coordinating function across healthcare services is an important enabler in a crisis when the function has well-established, trustful prior collaborations with the services.

Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review.

To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings. A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach. Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared. English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients. The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research. A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings. This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews. This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions. The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885.

Longer travel times to acute hospitals are associated with lower likelihood of cancer screening receipt among rural-dwelling adults in the U.S. South.

Given rural hospitals' role in providing outpatient services, we examined the association between travel burdens and receipt of cancer screening among rural-dwelling adults in the U.S. South region. First, we estimated network travel times and distances to access the nearest and second nearest acute care hospital from each rural census tract in the U.S. South. After appending the Centers for Disease Control's PLACES dataset, we fitted generalized linear mixed models. Longer distances to the second nearest hospital are negatively associated with breast, colorectal, and cervical cancer screening receipt among eligible rural-dwelling adults. Rural-dwelling women in counties with 1 closure had reduced likelihood of breast cancer screening. Residence in a partial- or whole-county Health Professional Shortage Area (HPSA) was negatively associated with cancer screening receipt. Specialist (OB/GYN and gastroenterologist) supply was positively associated with receipt of cancer screening. Uninsurance was positively associated with cervical and breast cancer screening receipt. Medicaid expansion was associated with increased breast and cervical cancer screening. Rural residents in partial-county primary care HPSAs had the lowest rates of breast, cervical, and colorectal cancer screening, compared with whole-county HPSAs and non-shortage areas. These residents also faced the greatest distances to their nearest and second nearest hospital. This is notable because rural residents in the South face greater travel burdens for cancer care compared with residents in other regions. Finally, the positive association between uninsurance and breast and cervical cancer screening may reflect the CDC's National Breast and Cervical Cancer Early Detection Program's effectiveness.

Added value of inflammatory markers to vital signs for predicting mortality in patients with suspected infection: external validation and model development.

It is crucial to identify high-risk patients with infectious conditions for appropriate management. We previously found that inflammatory markers added value to vital signs for predicting mortality in patients with suspected infection. In this study, the aim was to externally validate the added value of the inflammatory markers and to develop a new prediction model. For the external validation, consecutive adult patients with suspected infection admitted to the department of general medicine at two acute care hospitals were evaluated. A prognostic model for 30-day in-hospital mortality based on vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Similar to the previous finding, all inflammatory markers except C-reactive protein showed significant contributions. Subsequently, a prediction model was developed using vital signs and markers with significant added value using a dataset that combined the external validation data with the data of the previous study. The new model was compared with a model based on the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) score. The newly developed model showed a higher c-index than the qSOFA model [0.756 (95% CI 0.726-0.786) vs. 0.663 (0.630-0.696), p < 0.001]. Using the new model, 9.0% of patients who died were correctly reclassified compared with the qSOFA model at the threshold of 10% mortality risk. The new model including these markers showed potential to outperform the qSOFA model.

Examining the joint effect of clinical quality, meaningful use of HIT and patient-caregiver interaction on mortality rates in US acute care hospitals.

Healthcare quality has long been defined and assessed using different theories that outline care delivery as a product of two factors; one being the clinical aspect symbolizing the science of care and the other being the non-clinical aspect symbolizing non-medicinal aspect of care delivery. To the best of our knowledge, the joint effect of the clinical, social and technological aspects of care on outcome quality has not been investigated in the literature. The current study empirically investigates the joint effect of the clinical, social and technological care quality dimensions on mortality rates through analyzing longitudinal data from 3081 US hospitals. Six-year data from more than 3000 acute care hospitals is analyzed using econometric analysis with two stage least square instrumental variable regression models. Hospitals that jointly focus on clinical, social and technological care dimensions realize lower mortality rates. Combining clinical quality (CM) with either meaningful use of health information technology (MUHIT) or patient-caregiver interaction (PCI) reduces mortality rates. The lowest mortality rate is realized when hospitals combine CM, PCI and MUHIT. Our study provides empirical evidence on the importance of combining clinical and non-clinical care measures to reduce mortality rates in hospitals. Our results indicate that hospitals that combine dual quality dimensions, clinical quality with either PCI or MUHIT, can also realize improvement in mortality rates. However, the best outcome can be realized by focusing on the triple quality dimensions (CM, PCI and MUHIT). The study provides pointers to healthcare professionals and policy makers on the impact of non-clinical care on the clinical-mortality link in hospitals.

Risk factors for deep vein thrombosis and pulmonary embolism: a comparative study between acute hospital care and mental health inpatient settings for older people

Purpose This study aims to establish if risk factors for venous thromboembolism (VTE) in older hospitalized psychiatric patients differ from geriatric inpatients and if the current risk assessment tools being used are suitable. Design/methodology/approach The authors undertook a single centre retrospective review of 75 records for presence of predetermined risk factors. In total, 55 discharged patients with thrombotic events within geriatric settings were compared with 20 from mental health settings. Differences in risk factors were determined using t-test and Fisher’s exact test. Findings VTE patients in geriatric units were older and had reduced mobility. Psychiatric patients were more likely to be dehydrated and treated with psychotropics. Whilst rates of VTE screening were comparable in both settings, geriatric inpatients were more frequently prescribed thromboprophylaxis. Research limitations/implications Older psychiatric inpatients differ from those in medical/surgical settings in their profiles and risk factors for VTE. Approaches for VTE risk management also differed. Practical implications The study suggests the need for VTE screening tools and treatment protocols specific to older psychiatric settings. Social implications Targeted approaches may improve outcomes specific to each group. Originality/value To the best of the authors’ knowledge, this is the first attempt in comparing VTE risk factors across acute physical health care and mental health settings.

Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial

BackgroundHome-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults.MethodsThe study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods.DiscussionThis study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries.Trial RegistrationCRIS KCT0007921.