Acute Inpatient Care Research Articles

Epilepsy in acute psychiatric inpatient settings: Prevalence, treatment gaps, and mortality.

The underrepresentation of acute psychiatric settings in epilepsy research presents a barrier to delivering equitable healthcare for people with comorbid epilepsy and severe mental illness. We aimed to report the prevalence of epilepsy among people receiving acute psychiatric inpatient care and examine the sociodemographic and clinical characteristics influencing their treatment outcomes. We analysed electronic patient records to estimate the lifetime prevalence of epilepsy in a retrospective cohort of 9,237 people admitted to psychiatric inpatient wards in South London between 2015 and 2019. Hospital and national databases were used to examine the characteristics of those with epilepsy, including sociodemographic variables, antiseizure medication prescriptions, and engagement with specialist neurology services. Kaplan-Meier and Cox regression analyses identified predictors of all-cause mortality in individuals with epilepsy and a comparator cohort without epilepsy. The lifetime prevalence of epilepsy in this population was 3% (95% CI: 2.65 to 3.36). Among individuals with epilepsy, 64.1% were prescribed two or more antiseizure medications, while only 32.6% received specialist neurology input in the year before and after their latest admission. Additionally, 72.8% lived in areas with high levels of socioeconomic deprivation. Adjusting for clinical and demographic covariates, the presence of epilepsy was associated with a 43% increased risk of mortality in this population (HR = 1.43, 95% CI: 1.08-1.90, p=0.01). Epilepsy has an elevated prevalence and is a predictor of increased mortality among people receiving acute psychiatric inpatient care. Improving outcomes in this population will require interdisciplinary collaboration and patient advocacy.

The Role of Value Analysis in Pressure Injury Prevention: A Quality Improvement Project.

Global pressure injury (PI) statistics reveal that hospital-acquired pressure injuries (HAPIs) remain a substantial burden, with over 1 in 10 hospitalized adults being affected. The purpose of this analysis is to describe how consistent collection, analysis, and use of data allow hospitals to validate their clinical and economic outcomes and to adjust PI prevention strategies. HAPI incidence data for acute care patients at a 280-bed regional community hospital in the Mid-Atlantic region of the United States (West Virginia) were collected from January 2012 to July 2023. Multilayered silicone foam dressings from 3 manufacturers were used during data collection and outcomes evaluated. The average annual HAPI incidence was calculated retrospectively to allow comparison of outcomes during the time periods that various soft silicone multilayered foam manufacturers were used. When using dressing 1, the hospital experienced an average of 10.40 HAPI per year. When using dressing 2, the hospital experienced an average of 5.56 HAPI per year, and when using dressing 3, the average was 26.29 HAPI per year. Additionally, an estimated sum of US $451229.91 was saved when using dressing 2 compared to dressing 3, and US$105352.28 was saved during the use of dressing 2 as compared to dressing 1. Monitoring data over time can validate product selection decisions to ensure they are advantageous to both costs and the delivery of quality care.

The Effectiveness of Pressure Injury Prevention Education for Patient Care Technicians in an Adult Acute Care Setting: A Quality Improvement Project.

The purpose of this quality improvement project was to determine whether hospital-acquired pressure injuries (HAPIs) could be prevented by implementing an educational tool kit for patient care technicians (PCTs). Data were collected from 24 PCTs and 43 patients in a 26-bed inpatient adult acute care unit at an academic medical center in the mid-Atlantic region of the United States. Outcome data were collected over an 8-week period from September to November 2021. Hospital-acquired pressure injury prevalence was collected using the National Database of Nursing Quality Indicators (NDNQI) survey process. Full- and part-time PCTs' knowledge and attitudes were assessed through modified Pressure Injury Prevention Knowledge and Attitudes towards Pressure Ulcer Prevention Instruments. The PCTs' compliance with prevention strategies was assessed among patients using the modified NDNQI audit scores. Descriptive statistics, Fisher's Exact test, and Mann-Whitney U test were used for analysis. Among the 24 PCTs, 66.7% (n=16) had received prior education on HAPI prevention strategies. Hospital-acquired or unit-acquired pressure injury prevalence rates did not change significantly following the educational intervention. Mean Pressure Injury Prevention Knowledge scores increased from pre- to post-intervention (92.86; SD 9.63 vs 94.05; SD 12.86). Average Attitude towards Pressure Ulcer Prevention scores decreased from pre- to post-intervention (27.79; SD 4.88 vs 21.0; SD 7.51), indicating poorer attitudes toward pressure injury prevention. The mean NDNQI audit scores significantly improved from pre-implementation (M 1.40; SD 0.82, n =20) to measurement following the intervention (M 2.35; SD 0.99, n =23; P=.014). An educational curriculum tailored for PCTs increased HAPI prevention strategies. The project site incorporated the HAPI prevention educational tool kit from this quality improvement project into their annual hospital-wide training for all PCTs to learn and implement HAPI prevention strategies in their work setting.

Nursing prioritization and rationing decisions in acute care hospitals during the Covid-19 pandemic: a qualitative study

Nursing prioritization and rationing decisions in acute care hospitals during the Covid-19 pandemic: a qualitative study Abstract:Background: The Covid-19 pandemic has put decisions regarding prioritization and rationing of care resources on the health policy agenda. The effects on the allocation of nursing resources in clinical practice are unclear. Aim: In order to derive implications for future pandemic situations, we analyzed the extent to which decisions were made about the distribution of resources in acute inpatient care and how bottlenecks were dealt with. Methods: We conducted semi-structured interviews with nursing staff (n = 16) and nursing team leaders (n = 10) in five acute-care clinics in Germany and analyzed them inductively using thematic framework analysis. Results: In acute inpatient care under pandemic conditions, prioritization and rationing decisions were made, such as the postponement or reduction of nursing measures, in order to overcome pandemic-specific challenges. These decisions affected certain patient groups and certain near- and distant-patient services, in particular fundamental care measures, such as support with personal hygiene and nutrition, as well as access to acute inpatient care. The decisions were made implicitly rather than according to evidence-based criteria. Conclusions: Nursing prioritization and rationing decisions were made during the pandemic. These decisions are similar to comparable decisions outside of the pandemic, particularly in terms of insufficient evidence base, and emphasize the need for empirically based decision criteria.

Can a mechanical circulatory support comprehensive approach to cardiogenic shock at referral centers reduce 30-day mortality?

Although mortality risk prediction in cardiogenic shock (CS) is possible, assessing the impact of the multitude of therapeutic efforts on outcomes is not straightforward. We assessed whether a temporary mechanical circulatory support comprehensive approach to the treatment of CS may reduce 30-day mortality as compared to expected mortality predicted by the recently proposed Cardiogenic Shock Score (CSS). Consecutive CS patients supported by pVAD Impella (Abiomed, Danvers, MA) at two national referral centers were included. 170 patients were included: age was 65 ± 13 years, and 75.9% were male and acute myocardial infarction was the prevalent cause of shock (71.1%). Expected mortality according to CSS was higher than observed (51.8% vs. 41.5%, p < 0.001), this trend being particularly evident for CSS > 4. The AUC ROC curve confirmed poor diagnostic accuracy in this population (AUC 0.53 CI: 0.23–0.82, p = 0.83). The lower observed mortality compared to the expected mortality in critical cardiogenic shock population underscores the role of a comprehensive approach to acute cardiac care patients at referral centers, which should consider including temporary mechanical circulatory support.

Predictive Factors and the Predictive Scoring System for Falls in Acute Care Inpatients: Retrospective Cohort Study.

Falls in hospitalized patients are a serious problem, resulting in physical injury, secondary complications, impaired activities of daily living, prolonged hospital stays, and increased medical costs. Establishing a fall prediction scoring system to identify patients most likely to fall can help prevent falls among hospitalized patients. This study aimed to identify predictive factors of falls in acute care hospital patients, develop a scoring system, and evaluate its validity. This single-center, retrospective cohort study involved patients aged 20 years or older admitted to Shizuoka General Hospital between April 2019 and September 2020. Demographic data, candidate predictors at admission, and fall occurrence reports were collected from medical records. The outcome was the time from admission to a fall requiring medical resources. Two-thirds of cases were randomly selected as the training set for analysis, and univariable and multivariable Cox regression analyses were used to identify factors affecting fall risk. We scored the fall risk based on the estimated hazard ratios (HRs) and constructed a fall prediction scoring system. The remaining one-third of cases was used as the test set to evaluate the predictive performance of the new scoring system. A total of 13,725 individuals were included. During the study period, 2.4% (326/13,725) of patients experienced a fall. In the training dataset (n=9150), Cox regression analysis identified sex (male: HR 1.60, 95% CI 1.21-2.13), age (65 to <80 years: HR 2.26, 95% CI 1.48-3.44; ≥80 years: HR 2.50, 95% CI 1.60-3.92 vs 20-<65 years), BMI (18.5 to <25 kg/m²: HR 1.36, 95% CI 0.94-1.97; <18.5 kg/m²: HR 1.57, 95% CI 1.01-2.44 vs ≥25 kg/m²), independence degree of daily living for older adults with disabilities (bedriddenness rank A: HR 1.81, 95% CI 1.26-2.60; rank B: HR 2.03, 95% CI 1.31-3.14; rank C: HR 1.23, 95% CI 0.83-1.83 vs rank J), department (internal medicine: HR 1.23, 95% CI 0.92-1.64; emergency department: HR 1.81, 95% CI 1.26-2.60 vs department of surgery), and history of falls within 1 year (yes: HR 1.66, 95% CI 1.21-2.27) as predictors of falls. Using these factors, we developed a fall prediction scoring system categorizing patients into 3 risk groups: low risk (0-4 points), intermediate risk (5-9 points), and high risk (10-15 points). The c-index indicating predictive performance in the test set (n=4575) was 0.733 (95% CI 0.684-0.782). We developed a new fall prediction scoring system for patients admitted to acute care hospitals by identifying predictors of falls in Japan. This system may be useful for preventive interventions in patient populations with a high likelihood of falling in acute care settings.

Impact of in-hospital COVID-19 quarantine policy changes on quality of acute stroke care: a single center experience.

The COVID-19 pandemic is known to impact in-hospital processes for acute stroke patients, potentially resulting in delays due to quarantine and screening measures. The purpose of this study was to determine effects of changes in in-hospital quarantine policies on quality of care for acute stroke patients. Hyperacute ischemic stroke patients who were admitted to Korea University Guro Hospital between January 2019 and February 2021 via the emergency department were included in this study. All had neurological symptoms within 6 h before arrival. As a mandatory COVID-19 real-time PCR screening test was implemented in March 2020, changes in quality indicators according to the progress of COVID-19 pandemic and changes in in-hospital quarantine policy, including door-to-image time (DIT), door-to-referral time, door-to-needle time (DNT), door-to-puncture time (DPT), and functional outcomes (discharge and 3-month modified Rankin's scale) were determined. A total of 268 hyperacute stroke patients were analyzed. The number of hyperacute stroke patients gradually decreased as the pandemic progressed. Time indicators, including door-to-referral time, DIT, and DPT during the pandemic were increased. When pre-and post-COVID-19 screening epochs were compared, DIT, door-to-neurologist referral time, and DPT showed numerical increases. However, after accounting for potential confounders, a significant delay in DIT was found to be associated with the in-hospital COVID-19 quarantine policy. Our study showed that enhancing in-hospital COVID-19 quarantine measures might increase the response time for hyperacute stroke care, suggesting an impact on the quality of care.

Towards a common definition of hospital-acquired deconditioning in adults: a scoping review

BackgroundHospital-acquired deconditioning is a term used in clinical practice, describing a loss of physical and/or cognitive function associated with hospitalisation. Previous reviews have addressed interventions, its prevalence in older adults...

Point prevalence survey of antibiotics usage in a tertiary care public sector hospital employing WHO methodology.

Background: Antimicrobial resistance (AMR) kills 7 million people annually. WHO recognized AMR as a global threat in 2017 and launched the Point Prevalence Survey (PPS) methodology in 2018. The situation in Pakistan is even worse with an overall prevalence of antibiotic usage of 75 per 100 population. Material and Methods: This cross-sectional survey was conducted on a single day, 25th May 2024, at the Pakistan Institution of Medical Sciences (PIMS), with a sample size of 271 of 822 eligible patients. The PPS team collected the data using a questionnaire based on the WHO PPS methodology. All acute care and ward patients hospitalized at or before 8:00 A.m. were included. Results: A total of 271 patients were included in the survey, 110 (40.60%) were females, and 161 (59.40%) were males. The patients aged&gt; 2 months were 248 (91.50%) and &lt; 2 months were 23 (8.5%). The prevalence of antibiotic use in PIMS was 210 (77.6%). The culture sample sent before the first dose of antibiotic was only in 57 (27.1%) patients. The largest indication was community-acquired infections 40 (55.56%). Blood was the most common form of sample sent 45 (47.36%). The culture positivity rate was 21.05%. Klebsiella Pneumoniae was the most detected organism at 25% followed by Pseudomonas aeruginosa at 15%. The target antibiotic prescriptions were only 13.3%. Ninety percent of the antibiotics were given via parenteral route. Ceftriaxone was the most popular antibiotic used 62(20%). Conclusion: Antibiotics are widely used in our hospital, with the majority being empirical. Most antibiotics are used to treat community-acquired illnesses. Patients whose cultures were sent before their initial antibiotic treatment make up a minor proportion. Keywords: Community-acquired infections, Indication, Culture, Antibiotic consumption, Point prevalence survey, MDROs

Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre

The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ2-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.

A qualitative analysis of healthcare professionals’ experiences with an internet-based emotion regulation intervention added to acute psychiatric inpatient care

BackgroundHealthcare professionals play an important role in successfully implementing digital interventions in routine mental healthcare settings. While a larger body of research has focused on the experiences of mental healthcare professionals with the combination of digital interventions and face-to-face outpatient treatment, comparatively little is known about their experiences with digital interventions combined with inpatient treatment. This is especially true for acute psychiatric inpatient care, where studies on the implementation of digital interventions are more rare. The current study aimed to investigate healthcare professionals’ experiences with an internet-based emotion regulation intervention added to acute psychiatric inpatient treatment.MethodsPhysicians, nurses, psychologists, social workers, and occupational therapists from three acute inpatient wards (n = 20) were interviewed regarding their experiences. A thematic analysis approach was used to analyze the interview data.ResultsThe following themes and corresponding subthemes were identified: lack of experience (few or no previous experiences, no expectations, few points of contact), the intervention as a contemporary complement (positive expectations, necessary and contemporary, positive effects on therapeutic work and patients, characteristics of the internet-based program), concerns about fit for acute psychiatric inpatient care (fit for acute psychiatric inpatients, doubts about implementation), the human factor as essential for implementation (the team makes or breaks it, guidance is key, patient characteristics), and requirements for implementation beyond the human factor (integration into existing treatment structure, resources, changes to the internet-based program, timing).ConclusionsWhile healthcare professionals reported few points of contact with the intervention, they saw it as a contemporary complement to acute psychiatric inpatient care with benefits for therapeutic work and patients. The findings further suggest that specific concerns regarding the fit for acute psychiatric inpatient care remain and that human factors such as support from the ward team, human guidance during the intervention and being mindful of specific patient characteristics are considered important for implementation. Moreover, factors such as integration of the intervention into the ward program, resource availability and the timing of the intervention during a patient’s individual stay should be considered for successful implementation.Trial registrationClinicaltrials.gov, NCT04990674, 04/08/2021.

Intravenous Pump Flow Accuracy: A Systematic Review.

Intravenous pumps (IVPs) deliver IV medications to millions of acute care patients each year and result in many adverse events reported to the US Food and Drug Administration (FDA). Although the use of IVPs has improved overall safety, there are still high rates of error that risk the safety of all patients, especially those of advanced age and those suffering from critical illness. Most of the documented errors are based on clinician reports, although there is reason to believe that errors due to flow rate inaccuracy go undetected and unreported. The purpose of this systematic literature review was to explore literature regarding flow rate accuracy for IVPs used in US acute care medicine. The systematic review was conducted by searching PubMed, CINHAL, and Web of Science. Articles chosen were from any year, written in the English language, and had content pertaining to the use of IVPs and key concepts of interest. Concepts discussed throughout the literature are relevant to the IVPs used for patient care, including outlet pressure, intake pressure, dead volume, and pump setup. This review provides a conceptual overview of what is known about this technology but reveals a gap in knowledge related to actual IVP clinical accuracy.

Exploring Clinician Barriers and Enablers in Referring Patients to a Virtual Hospital for Acute Care

Background: Virtual hospitals offer a promising solution to alleviate pressures on traditional healthcare systems by providing acute care in patients' homes. Despite the implementation of a virtual hospital model in South Australia, referral rates remain below expectations. Aim: To explore clinician attitudes, beliefs, barriers, and enablers influencing referrals to a virtual hospital for acute care. Methods: A qualitative exploratory study was conducted using semi-structured interviews with nine clinicians who had experience referring patients to the virtual hospital. Data were analysed thematically using a grounded theory approach. Results: Four key themes emerged: (1) Complexity of the healthcare ecosystem leading to duplication and navigation challenges; (2) Ambiguity in patient selection criteria causing uncertainty in referrals; (3) Higher social complexity and non-medical care needs acting as barriers; (4) Interoperability issues and the need for effective change management. Conclusions: Addressing the identified barriers through refining referral pathways, clarifying eligibility criteria, enhancing support for patients with complex needs, and improving system interoperability could increase referral rates to the virtual hospital. Engaging clinicians in the co-design of virtual care models is essential for successful implementation.

Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care.

The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients. The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent). In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40). Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial.

The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. From 10/25/2018 to 03/29/2019, and 10/01/2019 to 11/15/2019, all adults (≥18 years of age) admitted for acute inpatient psychiatric care in Trondheim, Norway, were randomly allocated to a ward with a blue-depleted evening light environment or a ward with a standard light environment. Baseline and outcome data for individuals who provided deferred informed consent were used. The primary outcome measure was the mean duration of admission in days per individual. Secondary outcomes were estimated mean differences in key clinical outcomes: Improvement during admission (The Clinical Global Impressions Scale-Improvement, CGI-I) and illness severity at discharge (CGI-S), aggressive behaviour during admission (Broset Violence Checklist, BVC), violent incidents (Staff Observation Aggression Scale-Revised, SOAS-R), side effects and patient satisfaction, probabilities of suicidality, need for supervision due to suicidality, and change from involuntary to voluntary admission. The Intent to Treat sample comprised 476 individuals (mean age 37 (standard deviation (SD) 13.3); 193 (41%) were male, 283 (59%) were female). There were no differences in the mean duration of admission (7.1 days for inpatients exposed to the blue-depleted evening light environment versus 6.7 days for patients exposed to the standard evening light environment; estimated mean difference: 0.4 days (95% confidence interval (CI) [-0.9, 1.9]; p = 0.523). Inpatients exposed to the blue-depleted evening light showed higher improvement during admission (CGI-I difference 0.28 (95% CI [0.02, 0.54]; p = 0.035), Number Needed to Treat for clinically meaningful improvement (NNT): 12); lower illness severity at discharge (CGI-S difference -0.18 (95% CI [-0.34, -0.02]; p = 0.029), NNT for mild severity at discharge: 7); and lower levels of aggressive behaviour (difference in BVC predicted serious events per 100 days: -2.98 (95% CI [-4.98, -0.99]; p = 0.003), NNT: 9). There were no differences in other secondary outcomes. The nature of this study meant it was impossible to blind patients or clinical staff to the lighting condition. Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff. Clinicaltrials.gov NCT03788993; 2018 (CRISTIN ID 602154).

Examining the potential of an internet-based emotion regulation intervention added to acute psychiatric inpatient care: results from a randomized controlled pilot trial.

The feasibility and the preliminary effectiveness of an internet-based emotion regulation intervention added to acute psychiatric inpatient care were assessed with a randomized controlled pilot trial. Sixty patients were allocated in a 1:1 ratio to the intervention group or treatment as usual (TAU). Feasibility was evaluated via patient satisfaction, system usability, and program usage. The primary outcome was symptom severity (Brief-Syptom-Inventory-18-GSI), secondary outcomes included two emotion regulation measures. Assessments occurred at baseline, after four weeks (T1), eight weeks (T2), and patient discharge. Satisfaction scores (CSQ-8: M = 2.97, SD = 0.64) and usability ratings (SUS: M = 69.89, SD = 10.34) were positive. Program usage was low, with only 12 of 30 patients completing at least 50 % of the program. In the ITT-analysis, no significant group-by-time interaction effects were found for symptom severity or emotion regulation. Descriptively, effect sizes favored the intervention for symptom severity at T1 (d = 0.16) and T2 (d = 0.12) and favored TAU for the emotion regulation parameters at both time points. Thus, while the internet-based program showed good usability and satisfaction, it did not significantly impact symptom severity or emotion regulation. Future research should examine how to enhance program use in this treatment context.

Improving Mobility in Acute Care Patients with a Mobility Technician: A Quality Improvement Pilot Project

Improving Mobility in Acute Care Patients with a Mobility Technician: A Quality Improvement Pilot Project

Effects of early exposure to palliative care on end-of-life outcomes in patients with cancer in a community setting

ObjectiveAlthough prior studies show that exposure to early outpatient palliative care (OPC) versus no exposure is associated with improved outcomes at the end of life (EoL) for patients with cancer,...

Концепция периоперационного риска: обзор литературы

INTRODUCTION: Perioperative risk refers to the likelihood of adverse events occurring during and after surgery. For the purpose of defining and classifying adverse events and predicting them, a comprehensive search of Pubmed and Lens.org was made according to the author expert opinion. OBSERVATIONS: Traditionally, two main types of postoperative adverse events have been investigated: complications and mortality. However, over the past decade, there has been a growing trend to expand the range of adverse events analyzed, from intraoperative critical events and the quality of recovery from anesthesia to the development of intensive care syndrome, assessing quality of life, disability, and survival over time. An important aspect associated with adverse events and outcomes is the provision of additional resources for a long-term stay for patients with acute respiratory viral infections and inpatient care after discharge, among other things. The review formulates its own concept of perioperative risk, based on a critical analysis of literature, with an emphasis on the need to create an ideal tool, such as a calculator, that must undergo external validation. This tool should include available, modifiable variables, and accurately determine the full range of adverse events and outcomes during the intra- and early postoperative periods, as well as delayed events. The concept shall also focus on identifying and characterizing patients with a high risk of perioperative complications.

Abstract Su603: Out-of-hospital cardiac arrest presenting with ST-segment elevation myocardial infarction: Real world assessment and treatment

Background: Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described. Objectives: This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice. Methods: We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis. Results: A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy. Conclusion: This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.