Acute Care Medical Units Research Articles

Efficacy of an Aspiration Prevention Program That Utilizes the Gugging Swallowing Screen in Older Patients.

Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001). The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.

Still WALKing-FOR: 2-year sustainability of the ‘WALK FOR’ intervention

Abstract Background low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. Methods a quasi-experimental three-group comparative design (N = 366): pre-implementation, i.e. control group (n = 150), immediate post-implementation (n = 144) and 2-year post-implementation (n = 72). Results mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F = 15.778 P < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F = 16.250, P < 0.01. Conclusions the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation.

Nurse-led implementation of awake prone positioning.

This article discusses the pathophysiology of COVID-19 acute respiratory distress syndrome (ARDS), the evidence supporting the use of awake prone positioning (APP) for adult patients with COVID-19 ARDS cared for in acute care medical units, and a quality improvement initiative to support a standardized APP process on a COVID-19 medical unit.

A STUDY ON FASTING LIPID PROFILE IN NONADIABETIC STROKE PATIENTS

Objectives: To study serum fasting lipid profile in patients with acute ischaemic stroke & to determine the significant correlation between them. To assess the role of aggressive control of dyslipidemia on recovery of stroke. Design: Prospective study. Setting: Patients admitted with Ischemic stroke into the Acute Medical Care Unit and Medical Wards in the department of General Medicine, SAIMS Hospital Indore, from December 2019 to November 2021, were taken for the study. Patients were subjected to a Fasting lipid profile at presentation and followed- up at 12 weeks and rechecked the fasting lipid profile and correlated with the recovery of stroke. Participants: A total of 50 Ischaemic stroke patients- 33 males and 17 females, participated. All subjects were above 50 years. Patients with suspected emboli of cardiac origin, haemorrhagic stroke, diabetes and h/o of head injury/usage of anticoagulant drugs were excluded from the study. None of the patients was on diet (or) other modifications to lower plasma lipid levels. Results: S.T.C was abnormal in 11 patients at onset and 8 pts after three months of statin therapy. TG was abnormal in 34 patients at the beginning and 35 pts after three months of treatment. LDL was abnormal in 32 patients at the beginning and 20 pts after three months of statin therapy. HDL was abnormal in 38 patients at onset and 35 pts after three months of treatment. VLDL was abnormal in 34 pts at the beginning & 35 pts after three months of statin therapy. After three months, the MRS score of most of the patients was 0 -1(21 pts), followed by a score of 0 (15 pts). Correlation between mNIHSS score and lipid profile showed a significant clinical improvement with reduction in the LDL levels & the corresponding p- value is .000, which is highly effective. Correlation between MRS score and lipid profile showed a good clinical outcome with a reduction in LDL levels & the corresponding p-value is 0.26, which is substantial. Conclusion: This study shows that higher levels of S.T.C, TG, LDL, VLDL is not the only significant risk factor for the occurrence of ischaemic CVD. A decrease in LDL levels shows significant improvement in clinical outcomes.

One more wall to cross: The role of psychologists in addressing integrated health among undocumented Latinx immigrants in inpatient medical settings.

Over the past decade, there has been increased attention to the benefits of an integrated health-care care model in which psychologists play a vital role collaborating with other health providers to deliver services in inpatient medical settings, such as emergency departments and acute care medical units. Psychologists working in inpatient medical settings can facilitate access to mental health services and referrals, reduce mental health stigma, improve health outcomes associated with insight into psychosocial factors that affect health and illness, improve communication between patients and providers, and increase sensitivity in addressing the health needs of diverse patients. Psychological services in inpatient medical units can be particularly valuable for marginalized populations, such as undocumented Latinx immigrants, who may not otherwise have access to services that can address the compounded effect that psychosocial stressors may have on their physical health. We illustrate the critical role that psychologists can play in inpatient medical settings to address the complex health needs of Latinx immigrants. In this case study, an undocumented young woman presented to an emergency department with acute liver failure. We focus on psychologists' specific contributions as part of the integrated medical team and how it may have impacted treatment effectiveness. We also provide practical assessment and treatment recommendations, along with proposing advocacy efforts to facilitate access to culture and context sensitive treatments for undocumented immigrants with complex health issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A STUDY ON FASTING LIPID PROFILE IN NON-DIABETIC STROKE PATIENTS

Objectives: To study serum fasting lipid profile in patients with acute ischaemic stroke & to determine the significant correlation between them. To assess the role of aggressive control of dyslipidemia on recovery of stroke. Setting: Patients admitted with Ischemic stroke into the Acute Medical Care Unit and Medical Wards in the department of General Medicine, SAIMS Medical Indore, from December 2019 to November 2021, were taken for the study. Patients were subjected to a Fasting lipid profile at presentation and followed– up at 12 weeks and rechecked the fasting lipid profile and correlated with the recovery of stroke. Participants: A total of 50 Ischaemic stroke patients- 33 males and 17 females, participated. All subjects were above 50 years. Patients with suspected emboli of cardiac origin, haemorrhagic stroke, diabetes and h/o of head injury/usage of anticoagulant drugs were excluded from the study. None of the patients was on diet (or) other modifications to lower plasma lipid levels. Results: S.T.C was abnormal in 11 patients at onset and 8 pts after three months of statin therapy. TG was abnormal in 34 patients at the beginning and 35 pts after three months of treatment. LDL was abnormal in 32 patients at the beginning and 20 pts after three months of statin therapy. HDL was abnormal in 38 patients at onset and 35 pts after three months of treatment. VLDL was abnormal in 34 pts at the beginning & 35 pts after three months of statin therapy. After three months, the MRS score of most of the patients was 0 -1(21 pts), followed by a score of 0 (15 pts). Correlation between mNIHSS score and lipid profile showed a significant clinical improvement with reduction in the LDL levels & the corresponding p- value is .000, which is highly effective. Correlation between MRS score and lipid profile showed a good clinical outcome with a reduction in LDL levels & the corresponding p-value is 0.26, which is substantial. Conclusion: This study shows that higher levels of S.T.C, TG, LDL, VLDL is not the only significant risk factor for the occurrence of ischaemic CVD. A decrease in LDL levels shows significant improvement in clinical outcomes.

Differences in the Incidence of Adverse Events in Acute Care Hospitals: Results of a Multicentre Study.

Background: Adverse events are indicators of patient safety and quality of care. Adverse events clearly have negative impacts on healthcare system costs. Organizational and unit characteristics are not very often studied in relation to adverse events. The aim of the study was to find the differences in the incidence of adverse events and healthcare-associated infections in hospitalized patients in Czech acute care hospitals according to type of hospital and type of unit. Methods: This cross-sectional multicentre study was conducted in 105 acute care medical and surgical units located in 14 acute care hospitals throughout the Czech Republic. The data on adverse events and healthcare-associated infections were reported monthly by nurse researchers. The data were collected from June 2020 to October 2020. Results: The incidence of healthcare-associated infections, pressure ulcers, and medication errors was significantly lower in large hospitals. Statistically significant differences have been further found between the incidence of pressure ulcers (<0.001), falls without injury (<0.001), and falls with injury (<0.001) in surgical and medical units. More pressure ulcers, falls without injury, and falls with injury have been reported in surgical units. Conclusion: The type of hospital and type of unit affected the incidence of adverse events at acute care hospitals. To reduce adverse events, a systematic adverse event measurement and reporting system should be promoted.

Comprehensive evaluation of using computerised provider order-entry system for hospital discharge orders

BackgroundComputerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes. ObjectivesTo evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit. SettingA prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated. ResultsA total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage. ConclusionThis study highlights that most HDO were edited via the CPOE system. Together with pharmacist’s interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital’s Electronic Health Records. Providing regular training for physicians is also a requirement.

Discussion Guide for the Sinvani Article

Discussion Guide for the Sinvani Article

Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit.

Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare.

Patterns and outcomes of admissions to the medical acute care unit of a tertiary teaching hospital in South Africa.

BackgroundA Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. Improved healthcare delivery systems at the MACU may result in shorter hospital stays, better outcomes, and less mortality.ObjectivesThe study's objective was to describe the demographics, diagnoses, disease patterns, and outcomes, including patient's mortality, admitted to the MACU at CHBAH.MethodsRecords of 200 patients admitted, between March 2015 to August 2015, to the MACU at CHBAH were reviewed. Patient demographics, diagnosis at admission, duration of stay, and outcomes were documented. Patients transferred to the medical ward, the Intensive Care Unit (ICU), or discharge. The leading causes of mortality were documented.ResultsOf the 200 patients, 59% were females. The patients' mean age was 46 (17.2) years, and the mean duration of stay at the MACU was 1.45 (1.25) days. Non-communicable diseases accounted for 76% of admissions. The most frequently diagnosed conditions included: diabetic ketoacidosis acidosis (DKA) and hyperosmolar non-ketotic (HONK) (17.5%), non-accidental self-poisoning (16%), hypertensive emergencies (9.5%), decompensated cardiac failure (8%) and ischemic heart disease (7%). Infectious diseases comprised 14% of the diagnoses, of which cases of pneumonia were the most common (5%). Most patients (77.5%) were transferred to medical wards, 12% to ICU, while 10% demised at the MACU. The leading causes of death included sepsis (25%), DKA/HONK (20%), non-accidental self-poisoning (10%), and cardiac failure (10%).ConclusionNon-communicable diseases, particularly diabetic emergencies, were the leading causes of admission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The leading cause of mortality was sepsis related.

Clinician Perspectives on Caring for Dying Patients During the Pandemic : A Mixed-Methods Study.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff. To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic. Mixed-methods embedded study. (ClinicalTrials.gov: NCT04602520). 3 acute care medical units in a tertiary care hospital from 16 March to 1 July 2020. 45 dying patients, 45 family members, and 45 clinicians. During the pandemic, clinicians continued an existing practice of collating personal information about dying patients and "what matters most," eliciting wishes, and implementing acts of compassion. Themes from semistructured clinician interviews that were summarized with representative quotations. Many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and personal protective equipment, with attendant practical and psychological consequences. During hospitalization, family visits inside or outside the patient's room were possible for 36 patients (80.0%); 13 patients (28.9%) had virtual visits with a relative or friend. At the time of death, 20 patients (44.4%) had a family member at the bedside. Clinicians endeavored to prevent unmarked deaths by adopting advocacy roles to "fill the gap" of absent family and by initiating new and established ways to connect patients and relatives. Absence of clinician symptom or wellness metrics; a single-center design. Clinicians expressed their humanity through several intentional practices to preserve personalized, compassionate end-of-life care for dying hospitalized patients during the SARS-CoV-2 pandemic. Canadian Institutes of Health Research and Canadian Critical Care Trials Group Research Coordinator Fund.

Maintaining Safety Standards While Building an Urban Alternate Care Facility in a Global Pandemic.

The Philadelphia region responded to the shortage of health care resources imposed by the 2020 COVID-19 pandemic through the creation of the COVID-19 Surge Facility at Temple University's basketball arena. The facility was designed as an acute care medical unit capable of supporting COVID-19 patients who were stable enough to be released from the intensive care unit but not ready for discharge home. Safety was optimized through the application of recommendations from the Joint Commission and Centers for Disease Control and Prevention (CDC). The safety goals include those established by the Joint Commission with regard to patient identification, security, identification of patient safety threats, communication, fire safety, laboratory services, and pharmacologic services. COVID-19-specific goals outlined by the CDC also are addressed and include recommendations for facility layout, managing staff respite and personal protective equipment, patient care areas, supply storage, airflow, and patient hygiene. Although the goal was to meet all of these recommendations, some were not possible due to the austere environment of the arena. However, these shortcomings were met with innovative solutions that provided the next best options. By sharing these experiences, the authors hope to guide future alternate care facilities in their efforts to optimize safety.

Exploring acute care nurses' decision-making in psychotropic PRN use in hospitalised people with dementia.

To understand how acute care nurses make decisions about administering "as-needed" (PRN) psychotropic medications to hospitalised people with dementia (PWD). Behavioural and psychological symptoms of dementia occur in approximately 75% of PWD admitted to acute care. Despite this, few studies provide insight into the use and prevalence of psychotropic use in acute care. A qualitative descriptive design was used to explore acute care nurses' decision-making about PRN psychotropic medication administration to PWD. Semi-structured interviews were conducted with eight nurses from three acute care medical units in a large tertiary hospital in Western Canada. Conventional content analysis was used to develop three themes that reflect nurses' decision-making related to administering PRNs to hospitalised PWD. COREQ guidelines were followed. Three themes of legitimising control, making the patient fit and future telling were developed. Legitimising control involved medicating undesirable behaviours to promote the nurses' perceptions of safety. Making the patient fit involved maintaining routine and order. Future telling involved pre-emptively medicating to prevent undesirable behaviours from escalating. Nurses provided little to no mention of assessing for physical causes contributing to behaviours. PRNs were seen as a reasonable alternative to physical restraints and were frequently used. Additionally, organisational and unit routines greatly influenced nurses' decision-making. These findings provide an initial understanding of how nurses make decisions to administer PRN medications to hospitalised older people and may inform prescribing practices. There were novel findings about the lack of assessment prior to PRN administration, and the nurses' collective response in decision-making. More research is needed to better understand the complexities of nurses' decision-making, to assist in the development of interventions for nursing practice.

Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa.

Continuous intravenous infusion (CII) of insulin is the preferred method of treating diabetic ketoacidosis (DKA) worldwide, especially in patients with severe DKA. There is limited evidence evaluating low-dose bolus intravenous (IV) insulin management of DKA out of the intensive care unit (ICU). To conduct an audit of patients admitted with DKA, who were managed with bolus IV insulin at the medical acute-care unit (MACU), Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 4-month period to evaluate whether this is an effective treatment modality, as well as assess patient, disease and management characteristics related to the admissions. A prospective cross-sectional cohort study was done, interviewing 69 DKA patients from 1 September to 31 December 2017, and collecting relevant biochemical results from their hospital records. The current management protocol at CHBAH was observed, i.e. insulin therapy administered hourly as 10 IU IV insulin. The time to resolution of DKA, complications and deaths were recorded. Our cohort was predominantly male (60.56%), with an average age of 36 years. All patients were successfully treated with bolus IV insulin, with an average time to resolution of 21 hours. DKA was categorised as mild (19.72%), moderate (50.7%) and severe (29.58). Most patients presented with raised inflammatory markers (64.79%) and some degree of renal impairment (&gt;60%). Complications occurred in 9 patients (12.68%); 7 of these were related to factors precipitating the DKA admission. No deaths occurred. The only factor predicting a longer time to resolution was severity, with an odds ratio of 4.89 (confidence interval 1.04 -22.84; p=0.044). Outcomes are favourable, with bolus IV insulin being used as the treatment modality in patients with mild, moderate and severe DKA at CHBAH. Further studies are needed to corroborate these results in other centres.

Reducing Medication Administration Frequency in Veteran Community Living Centers

Background: A quality improvement initiative of the Veterans Health Administration (VHA) aims to reduce frequency of medication administration to Veterans per day. Medication administration practices in our community living center (CLC) units are similar to an acute care medical unit versus a home environment. The objective of this project was to reduce medication administration frequency in order to minimize the number of interruptions to both Veterans and nurses. Methods: A retrospective chart review was conducted for Veterans residing in a pilot CLC from January through March 2018. Electronic medical records and barcode medication administration (BCMA) logs were assessed. Data collected included demographic information and medication details (eg, drug name, frequency, administration time). Data were analyzed and pharmacist recommendations were documented into an Excel document, and then discussed with the pilot CLC unit medical provider in March 2018. The primary outcomes measured were the number and type of pharmacist recommendations, percent reduction in the average number of Veteran interruptions per day, and percent reduction in the average number of medication passes by nurse per day. Results: Thirty-one Veterans were identified with a range of 4 to 31 active prescription orders. Fifty-five pharmacist recommendations were made and 31 were implemented. The average number of Veteran interruptions per day was reduced by 13.9%. The average daily number of medication passes was reduced by 16.3%. Conclusion: Both Veteran interruptions and nurse workload decreased due to the implemented pharmacist recommendations. Pharmacists will continue medication consolidation on a monthly basis and spread this project to other CLC units.

Multicomponent Interventions Reduce High‐Risk Medications for Delirium in Hospitalized Older Adults

Delirium threatens the functional independence and cognitive capacity of patients. Medications, especially those with strong anticholinergic effects, have been implicated as a preventable cause of delirium. We evaluated the effect of multicomponent interventions aimed at reducing the use of 9 target medications in hospitalized older adults at risk of delirium. This continuous quality improvement program was undertaken at a tertiary care facility and 4 community hospitals in a hospital system. We included 21, 541 hospital admissions with patients aged 70 and older on acute care medical or surgical units from the preintervention (2012) period, and 27,764 from the postintervention (2015) period. Implemented interventions include formulary and policy changes, technology-assisted medication review, age-conditional order set modifications, best practice alerts, and education. The proportion of hospital admissions with individual's receiving at least 1 target medication declined from 45.6% to 31.3% (relative reduction (RR)=31.4%) from before to after the intervention, meaning that target medication exposure was avoided in approximately 4,000 older adults. The greatest effect was observed for zolpidem (11.2% to 5.3%, RR=52.6%) and diphenhydramine (12.9% to 7.1%, RR=45%). Furthermore, the mean number of doses administered during all hospital admissions was reduced for 7 of 9 medications. Multicomponent interventions implemented in our hospital system were effective at reducing exposure to target medications in hospitalized older adults at risk of delirium. These systematic changes applied throughout the medication use process are sustained today.

Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients

ObjectiveThe objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective. DesignClinical, prospective, controlled, 1-center intervention trial with 2 parallel groups. InterventionStructured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit. Setting and ParticipantsA large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female. MeasuresThe primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up. ResultsWe undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was −3226 US dollars (95% CI: −6167 to −285). ConclusionThe results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.

Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care?

ObjectivesOur aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction.DesignTREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards.SettingThis study was conducted in the NÄL-Uddevalla county hospital in western Sweden.ParticipantsIn this follow-up to the TREEE study, 229 frail patients, aged ≥75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female.InterventionDirect admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room.MeasurementsThe primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale.ResultsThe response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed?” (p=0.003), “Are you satisfied with the information you received on your diseases and medication?” (p=0.016), and “Are you satisfied with the planning before discharge from the hospital?” (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027).ConclusionAcute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room.

Evaluation of Cost Analysis of Prescriptions in the Acute Medical Care Unit of a Teaching Hospital in Chennai

Evaluation of Cost Analysis of Prescriptions in the Acute Medical Care Unit of a Teaching Hospital in Chennai