Admission Rate Of Patients Research Articles

THE INVISIBLE CRY OF NON-COVID-19 PATIENTS DURING COVID-19 PANDEMIC: THE NEGLECTED MANY

While the novel coronavirus has changed the face of the society and affected healthcare system immensely, non-COVID-19 patients tend to suffer the most. After 6 months of different phases of lockdown, patients are finding it very difficult to make their way to the hospitals and out- patient departments. Routine procedures including elective surgeries are completely withheld in the public sector. Hence, an obvious upgrading of their ailments are likely to occur in the near future. The pandemic has posed great challenges to those who used to travel miles to receive health care services in distant cities. It has also reduced the admission rate of patients to emergency departments. India, experiencing the highest surge of cases in the present time, is likely to suffer the brunt of this deadly war. With fast depletion of resources, non-COVID-19 patients are left with nothing but a blind fate that will leave them ruined by the time corona gets cured from the society.

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning.

Background: Widespread quick access to mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is one of the main challenges in stroke care. It is unclear if newly established MT units are required 24 h/7 d. We explored the diurnal admission rate of patients with AIS potentially eligible for MT to provide a basis for discussion of daytime-adapted stroke care concepts.Methods: Data collected from the Baden-Württemberg Stroke Registry in Germany were assessed (2008–2012). We analyzed the admission rate of patients with AIS stratified by the National Institutes of Health Stroke Scale (NIHSS) score at admission in 3-h intervals. An NIHSS score ≥10 was considered a predictor of large vessel occlusion. The average annual admission number of patients with severe AIS were stratified by stroke service level and calculated for a three-shift model and working/non-working hours.Results: Of 91,864, 22,527 (21%) presented with an NIHSS score ≥10. The average admission rates per year for a hospital without Stroke Unit (SU), with a local SU, with a regional SU and a stroke center were 8, 52, 90 and 178, respectively. Approximately 61% were admitted during working hours, 54% in the early shift, 36% in the late shift and 10% in the night shift.Conclusions: A two-shift model, excluding the night shift, would cover 90% of the patients with severe AIS. A model with coverage during working hours would miss ~40% of the patients with severe AIS. To achieve a quick and area-wide MT, it seems preferable for newly implemented MT-units to offer MT in a two-shift model at a minimum.

Seventy-two-hour Return Initiative: Improving Emergency Department Discharge to Decrease Returns.

Introduction:Unscheduled return visits within 72 hours of discharge account for 4% of pediatric emergency department (ED) visits each year and are a quality indicator of ED care. This project aimed to reduce the unexpected 72-hour return visit rate for a network of ED and urgent cares (UC) by improving discharge processes.Methods:A multidisciplinary team conducted a quality improvement initiative in the EDs/UCs of a tertiary children’s hospital network. The team developed discharge interventions through successive Plan-Do-Study-Act cycles. They included standardization of the electronic health record discharge workflow and implementation of “mini-after care instructions” and teach-back education. The team used a statistical process control chart to follow the 72-hour return rate, and a chi-square test to compare the pre- and post-intervention 72-hour return rate.Results:The ED/UC network discharged 219,196 patients during the study, 12/2014–4/2016. The baseline 72-hour return rate was 3.5% before interventions. The team implemented discharge interventions from 12/14 to 9/15. After the implementation of mini-after care instructions (4/15), 8 consecutive points fell below the mean on the statistical process control chart, and there was an 8.2% reduction in the 72-hour return rate (P < 0.01). Admission rates of 72-hour return patients remained stable throughout the study (27% pre-intervention and 28% post-intervention). Improvements to the ED/UC discharge process resulted in the estimated prevention of 600 ED/UC visits annually throughout the network.Conclusions:Quality improvement methodology and multidisciplinary enhancement of discharge processes significantly decreased 72-hour return rates across a network of pediatric EDs and UCs.

Effects of National Hospital Accreditation in Acute Coronary Syndrome on In-Hospital Mortality and Clinical Outcomes.

Acute coronary syndrome (ACS) is a life-threatening medical condition that accounts for an annual expenditure of more than $300 billion in the United States. Hospital accreditation has been shown to improve patient and hospital outcomes for various conditions. This study aimed to determine the benefits of hospital accreditation in patients with ACS. This nationwide population-based cohort study used Taiwan's National Health Insurance Research Database from 1997 to 2011 (n = 249,354). Multivariable logistic regression was used to analyze the risk of in-hospital events among those treated in accredited and non-accredited hospitals, and to compare outcomes in hospitals before and after accreditation. The effect of accreditation on these events was also stratified by accreditation grade. A total of 823 hospitals were included, of which 2.4% were medical centers, 13.7% were regional hospitals, and 83.8% were district hospitals. The in-hospital mortality [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.79-0.85; p < 0.001] and recurrent acute myocardial infarction (AMI) admission (OR, 0.81; 95% CI, 0.71-0.93; p = 0.003) rates were significantly lower in the after-accreditation group than in the before-accreditation group. There was a substantial and marked decrease in the in-hospital mortality rate after accreditation in 2008. This cohort study demonstrated that ACS accreditation was associated with better in-hospital mortality and recurrent AMI admission rates in ACS patients.

Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness.

Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Pre- and post-cohort study. Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4-24.0] days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data

BackgroundTo estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia.MethodsThe centers for Medicare & Medicaid Services (CMS) Integrated Data Repository, including the Medicare beneficiary enrollment database, was accessed in June 2015, February 2017, and February 2018. We evaluated patterns of delay in Medicare claims accrual, and used incomplete, non-final claims data to develop and validate models for real-time estimation of admissions, readmissions, and observation stays.ResultsThese real-time reporting models accurately estimate, within 2 months from admission, the monthly numbers of admissions, 30-day readmission and observation-stay rates for patients with AMI, HF, or pneumonia.ConclusionsThis work will allow CMS to track the impact of policy decisions in real time and enable hospitals to better monitor their performance nationally.

Comparison of admission rates among patients treated by male and female emergency physicians: a multicenter study

BackgroundNo study to date has looked at the gender of emergency medicine (EM) physicians in the United States in relation to admission rates. This study seeks to investigate admission rates of adult patients treated by female vs male EM physicians, to identify whether a practice pattern bias exists.MethodsThis was a multicenter retrospective study of four community hospitals. Population: All patient encounters between July 1, 2016 and June 30, 2017. Outcome: We compared multiple benchmarks, including admission rates, patient acuity, length of stay, return visits, patient age, and years of practice using descriptive statistics and Pearson Correlation Coefficients.Results171,762 encounters by 71 EM physicians; 29 females, 42 males. Average admission rates: female 30.1%, male 28.0%, p = .188. Average encounters: female 2456, male 2394, p = 0.77. Acuity: female 149.3, male 146.9, p = .227. Average length of stay (minutes): female 294.4, male 277.4, p = .137. Average patient age: female 50.9, male 50.2, p = .457. Median time of encounter: female 12.8, male 12.7, p = .964. Years of practice: female 16.2, male 19.1, p = .274. Average return visits per one thousand: female 8.5, male 8.5, p = .864. Secondary analysis of Pearson Correlation Coefficient of Significance; admission rate and length of stay: female 0.53, p = .0026; male 0.76, p < .0001. Admission rate and acuity: female 0.56, p = .0012; male 0.76, p < .0001. Admission rate and patient age: female 0.54, p = 0.0018; male 0.50, p = 0.0003.ConclusionNo statistically significant difference exists between the admission rates of male and female emergency medicine physicians. The admission rate in both groups had the highest correlation with patients’ age, acuity, and length of stay.

Association of availability of tap water system with admission rate after 30 days among burn injury patients: A nationwide population-based study

BackgroundWe investigated whether the availability of a tap water supply system is associated with lowering the admission rate 30 days after burn injury. MethodsWe analysed data from the Longitudinal Health Insurance Database 2000 from the National Health Research Institutes. It contains a random sample of 1,000,000 subjects out of 22 million beneficiaries of the National Health Insurance of Taiwan from 1996 to 2010. The included patients were diagnosed twice with burn injuries in local medical departments. The odds ratios and 95% confidence intervals were estimated by logistic regression model to evaluate the correlations of baseline characteristics and comorbidities. ResultsA total of 5,996 patients were identified after 1:1 propensity score matching. They had similar basic characteristics. Ultimately, 96 patients in the case cohort (1.10 per 1,000 person-years) and 58 patients in the control cohort (0.66 per 1,000 person-years) were admitted 30 days after a burn injury (adjusted hazard ratio 1.67, 95% confidence interval 1.21–2.32). A lower incidence of admission because of burn injury was found in the control cohort (log-rank test, p = 0.019). The advantageous effect of a well-equipped tap water system on a lower admission rate in burn patients was independent of comorbidities. ConclusionsThe results of this study demonstrated the association between lowering the admission rate at 30 days in burn patients in Taiwan and using a well-equipped tap water system. It also could offer important information to the government for enhancing the availability of tap water system in those areas lack adequate tap water supply which is useful to protect burn patients from following admission.

Analysis of emergency department visits for all reasons by adults with depression in the United States

BackgroundWe aimed to characterize Emergency Department (ED) utilization and outcomes of patients with depression seeking emergency care for all reasons.MethodsUsing 2014–2016 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with depression versus those without depression.ResultsApproximately 10,626,184 (11.4%) out of 92,899,685 annual ED visits were by patients with depression. ED patients with depression were mostly non-Hispanic White (74.0%) and were less likely to be male than patients without depression (aOR: 0.62; [95%] CI: 0.57–0.68). ED patients with depression were more likely to be admitted to the hospital (aOR: 1.50; CI: 1.38–1.63) than patients without depression. Among ED patients with depression, males were more likely than females to be seeking emergency care for psychiatric reasons (OR: 2.45; 95% CI: 2.10–2.87)) and to present with overdose/poisoning (OR: 1.46; CI: 1.03–2.05).ConclusionsWe described the unique demographic, socioeconomic, and clinical characteristics of ED patients with depression, using the most comprehensive, nationally representative study to date. We revealed notable gender disparities in rates and reasons for admissions. The higher hospital and ICU admission rates of ED patients with depression suggests this population requires a higher level of emergency care, for reasons that remain poorly understood.

Trends and seasonal variation of hospitalization and mortality of interstitial lung disease in the United States from 2006 to 2016

BackgroundIn the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016.MethodFrom the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition. Subgroups of idiopathic interstitial fibrosis (IPF), acute respiratory failure (ARF), pneumonia were analyzed.ResultsFrom 2006 to 2016, all-cause hospital admission rate of patients with interstitial lung disease (ILD) and IPF-only subgroup declined but their overall mortality remained unchanged (except IPF subgroup and acute respiratory failure subgroup). Acute respiratory failure related admission account for 23% of all causes and pneumonia 17.6%. Mortality of ILD in general and subgroup of ILD with ARF was highest in winter, up to 8.13% ± 0.60 and 26.3% ± 10.2% respectively. The seasonal variations of hospital admission and mortality of ILD in general was not changed when infectious pneumonia cases were ruled out. All cause admission rates were highest in months from January to April. Subgroup analysis also showed seasonal variations with highest hospitalization rates for all subgroups (IPF, ARF, pneumonia) in the months from December to April (winter to early Spring).ConclusionFrom 2006 to 2016, admission rates of ILD of all causes and IPF subgroup declined but in-hospital mortality of ILD of all causes remained unchanged. Mortality of IPF subgroup and acute respiratory failure subgroup trended down. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospitalization rates for all subgroups (IPF, ARF, pneumonia) were highest in the months from December to April.

Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea

ObjectiveWe aimed to analyze the differences in epidemiological aspects and clinical courses of acute poisonings in each region of the Gyeonggi-do province in Korea.MethodsThis retrospective study analyzed data from the National Emergency Department Information System of Korea. We retrospectively reviewed cases of acute poisonings between April 2006 and March 2015 recorded at 13 emergency departments in eight different cities of Gyeonggi-do province in Korea. The differences in the incidence, age distribution, causative agent, and clinical course of poisonings among regions were the main outcomes measured.ResultsThe proportion of poisonings in the ≤9 age group was high in Yongin (17.44%) and that in ≥65 age group was high in Gwangmyeong (21.76%). The proportion of cases involving carbon monoxide was high in Ansan (8.82%) in patients hospitalized and the proportion of cases involving pesticides was high in Pyeongtaek (52.78%) in patients admitted to the intensive care unit. The admission rate of poisoned patients was high in Osan (36.02%).ConclusionIn this study, differences in the characteristics of poisoned patients between 8 cities were noted. Therefore, hospitals need to arrange treatment resources for poisoned patients according to the characteristics of the specific region. The results of this study may serve as evidence for new strategies to prepare for the acute poisonings in hospitals.

313 The Effect of Maintenance Phosphate Binder Use On Hospital Admission Rate For Patients With In-Range Serum Phosphorus

313 The Effect of Maintenance Phosphate Binder Use On Hospital Admission Rate For Patients With In-Range Serum Phosphorus

REGIONAL VARIATION IN INCIDENCE AND OUTCOMES OF PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME: INSIGHT FROM THE NATIONAL INPATIENT SAMPLE

There is limited information about variations in admission rate and outcomes in patients admitted with Acute coronary syndrome(ACS). Our study seeks to explore this gap; its importance in clinical and resource planning cannot be overemphasized. Using the National inpatient sample(NIS), we tested

Annual rates of and factors influencing inpatient and outpatient transient ischaemic attacks in Chinese population: a nationally representative cross-sectional survey

ObjectivesTo investigate the rates and influencing factors of transient ischaemic attack (TIA) inpatient admissions and outpatient visits in China.SettingA door-to-door survey of 178 059 families from 155 urban and rural...

The alcohol detoxification protocol and creation of the e-consult at Central Texas Veterans health care system

Within the Central Texas Veterans Health Care System, the alcohol-related disorder readmission rate has been recognized as an area that needs improvement. The aim of this quality improvement initiative was to develop an alcohol detoxification protocol. This protocol assesses the need for inpatient vs outpatient management of alcohol withdrawal and provides guidance pertaining to medication options, with emphasis on prescribing gabapentin for treatment of alcohol withdrawal. The protocol also contains the alcohol detox e-consult, which prompts a physician to call the patient daily to assess alcohol withdrawal, ability to abstain from alcohol, medication compliance, interest in substance abuse treatment programs, and appropriate follow-up. After implementing the protocol and e-consult, we saw a reduction in the admission rate of alcohol-related disorders and patients found the consult helpful.

Enterovirus, parechovirus, adenovirus and herpes virus type 6 viraemia in fever without source

ObjectivesTo evaluate the potential associations between fever without a source (FWS) in children and detection of human enterovirus (HEV), human parechovirus (HPeV), adenovirus (AdV) and human herpesvirus type 6 (HHV-6)...

Predictors of Emergency Room Admission in Patients With Liver Cirrhosis: A Prospective, Descriptive Study.

This study aimed to identify the predictors of emergency room (ER) admission in patients with liver cirrhosis. The data of 215 patients with liver cirrhosis who visited the ER were collected from January 1 to March 15, 2017, at Yeungnam hospital in Daegu city, South Korea. Measurement scales were designed on the basis of the liver function test and evaluation of anxiety and depression, self-care, and family support. Diseases that cause liver cirrhosis, their associated characteristics, and respective hematologic examination results were reviewed from the hospital's electronic medical records. Among the 215 patients with liver cirrhosis who visited the ER, 47 (21.9%) had previous ER admissions, whereas 168 (78.1%) had none. Fifteen predictive factors that were significantly different between the ER admission and non-ER admission groups were included as variables in logistic regression analysis. This analysis revealed that the 3 significant predictors of ER admission in patients with liver cirrhosis were number of prior complications, serum bilirubin level, and self-care compliance. An increased number of prior complications, increased bilirubin level, and low self-care compliance increased the ER admission rates in patients with liver cirrhosis. Thus, further studies are necessary to measure the effects of nursing intervention strategies based on these findings.

Impact of lockdown on non-COVID-19 patients

Background: Severe acute respiratory syndrome coronavirus 2 pandemic gripped many nations and lockdowns were declared to limit its spread. During those harrowing lockdown times what happened to non-COVID patients has not been answered yet. Objectives: In the present study, the authors have tried to study the impact of lockdown on the non-COVID patients. Materials and Methods: It was a retrospective study conducted in a tertiary care institute. The impact of lockdown (March 24, 2020–May 31, 2020) on number of patients visiting outpatient department (OPD), admission, and deaths of non-COVID patients due to medical causes in wards of internal medicine and emergency was studied and compared with the corresponding period in 2019 (March 24, 2019–May 31, 2019). Results: OPD numbers plummeted from 14,050 in 2019 to just 3916 during lockdown a reduction of 258.78%. The total admissions appreciated from 887 in 2019 to 959 during lockdown 2020 an increase of 8.11%. The rate of admission substantially surged from 6.31% in 2019 to 24.48% in lockdown. Death rate witnessed a marginal increase from 2.36% in 2019 to 3.64% during lockdown. Mortality from renal causes increased substantially from two cases in 2019 to 10 in lockdown an increase of 400%. Conclusion: The research points out that during lockdown times OPD numbers plummeted significantly and admission rate of non-COVID patients showed an upward trend. A slight insignificant increase of in hospital mortality rate of non-COVID patients was also noted. These observations point out that non-COVID patients received due medical care during lockdown 2020.

Prediction of adverse outcomes using non-endoscopic scoring systems in patients over 80 years of age who present with the upper gastrointestinal bleeding in the emergency department.

The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed. The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145). The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.

Comparison of inpatient admission rates of patients treated with apixaban vs. warfarin for venous thromboembolism in the emergency department

ABSTRACTObjectives: This study evaluated inpatient admission status, hospitalization length of stay (LOS), hospital costs, and readmissions of patients who were diagnosed with venous thromboembolism (VTE) and treated with apixaban or warfarin in the emergency department (ED).Methods: Patients (≥18 years) with an ED visit with a primary discharge diagnosis code of VTE were identified from the Premier Hospital database (8/1/2014-5/31/2018). Patients who received apixaban or warfarin during the ED visit were selected and grouped into two treatment cohorts. Outcomes of ED disposition (discharged or admitted to the inpatient setting), hospital LOS, hospital cost of index event, and rate of 1-month readmissions were compared for the study cohorts.Results: Of the overall study population, 30.5% (n = 12,174; mean age: 59.7 years) received apixaban and 69.5% (n = 27,767; mean age: 59.3 years) received warfarin for VTE in the ED. After adjusting for patient and hospital characteristics, the regression analysis showed that apixaban was associated with a significantly lower likelihood of admission to the inpatient setting vs. warfarin (Odds Ratio [OR]: 0.12, 95% Confidence Interval [CI]: 0.12 to 0.13; p < 0.001). Correspondingly, mean index hospital LOS was 1.42 days shorter (95% CI: −1.47 to −1.36; p < 0.001) and mean index event hospital cost per patient was significantly lower by $4,276 ($3,732 [95% CI: $3,565 to $3,907] vs. $8,008 [95% CI: $7,676 to $8,355]; p < 0.001). Also, the likelihood of all-cause 1-month readmission was significantly lower for patients treated with apixaban vs. warfarin (OR: 0.85, 95% CI: 0.79 to 0.92; p < 0.001).Conclusions: In the real-world setting, VTE patients with an ED visit who were treated with apixaban vs. warfarin had a lower likelihood of being admitted to the inpatient setting, which was reflected in shorter average LOS and lower average index event cost. Additionally, the risk of 1-month readmission was also lower for patients treated with apixaban vs. warfarin.