Average Length Of Stay Research Articles

The Persistent Effects of the COVID-19 Pandemic on Total Joint Arthroplasty Changes in Practice Patterns in the United States From 2020 to 2021

BackgroundThe SARS-CoV-2 (COVID-19) pandemic has dramatically disrupted orthopaedic surgery practice patterns. This study aimed to examine differences between patients who underwent total joint arthroplasty (TJA) before the pandemic compared to 2020 and 2021. MethodsA retrospective cohort study was performed on all patients who underwent elective inpatient TJA from January 2017 to December 2021 using a national large database. Descriptive statistics were utilized to trend length of stay (LOS) and patient age. Patient demographics, discharge destinations, and rates of medical comorbidities were assessed for patients undergoing TJA in 2020 and 2021 compared to patients from prepandemic years (2017 to 2019). Overall, 1,173,366 TJAs were identified (2017 to 2019: 810,268 TJAs, average 270,089 cases/year; 2020: 175,185 TJAs; 2021: 187,627 TJAs). There was a 35.3% and 30.5% decrease in 2020 and 2021, respectively, when compared to the prepandemic annual average. ResultsAverage LOS decreased from 1.6 days in January 2020 to 0.9 days by December 2021. Same-day discharges increased from 6.2% of cases in 2019 to 30.5% in 2021. Discharge to skilled nursing facilities (SNF) reduced from 11.3% in 2017 to 2019 to 4.3% and 4.5% in 2020 and 2021, respectively. Patients ≥70 years old undergoing elective TJA decreased from 39.6% in 2017 to 2019 to 29.2% in April 2020. ConclusionIn response to the COVID-19 pandemic, same-day discharges following primary elective TJA increased markedly, the average LOS decreased, discharges to SNFs decreased, and a preferential shift toward younger patients was observed. Level of EvidenceTherapeutic Level III.

The Impact of Non-English Language Preference on Pediatric Hospital Outcomes.

To characterize the relationship between non-English language preference (NELP) and hospital outcomes including length of stay (LOS), time of discharge, emergency department return visits, readmissions, and cost for pediatric general medicine inpatients. We conducted a retrospective analysis at an urban, quaternary care, free-standing children's hospital. Patients ages 0 to 18 admitted to any general medicine service between January 1, 2017, and December 31, 2019 were included. Patients were divided into 3 language preference categories: English, Spanish, and non-Spanish NELP. Single and multifactor regression analysis was used to model differences in outcome measures by language preference adjusted for technology dependence. A total of 4820 patients met criteria. In adjusted models, the average LOS for English-speaking patients was 126 hours; LOS for patients who preferred Spanish was not significantly different, whereas LOS for patients with non-Spanish NELP was 50% longer (P < .001). English-speaking patients were discharged earliest in the day (mean 3:08 pm), with patients who preferred Spanish discharged 0.5 hours later and patients with non-Spanish NELP discharged 1.1 hours later than English-speaking patients (P < .001). Patients with NELP were found to be technology-dependent more frequently (P < .001) than the English preference group. Emergency department return visits, readmissions, and cost were not significantly different between groups. NELP was associated with longer length of stay and discharges later in the day. The most pronounced differences occurred in patients with non-Spanish NELP who also had more frequent technology dependence and more limited access to interpreters.

A preliminary evaluation of N-acetylcysteine's effects on patient adherence to treatment for cocaine use disorder.

Cocaine use disorder (CUD) is a disabling disease associated with high rates of relapse and intense cravings. Patients with CUD struggle to adhere to treatment, which contributes to relapse and frequent readmissions to residential rehab (RR) facilities. Preliminary studies suggest that N-acetylcysteine (NAC) attenuates cocaine-induced neuroplasticity and, therefore, may assist with cocaine abstinence and adherence to treatment. This retrospective cohort study obtained data from 20 RR facilities across Western New York. Eligible subjects were 18 or older, diagnosed with CUD, and were divided based on their exposure to 1200 mg NAC twice daily during RR. The primary outcome was treatment adherence measured by outpatient treatment attendance rates (OTA). Secondary outcomes included length of stay (LOS) in RR and craving severity on a 1 to 100 visual analog scale. One hundred eighty-eight (N = 188) patients were included in this investigation: NAC, n = 90; control, n = 98. NAC did not significantly impact OTA (% appointments attended), NAC 68%; control 69%, (P = .89) or craving severity NAC 34 ± 26; control 30 ± 27, (P = .38). Subjects treated with NAC had a significantly longer average LOS in RR compared with controls, NAC 86 ± 30; control 78 ± 26, (P = .04). In this study, NAC did not impact treatment adherence but was associated with a significantly longer LOS in RR for patients with CUD. Owing to limitations, these results may not be applicable to the general population. More rigorous studies examining NAC's impact on treatment adherence in CUD are warranted.

Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China

BackgroundAs the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010–2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper aims to investigate the characteristics and cost of hospitalized lung cancer patient, to examine the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and to explore the medical insurance payment method that can be conducive to controlling the cost of lung cancer.MethodThis is a 2010–2016, 7-year cross-sectional study. CHIRA data are not available to researchers after 2016. The Medical Insurance Database of CHIRA was screened using the international disease classification system to yield 28,200 inpatients diagnosed with lung cancer (ICD-10: C34, C34.0, C34.1, C34.2, C34.3, C34.8, C34.9). The study includes descriptive analysis and regression analysis based on generalized linear models (GLM).ResultsThe average patient age was 63.4 years and the average length of hospital stay (ALOS) was 14.2 day; 60.7% of patients were from tertiary hospitals; and 45% were insured by FFS. The per-diem payment had the lowest hospital expenses (RMB7496.00/US$1176.87), while CAP had the lowest OOP expenses (RMB1328.18/US$208.52). Compared with FFS hospital expenses, per-diem was 21.3% lower (95% CI = -0.265, -0.215) and case-based payment was 8.4% lower (95% CI = -0.151, -0.024). Compared with the FFS, OOP expenses, per-diem payments were 9.2% lower (95% CI = -0.130, -0.063) and CAP was 15.1% lower (95% CI = -0.151, -0.024).ConclusionFor lung cancer patients, per-diem payment generated the lowest hospital expenses, while CAP meant patients bore the lowest OOP costs. Policy makers are suggested to give priority to case-based payments to achieve a tripartite balance among medical insurers, hospitals, and insured members. We also recommend future studies comparing the disparities of various diseases for the cause of different medical insurance schemes.

Characteristics of Hospitalized Pediatric Patients with a Malnutrition Diagnosis at Riley Hospital for Children

Background: A diagnosis of malnutrition in hospitalized patients has been shown to negatively affect clinical outcomes by impairing immune responses (a subsequently increasing infection and complication rates), increasing the average length of stay in the hospital, and increasing mortality. In the past, there have been efforts to study the characteristics and prevalence of pediatric populations diagnosed with malnutrition in a hospital setting, but until 2014, no universal standards were used for malnutrition diagnosis and documentation. In 2014, The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) introduced a recommendation for standardization of identification and documentation of pediatric malnutrition. These recommendations guided a series of malnutrition awareness initiatives at Riley Hospital for Children (Riley) with a focus on increasing malnutrition documentation efficiency and integrity. Subsequently, the number of malnutrition diagnoses at Riley has increased from 2016 when the initiative started through 2021.&#x0D; Objective: The purpose of this study is to identify characteristics of patient populations diagnosed with malnutrition that may benefit from early intervention.&#x0D; Methods: Individuals with a diagnosis of malnutrition at Riley Hospital for Children (excluding Obstetric patients) from the years 2019-2021 were included in this study. Patient level data was used to study average length of stay (LOS), 30-day readmission percentage, admitting service, primary diagnosis, and demographics of this population.&#x0D; Results: Preliminary data analysis suggests there is a decreasing trend in readmission within 30 days for patients diagnosed with malnutrition. A similar trend is seen in the entire population of patients treated at Riley Hospital for Children in the same period. Of note, the entire patient population of Riley has seen a decreasing average length of stay while the patient population with a malnutrition diagnosis have seen an increasing average LOS. These observations have not been evaluated for significance at this time.

Weekend Effect on Mortality, Access to Renal Replacement Therapy, and Other Outcomes Among Patients With End-Stage Renal Disease: A Retrospective Analysis of the Nationwide Inpatient Sample.

A large body of research has been conducted on the "weekend effect," which is the reportedly increased risk of adverse outcomes for patients admitted to the hospital on weekends versus those admitted on weekdays. This effect has been researched in numerous patient populations, including sub-populations of end-stage renal disease (ESRD) patients, with varying conclusions. To assess whether differences in in-hospital mortality, access to renal replacement therapy (RRT), time to RRT, and other important outcomes exist in patients with ESRD or patients on RRT admitted on the weekend versus weekdays. A retrospective cohort study was conducted using the 2018 Nationwide Inpatient Sample.Patients were included if they were adults with a principal or secondary diagnosis of ESRD or if they were admitted with a diagnosis related to initiation, maintenance, or complications of RRT. Patients admitted between midnight Friday and midnight Sunday were classified as weekend admissions. Primary outcome measurements includedin-hospital mortality, in-hospital dialysis (peritoneal dialysis, hemodialysis, and continuous RRT), and renal transplantation (TP). Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. The study included 1,144,385 patients who satisfied the inclusion criteria. Compared with patients admitted on weekdays, patients with ESRD admitted on weekends had 8% higher adjusted odds of in-hospital mortality (OR: 1.08; 95% CI: 1.03-1.13; p = 0.002), 9% lower adjusted OR of any RRTover the weekend than on weekdays (OR: 0.91; 95% CI: 0.89-0.93; p = 0.000), lower RRT rates (within 24 hours) (adjusted OR: 0.71; 95% CI: 0.70-0.73; p = 0.000), higher odds of renal TP (adjusted OR: 1.32; 95% CI: 1.20-1.45; p = 0.000), and higher hospitalization charges (mean adjusted increase: $1451; p= 0.07). The limitations of the study include the use of retrospective data and an administrative database. Compared with weekday admissions, patients with ESRD admitted on weekends had higher odds of mortality, higher mean hospitalization charges, and higher odds of renal TP. They had lower overall RRT rates, and a longer time to first RRT. However, the average LOS was similar for both weekend and weekday admissions.

Impact of an Acquisition Advanced Practice Provider on Home Hospital Patient Volumes and Length of Stay.

In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes.

A Protocol for Reducing Intensive Care Utilization After Craniotomy: A 3-Year Assessment.

Craniotomy patients have traditionally received intensive care unit (ICU) care postoperatively. Our institution developed the "Non-Intensive CarE" (NICE) protocol to identify craniotomy patients who did not require postoperative ICU care. To determine the longitudinal impact of the NICE protocol on postoperative length of stay (LOS), ICU utilization, readmissions, and complications. In this retrospective cohort study, our institution's electronic medical record was queried to identify craniotomies before protocol deployment (May 2014-May 2018) and after deployment (May 2018-December 2021). The primary end points were average postoperative LOS and ICU utilization; secondary end points included readmissions, reoperation, and postoperative complications rate. End points were compared between pre- and postintervention cohorts. Four thousand eight hundred thirty-seven craniotomies were performed from May 2014 to December 2021 (2302 preprotocol and 2535 postprotocol). Twenty-one percent of postprotocol craniotomies were enrolled in the NICE protocol. After protocol deployment, the overall postoperative LOS decreased from 4.0 to 3.5 days ( P = .0031), which was driven by deceased postoperative LOS among protocol patients (average 2.4 days). ICU utilization decreased from 57% of patients to 42% ( P < .0001), generating ∼$760 000 in savings. Return to the ICU and complications decreased after protocol deployment. 5.8% of protocol patients had a readmission within 30 days; none could have been prevented through ICU stay. The NICE protocol is an effective, sustainable method to increase ICU bed availability and decrease costs without changing outcomes. To our knowledge, this study features the largest series of patients enrolling in an ICU utilization reduction protocol. Careful patient selection is a requirement for the success of this approach.

Differences in Characteristics and Length of Stay of Elderly Emergency Patients before and after the Outbreak of COVID-19.

(1) Background: COVID-19 has spread worldwide and affected Taiwan's medical system and people's lives. This study aimed to explore the impact of medical utilization on the characteristics and length of stay (LOS) of elderly emergency department (ED) patients before and after COVID-19; (2) Methods: We gathered ED visits from January to September 2019 (pre-pandemic group) and from January to September 2020 (pandemic group). The data analysis methods included descriptive statistics, the Pearson's chi-square test, the independent sample t-test, and binary logistic regression; (3) Results: In 2020, during COVID-19, a significant decrease in ED monthly visits occurred from January; the maximum decrease was 32% in March. The average LOS during COVID-19 was shortened, with a significant reduction in diagnoses compared with the pre-pandemic period; (4) Conclusions: The threat of COVID-19 has changed the elderly's behavior in ED visits and shortened the LOS of ED. The study's results emphasize the importance of analyzing the medical utilization of elderly ED patients and understanding the medical quality of healthcare institutions. With Taiwan's rapidly aging society, the demand for healthcare increases from time to time. The overcrowding of medical attention is often a problem. The results recommend that the overcrowding problem has the opportunity to be solved.

Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis.

An incidental durotomy (IDT) is a frequent complication of spinal surgery. The conventional management involving a period of flat bed rest is highly debatable. Indeed, there are scanty data and no consensus regarding the need or ideal duration of post-operative bed rest following IDT. To systematically evaluate the literature regarding the outcomes of mobilization within 24h and after 24h following IDT in open lumbar or thoracic surgery with respect to the length of hospital stay, minor and major complications. A systematic review of the literature using PubMed, Embase and Cochrane and dating up until September 2022 was undertaken following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. Out of 532 articles, 6 studies met the inclusion criteria (1 Level-I, 4 level-III and 1 Level-IV evidence) and were analyzed. Overall, 398 patients of mean age 59.9years were mobilized within 24h. The average length of stay (LOS) for this group was 5.7days. Thirty-four patients (8.5%) required reoperation while the rate of minor complications was 25.4%. Additionally, 265 patients of mean age 63years with IDT were mobilized after 24h. The average LOS was 7.8days. Twenty patients (7.54%) required reoperation while the rate of minor complications was 55%. Meta-analysis comparing early to late mobilization, showed a significant reduction in the risk of minor complications and shorter overall LOS due to early mobilization, but no significant difference in major complications and reoperation rates. Although early mobilization after repaired incidental dural tears in open lumbar and thoracic spinal surgery has a similar major complication/ reoperation rates compared to late mobilization, it significantly decreases the risk of minor complications and length of hospitalization.

Integrating the clinical frailty scale with emergency department triage systems for elder patients: A prospective study

BackgroundThis prospective study investigated whether integrating the Clinical Frailty Scale (CFS) with a triage system would improve triage for older adult emergency department (ED) patients. MethodsWe enrolled ED patients aged 65 years or older at 5 study sites in Taiwan between December 2020 and April 2021. All eligible patients were assigned a triage level by using the Taiwan Triage and Acuity Scale (TTAS) in accordance with usual practice. A CFS score was collected from them. The primary outcome was critical events, defined as ICU admission or in-hospital mortality. The secondary outcomes were ED medical expenditures, number of orders in the ED, and length of hospital stay (LOS). We applied a reclassification concept and integrated the CFS and TTAS to create the Triage Frailty Acuity Scale (TFAS). We compared the outcomes achieved between the TTAS and TFAS. ResultsOf 1023 screened ED patients, 890 were enrolled. The majority were assigned to TTAS level 3 (73.26%) and had CFS scores of 4 to 9 (55.96%). The primary outcomes were better predicted by the TFAS than the TTAS (area under the curve [AUC] 0.82 vs. 064). Using multivariable approach, TTAS level 1 (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.7–13.4) and CFS score (OR, 5.8; 95% CI, 1.9–17.2) were significantly associated with the primary outcomes. For older adults at the highest triage level, the TFAS was not associated with an increase in the primary outcomes compared with the TTAS; however, the TFAS was associated with a significant decrease in the number of older ED patients assigned to triage levels 3 to 5. In addition, TFAS had a longer average LOS but did not have a higher average number of orders or ED medical expenditures compared to TTAS. ConclusionsThe TFAS identified more older ED patients who had been triaged as less emergent but proceeded to need ICU admission or in-hospital death. Incorporating the CFS into triage may reduce the under-triage of older adults in the ED.

Determining the Association Between Emergency Department Crowding and Debriefing After Pediatric Trauma Resuscitations.

Debriefing in the pediatric emergency department (PED) is an invaluable tool to improve team well-being, communication, and performance. Despite evidence, surveys have reported heavy workload as a barrier to debriefing leading to missed opportunities for improvement in an already busy ED. The study aims to determine the association between the incidence of debriefing after pediatric trauma resuscitations and PED crowding. A total of 491 Trauma One activations in Riley Children's Hospital Pediatric Emergency Department that presented between April 2018 to December 2019 were included in the study. Debriefing documentations, patient demographics, time and date of presentation, mechanism of injury, injury severity score, disposition from PED, and length of stay (LOS) were collected and analyzed. The National Emergency Department Overcrowding Scale score at arrival, Average LOS, total PED census, total PED waiting room census, and rates of left without being seen were compared between groups. Of 491 Trauma One activations presented to our PED, 50 (10%) trauma evaluations had documented debriefing. The National Emergency Department Overcrowding Scale score at presentation was significantly lower in those with debriefing versus without debriefing. In addition, the PED hourly census, waiting room census, average LOS, and left without being seen were also significantly lower in the group with debriefing. In addition, trauma cases with debriefing had a higher proportion of patients with profound injuries and discharges to the morgue. Pediatric emergency department crowding is a significant barrier to debriefing after trauma resuscitations. However, profound injuries and traumatic pediatric deaths remain the strongest predictors in conducting debriefing regardless of PED crowding status.

Epidemiological/Disease and Economic Burdens of Cervical Cancer in 2010–2014: Are Younger Women at Risk?

Cervical cancer is an important factor threatening women's health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and the Potential Years of Life Loss (PYLL) and potential economic loss were calculated by the direct method to assess indirect burden. During the observation period, there were 1115 new cases and 137 deaths. The incidence rate was 14.85/100,000 person years, the mortality was 1.82/100,000 person years, and the five-year survival rate was 75.3%. The age of onset was mainly concentrated in the 30-59 age group (82.9%) and the tendency was towards younger populations. The age of onset (HR = 1.037, 95% CI = 1.024-1.051), the frequency of hospitalization services (HR = 1.085, 95% CI = 1.061-1.109), and the average length of stay (ALOS) (HR = 1.020, 95% CI = 1.005-1.051) were the related factors affecting overall survival. Among the direct economic burden, the average outpatient cost was $4314, and the average hospitalization cost was $12,007. The average outpatient and hospitalization costs within 12 months after onset were $2871 and $8963, respectively. As for indirect burden, the average Potential Years of Life Loss (PYLL) was 27.95 years, and the average potential economic loss was $95,200. The epidemiological and economic burden reported in the study was at a high level, and the onset age of cervical patients gradually became younger. The age of onset, the frequency of hospitalization services and the ALOS of cervical cancer patients should be given greater attention. Policymakers and researchers should focus on the trend of younger onset age of cervical cancer and the survival situation within 12 months after onset. Early intervention for cervical cancer patients, particularly younger women, may help reduce the burden of cervical cancer.

Health economic evaluation of an internal medicine intermediate care unit (IMC) with gastroenterological focus at a maximum care university hospital - Evaluating the Profitability of Intermediate Care (IMC) in modern University Hospital Gastroenterology

Intermediate care (IMC) units meet the complex treatment needs of patients with specific diseases and/or those requiring advanced nursing care and can help turning the occupancy management of intensive care unit (ICU) beds more efficient. Despite the exclusion of nursing staff costs from the Diagnosis-Related-Groups (DRG) reimbursement system, prolonged periods of below-average monthly revenues due to loss of complex DRGs and/or misallocation/blocking of IMC beds can lead to a fixed cost refinancing problem; this again brings to the fore the question of the profitability of an IMC unit. Thus, the aim of this work has been to evaluate the profitability of a gastroenterological IMC, as part of an interdisciplinary medical IMC (MIMC) at the University Hospital Essen, for the period 01.01.2014-31.12.2016. Retrospectively, 1015 cases of the MIMC ward of the Department of Gastroenterology and Hepatology (Med.G./MIMC; N=12 beds) were examined with regard to length of stay (LoS), admission/main diagnosis, procedures provided as well as secondary diagnoses, revenues, age, and sex (median patient age 57 years; ♂ 61%, ♀ 39%). Overall, 85% of DRG reimbursements comes from treatment cases within the top 20 base DRGs; these highlight the hepatology focus of Med.G./MIMC. The case-mix (CM) monthly average is 65; the CM index (CMI), which has significant seasonal variation (analogous to CM), monthly average is 10.891 (2014-2016). The average LoS on the Med.G./MIMC is 12.3 days, which is significantly higher than the average LoS in German hospitals (7.2 days). Concrete economic assessment of Med.G./MIMC reveals that the inpatient revenues increase from € 2.90 million to € 3.72 million (2014-2016). Thus, there is a positive development of primary revenues from € 2.98 million (2014) to € 3.56 million (2015) to € 3.81 million (2016), with largely constant expenses in the area of primary costs and of claimed secondary services. Empirically, taking into account the potential interdisciplinary synergy effects, this can be considered as an exceptionally good health economic development/outcome.

PRIMARY TOTAL HIP ARTHROPLASTIES UNDER BRAZILIAN PUBLIC HEALTH SYSTEM (2012-2021).

To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .

EFFECTIVENESS OF USING THE BED FUND AND HUMAN RESOURCES FOR PROVIDING MEDICAL CARE TO CHILDREN WITH RESPIRATORY DISEASES.

The aim: Retrospectively evaluate the effectiveness of the use of beds and human resources for the treatment of children with respiratory diseases in hospitals in the period 2008-2021. Materials and methods: We calculated indicators that characterize the efficiency of the use of bed and personnel resources: the density of beds per 10,000, the rate of hospitalized children per 10,000 (RH per 10,000), the bed occupancy rate per year (BOR), average length of stay (ALOS), full-time positions (FTP) per 100,000, number of beds per 1 FTP of doctors. Results: During 2008-2021, there was a significant decrease in the density of all types of beds. The percentage of hospitalized children for inpatient treatment decreased, BOR decreased, and ALOS decreased. The density of full-time positions of allergists increased by +23.78%, pediatricians by +4.86%, pulmonologists decreased by -13.15%. In 2021, there were 10.31 beds for 1 FTP of an allergist, 12.8 beds for 1 FTP of a pulmonologist, and 5.83 beds for 1 FTP of a pediatrician. According to the correlation matrix, it was established that the more beds there are for 1 full-time position of a pediatrician and 1 full-time position of an allergist, the longer the ALOS and the bed occupancy rate are. Conclusions: When planning staffing of health care institutions, it is necessary to mind the level of urbanization of the region, and ensure status of the general practitioner as a leading medical specialist responsible for medical care during the first meeting with the patient and his subsequent follow-up.

The Implementation of Patient Blood Management in a Tertiary Hospital: a 9-Year Retrospective Study of Blood Transfusion Practice.

To analyze the changes in clinical transfusion practice and explore the exact benefits after the implementation of patient blood management (PBM). The retrospective study included transfusion practice data from West China Hospital of Sichuan University during the years 2009 - 2018. The data of surgical patients in 2010 were taken as the baseline (pre-PBM), and the data of surgical patients from 2012 to 2018 (post-PBM) were compared with the baseline. Outcome measures were the change in transfusion practice, patient outcomes, and economic benefits pre/post-PBM. Compared with pre-PBM, the rapid growth of clinical red blood cell (RBC) consumption was curbed, the total units of red blood cells (RBCs) transfused was 65,322 units pre-PBM and was 51,880.5 units in 2011. The transfusion rate per 1,000 surgical patients post-PBM was lower, and the mean units of intraoperative transfusion and surgery transfusion represented a 50% reduction. According to the product-acquisition cost, PBM had saved 46.58 million Renminbi (RMB) in 2012 - 2018. The proportion of ambulatory surgery and interventional surgery increased, the proportion of Hb transfusion trigger was significantly lower than that in 2010, and the average length of stay (ALOS) was improved. Properly implementing a PBM program had the potential to reduce unnecessary transfusions and the related risks and costs.

Cardiac surgery intensive care unit nursing workload assessment using Nursing Activities Score

Introduction/Objective. Nursing Activities Score (NAS) is one of the most accepted and widely used scores for assessing the workload of the nursing staff in regards of qualitative and quantitative adequacy. The aim of this study was to evaluate and analyze nursing workload in the cardiac surgery intensive care unit (CSICU) using the NAS in a contemporary set of patients undergoing heart surgery. Methods. The study included 809 consecutive patients who had a major cardiac surgery in 2019 admitted to adult CSICU. Demographic data were collected from medical records [sex, age, type of treatment, length of stay (LOS), and discharge], EuroSCORE II, and NAS value. Results. The majority of patients underwent a coronary (43.1%), valvular (32.6%), and combined (24.2%) cardiac surgery procedure. The average patient LOS in CSICU was 2.5 ? 3.4 days. The average NAS value in our sample was 100.8% ? 63.1%. NAS value during the first operative day was a poor marker of the outcome in terms of mortality (C-index 0.520, 95% CI ? 0.422?0.617, p = 0.676). Significant difference was observed in terms of average NAS value between the patients submitted to coronary surgery and combined surgery (p = 0.001). NAS has been shown to be useful for assessing activity in a CSICU, confirming the optimal workload of nurses, while higher NAS values in our hospital indicate increased workload compared to similar institutions. Conclusion. NAS provided viable information regarding the care and hospitalization of patients in a CSICU. In accordance with NAS, the optimal level of nursing workload was established in our hospital settings.

Enhanced recovery after surgery reduces length of stay after colorectal surgery in a small rural hospital in Ontario.

Enhanced recovery after surgery (ERAS) programmes include pre-operative, intraoperative and post-operative clinical pathways to improve quality of patient care while reducing length of stay (LOS) and readmission. This study assessed the feasibility and outcomes of an ERAS protocol for colorectal surgery implemented over 2 years in a small, resource-challenged rural hospital. A prospective cohort study used retrospectively matched controls to assess the effect of ERAS on LOS in patients undergoing colorectal surgery in a small rural hospital in northern Ontario, Canada. ERAS patients were matched to two patients in the control group based on diagnosis, age and gender. Patients had open or laparoscopic colorectal surgeries, with those in the intervention group treated per ERAS protocol and given instructions on pre- and post-operative self-care. Most of the 47 ERAS patients recruited to the study reported adherence to ERAS protocols before surgery. Adherence to protocol was strongest for chewing gum in the days after surgery. Most patients were sitting in a chair for their afternoon meal by the 1st day and most were walking down the hallway by the 2nd day. The control group had significantly higher (P < 0.001) malignant neoplasm of the colon (C18, 69% vs. 35%) and significantly lower malignant neoplasm of the rectum (C20, 0% vs. 5%). The control group had an average ln-transformed LOS that was significantly longer (exponentiated as 1.7 days) than ERAS patients (t-test, P < 0.001). This study found that ERAS could be implemented in a small rural hospital and provided evidence for a reduced LOS of approximately 2 days.

Factors Affecting the Length of Stay in the Emergency Department in Psychiatric Emergency Patients in the COVID-19 Pandemic Context.

To reduce overcrowding in emergency departments (ED), which is a serious international problem, it is important to reduce the length of ED stay (ED LOS) of emergency patients. In particular, due to the COVID 19 pandemic, psychiatric emergency patients spent much longer in ED. This study was conducted to identify the characteristics of psychiatric emergency patients who visited the ED during the COVID-19 pandemic and to identify factors affecting ED LOS. This retrospective study was conducted on adult patients aged 19 years or older who visited a psychiatric emergency center operated by an ED from 1 May 2020 to 31 April 2021 because of the COVID-19 pandemic. In this study, the average ED LOS of psychiatric emergency patients was 7.8 h. Factors affecting ED LOS for over 12 h were isolation (OR = 2.39, CI = 1.409-4.052), unaccompanied police officers (OR = 2.106, CI = 1.338-3.316), night-time visits (OR = 2.127, CI = 1.357-3.332), use of sedatives (OR = 1.671, CI = 1.030-2.713), and restraints (OR = 1.968, CI = 1.172-4.895). The ED LOS of psychiatric emergency patients is longer than that of general emergency patients, and a long ED LOS causes ED overcrowding. To reduce the ED LOS of psychiatric emergency patients, they must be accompanied by a police officer when visiting the ED, and the treatment process should be reorganized so that a psychiatrist can promptly intervene. Furthermore, it is necessary to reorganize the isolation guidelines and admission criteria for mental emergency patients.