Average Number Of Hospital Days Research Articles

Maternal and neonatal outcomes of abnormal placentation: a case–control study

Background There is limited information on neonatal outcomes in complicated pregnancies with abnormal placentation. The aim of this study was to assess the neonatal outcomes of abnormal placentation. Methods In this case–control study, known cases of abnormal placentation between the years 2010 and 2017 were extracted. The case group consisted of pregnant women with abnormal placentation (172 cases), while controls were selected from repeated cesarean section cases with normal placentation (341 people). Results In the case group, 145 cases (84.3%) had placenta accreta, 12 cases (7.07%) had placenta increta and five cases (8.7%) had placenta percreta. Characteristics significantly more common in the case group included lower mean gestational age and average neonatal weight (p < .001), low birth weight (LBW) and small for gestational age (SGA) (p < .001), admission to the NICU (p < .001), higher average number of hospitalization days in the NICU (p < .05), lower average 5-minute Apgar scores (p < .001), neonatal seizure (p = .004), cranial hemorrhage (p = .037), anemia (p = .002) and thrombocytosis (p = .029). The occurrence of abnormal placentation was associated with some underlying maternal characteristics such as high maternal age (p = .34), lower maternal weight (p = .044), multiparity (p = .11), history of previous abortion (p = .036), and history of cesarean (p = .001). The prevalence of placenta previa was significantly higher in the case group (p < .001). Conclusion The presence of placenta previa has a close relationship with abnormal placentation and is considered to be a potential risk factor for LBW, SGA, lower 5 minutes Apgar scores, first-day seizure, cranial hemorrhage, the necessity for NICU admission and occurrence of anemia and thrombocytosis in neonates.

Salt Taste Sensitivity and Heart Failure Outcomes Following Heart Failure Hospitalization

Salt taste sensitivity can change after heart failure (HF) hospitalization, however the relation between changes in salt taste sensitivity with HF symptoms, biomarkers, and outcomes is unknown. We assessed salt taste sensitivity over 12 weeks following HF hospitalization using a validated, point-of-care salt taste test. Subjects were divided into 2 groups: increase or no increase in salt taste sensitivity. HF biomarkers and outcomes were compared using 2-sample t tests and log-transformed t tests for non-normally distributed parameters. Baseline characteristics generally did not differ for subjects with an increase in salt taste sensitivity over 12 weeks compared with those without an increase in salt taste sensitivity. The total number of 12-week hospital days was 60 versus 121 days, with an average number of hospital days of 5.45 [3.88] versus 11.00 [6.74] (p = 0.03) among those hospitalized in the groups with an increase versus no increase in salt taste sensitivity, respectively. In conclusion, changes in salt taste sensitivity occurred in some but not all subjects in a 12-week period following HF hospitalization. Subjects with increased salt taste sensitivity over this time period were rehospitalized for fewer days. Improved salt taste sensitivity may represent a novel prognostic factor in postdischarge patients with HF.

The Geographical Distribution of Morbidity Caused By Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-2

Background:Chronic obstructive pulmonary disease (COPD) is one of the most prevalent causes for morbidity and mortality, and it creates a cumulative economic and social burden.Aims:To determine the distribution of the prevalence of patients in Turkey who were diagnosed with COPD and their morbidity rates, according to the regions and cities they belong to. Moreover, the study contributes to the prevention and cure services of COPD that should be planned in the future.Study Design:A retrospective cohort.Methods:The database of the Social Security Institution from 2016 has been scanned. All the data with prescription registration, with the code ICD-10, J44.0-J44.9, which were aimed for diagnosing and/or cure, have been evaluated with a retrospective cohort.Results:In 2016, 955,369 patients who were admitted as outpatients to the hospitals were diagnosed with COPD. The average number of annual COPD cases that were admitted was 2.09. Twenty percent (20%) of the outpatient applications were via emergency room. The rate of hospitalization among the applicants was 17.75%, with a total of 1,994,325. The average annual number of hospitalizations of men was higher than that of women. The average number of hospitalization days was 6.52. The region with the highest prevalence of outpatient admission and hospitalization was the Black Sea Region.Conclusion:The high rate of hospitalization was considered to be the outcome of the insufficient “outpatient” management.

Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes.

Background: We used the Taiwan National Health Insurance Research Database (NHIRD) to determine the differences in mortality and medical burden between patients with chronic obstructive pulmonary disease (COPD) with and without stroke. Methods: We enrolled participants aged ≥20 years and defined four subgroups in this study, namely patients with COPD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM): 491, 492, 494, and 496), patients with COPD with stroke (ICD-9 CM: 430–438), with COPD without stroke, and comparison subgroups. We calculated the hazard ratios and 95% CIs for all-cause mortality risk, average duration of hospitalization, and frequency of medical visits in these subgroups after adjustments were made for age, sex, and comorbidities. All participants were followed until the date of death, the date they were censored, the date they withdrew from the NHIRD, or 31 December, 2013. Results: In total, 9.70% (men vs. women, 11.19% vs. 8.28%) of patients with COPD developed subsequent stroke during the 14 year follow-up. After a stroke, the risk of mortality exhibited a 2.66- to 5.05-fold increase, especially in the younger ones. COPD with stroke was also a leading factor in the increase in the average number of hospitalization days and frequency of medical visits. Conclusion: The mortality risk of patients with COPD is considerably increased by stroke independent of the other effects of COPD. Moreover, the average number of hospitalization days and frequency of medical visits dramatically increased in patients with COPD after stroke.

The Relationship Between Polypharmacy and Hospital-stay Duration: A Retrospective Study.

BackgroundThere have been very few studies on the association of polypharmacy with clinical course. In this paper, we seek to evaluate the relationship between polypharmacy and hospitalization period.MethodsWe retrospectively analyzed 322 patients hospitalized from February to September 2017, after excluding short-term and orthopedic cases. Patients with polypharmacy were defined as those who were prescribed more than five drugs at the time of admission. The primary endpoint for all subjects regardless of polypharmacy was the hospitalization period. Using Mann-Whitney U test results, we compared the average number of hospital days between patients with and without polypharmacy. Secondary endpoints were hospitalization period with and without polypharmacy for each disease type.ResultsThe hospitalization period was significantly extended for patients with polypharmacy as compared to those without (31.6 vs. 23.2 days, p: 0.002). Those with an infection had significantly longer hospitalization than those without polypharmacy (27.6 vs. 18.1 days, p: 0.007). Malignancy, heart disease, and cerebrovascular disease did not have a significant effect on hospitalization regardless of polypharmacy.ConclusionPolypharmacy is related to an extended hospitalization period and is found to occur more frequently in patients hospitalized for an infection.

Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

ObjectiveTo evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta. MethodsThe clinical data of 623 patients with pernicious placenta previa combined with placenta accrete, who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed. All patients underwent abdominal aortic balloon occlusion combined with cesarean section, and 78 patients underwent sequential bilateral uterine artery embolization. We analyzed the operation time, intraoperative blood loss, blood transfusion volume, intraoperative and postoperative complications, fetal radiation exposure time and dose, and the Apgar score of the newborns. We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete. ResultsOf the 623 patients, 545 underwent only abdominal aortic balloon occlusion, and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding. The uterus was successfully preserved in all patients. Except for five cases of right lower extremity arterial thrombosis, the remaining patients did not have postoperative lower extremity arteriovenous thrombosis, renal insufficiency, late postpartum hemorrhage, ectopic embolism, spinal cord or peripheral nerve damage, pelvic infection, or other serious complications. The mean operative time was 65.3 (±14.5) min. The mean intraoperative blood loss was620 (±570) ml. Ninety-six patients (15.4%, 96/623) were treated with blood transfusion, and the average amount of blood transfused was 750 (±400) ml. The average number of hospitalization days was 6.8 (±3.4) days, the average time of fetal ray exposure was 5.2 (±1.6) s, and the average radiation dose was 4.1 (±2.7) mGy. The neonatal Apgar score, was 8.4 (±0.6) points at 1 ​min, and 9.6 (±0.4) points at 5 ​min. In the follow-up to May 31, 2019, 29 patients were lost to follow-up, 96 were lactating, and 498 were menstruating. Except for the cases lost to follow-up, the remaining 596 surviving newborns (including 2 twins) showed no abnormalities at the 42-day postnatal outpatient follow-up examination. ConclusionBalloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

YELKEN GÖĞÜS NEDENİYLE OPERE EDİLEN HASTALARIN RETROSPEKTİF ANALİZİ

Flail chest occurs when 3 or more ribs are broken from 2 or more parts, and paradoxical breathing mechanism occurs due to the asynchronous chest wall movement due to the floating segment formed. Paradoxical movements make breathing less efficient, resulting in poor oxygenation of the blood and potential asphyxia, and the mortality rate in the hospital is more than 33%. Flail chest treatment is controversial between conservative treatment and surgical treatment due to different study and result recommendations. Our study isolated flail chest due operated been flail chest complications in patients in intensive care and mechanical ventilation requirements, number of hospitalization days, chronic pain and drug use and investigate the cost-effectiveness of the conditions of Turkey with their impact on the mortality rate. In this retrospective study, patients (15M / 2F) operated for a total of 17 isolated flail chests (3 bilateral) between 2014-2019 were included in the study. The average number of intensive care hospitalization days of patients is 1.94 (1-7), the average number of hospitalization days is 7.3 (4-14), the mortality rate is 5.8% and the average number of plaques used per case is 7.76. and the extra cost per case is $ 886. According to our study results, it is seen that the patients we operated due to isolated flail chest have possible flail chest complications, ICU and mechanical ventilation needs, the number of hospitalization days, chronic pain and drug use and most importantly, the mortality rate is low. Although larger series are needed, we think that flail chest cases should be surgically stabilized according to these results.

1166. Infection Rate in Venous–Venous Extracorporeal Membrane Oxygenation (VV-ECMO)

BackgroundThe Extracorporeal Life Support Organization (ELSO) Infectious Disease Taskforce has identified infection rates as an area requiring further study. We aimed to evaluate our patients on venous–venous extracorporeal membrane oxygenation (VV ECMO) for infection rates, organisms, and specific factors that may alter infection risk.MethodsRetrospective data were collected from September 2012 to 2015 for adult patients on VV ECMO. Demographic information as well as type and location of cannulation, antibiotics prior to and during cannulation, and presence of bacteremia were obtained. Counts and percentages are reported for categorical variables.Results47 patients between 18 and 82 years of age with a median of age of 58 years were included. 76.6% (N = 36) were male. The average number of hospital days until cannulation was 7.8 days. 400 ECMO days were captured with a range of time on ECMO of 1–41 days. 46.8% (N = 22) of patients were alive at the time of discharge. 70.2% (N = 32) of cannulations were in the OR (Figure 1). 55% (N = 26) of patients had a Right Ventricular Assist Device (RVAD) with in-line oxygenator. 66% (N = 31) of all patients were on antibiotics prior to cannulation for other indications while 53% (N = 25) of all patients received perioperative antibiotics (Figure 2). 59% (N = 28) of all patients had blood cultures while on ECMO, with only 8% (N = 4) of all patients returning positive. Of the positive cultures, 2 were true bacteremia resulting in an infection rate of 5 per 1,000 ECMO days (Figure 3). One patient grew Escherichia coli while the other grew Escherichia coli and Streptococcus pneumoniae. Neither patient received antibiotics perioperatively or for other indications (Figure 4). Due to the low number of infected patients, further statistical analysis could not be performed.ConclusionWe report a low rate of bloodstream infection amongst our VV-ECMO patients. Further investigation to ascertain trends in infection rate with cannulation location/type as well as association with antibiotic is currently being pursued. Other avenues of research will include a comparison of infection rates between VV and Venous Arterial (VA) ECMO. Information from these investigations will help aid the development of guidelines to minimize the rate of nosocomial infections in ECMO patients. Disclosures All authors: No reported disclosures.

208 Neostigmine to Treat Colonic Pseudo-Obstruction in Cancer Patients

INTRODUCTION: Acute colonic pseudo-obstruction, or Ogilvie's syndrome, usually develops in patients post-operatively or during severe illness. It is defined as massive dilation of the colon without mechanical obstruction. Ogilvie's may resolve with conservative management, but frequently colonic decompression is needed to prevent bowel injury. Neostigmine is a drug used to treat Ogilvie's that can be tried prior to endoscopic decompression. It is a reversible acetylcholinesterase inhibitor, enhancing colonic motor activity. We aim to evaluate the demographics and clinical history of patients with Ogilvie's and the efficacy of neostigmine administration in treating Ogilvie's in our cancer population. METHODS: Retrospective data analysis was performed on patients from 2000 to 2018 who had colonic dilation, defined as &gt;8 cm in part of the colon on x-ray or cross-sectional imaging, and received neostigmine. RESULTS: The total number of patients in the study was 29. The mean age of patients was 66.7 years old (range: age 46.5–81.0). Of the 29 patients, 5 patients were female (17.2%). Leukemia was the primary malignancy in 10 patients (34.5%) and solid tumor in the other 19 patients (65.5%). Metastatic disease was found in 15 patients (51.7%). Recent chemotherapy was administered to 21 patients (72.4%). The average number of hospitalization days was 34.7 days (range: 2–120 days). Pan-dilation of the colon was noted in 10 patients (34.5%) and cecal dilation alone was noted in 7 patients (24.1%). The mean diameter of dilated colon segment was 10.8 cm (range 8.0–15.0 cm). Post-operative Ogilvie's was noted in 5 patients (17.2%). Active infection was identified in 18 patients (64.2%). One dose of neostigmine was required in 20 patients (71.4%) and remaining patients required 2 or 3 doses. Improvement of Ogilvie's was noted in 23 patients (79.3%) and complete resolution in 13 patients (44.8%). Colonoscopy was needed after a trial of neostigmine in 10 patients (34.5%). Bradycardia due to neostigmine was noted in 3 patients (10.3%) without other complications noted. CONCLUSION: In our study evaluating cancer patient, Ogilvie's was more common in elderly male patients with solid tumors and active infection. Metastatic disease was noted in about half of the study patients. It was most common to have pan-colonic dilation and isolated cecal dilation. Administration of neostigmine led to improvement of colonic pseudo-obstruction in the majority of patients (79.3%) with complete resolution noted in 44.8% of patients.

Changes in Salt Taste Sensitivity and Heart Failure Readmissions

Introduction Increased salt taste sensitivity may be associated with improved heart failure (HF) outcomes following HF hospitalization. Hypothesis An increase in salt taste sensitivity from admission to 12-weeks follow-up will be associated with fewer days rehospitalized and higher Kansas City Cardiomyopathy Questionnaire clinical summary scores (KCCQ-CSS) compared to subjects with no increase in salt taste sensitivity. Methods We examined salt taste sensitivity in the GOURMET-HF trial, a pilot study investigating the effects of home-delivered meals in post-discharge patients with HF. Salt taste sensitivity was assessed by measuring changes in salt taste recognition threshold on enrollment, discharge, 1, 4, and 12-weeks follow-up using Salsave test strips standardized with 0.6-1.6 mg/cm2 NaCl solution. Subjects were divided into two groups: increase or no increase salt taste sensitivity. Baseline characteristics between groups and outcomes were compared using two-sample t-tests, chi-squared tests, and log-transformed t-tests for parameters that were not normally distributed. Results Baseline characteristics did not differ for subjects with an increase in salt taste sensitivity over 12-weeks (n=25) compared to those without an increase in salt taste sensitivity (n=24); they were elderly (71 vs. 69 years) and predominately male (76 vs. 75%). There was a high representation of black (36 vs. 29%) and Hispanic (28 vs. 42%) subjects. Baseline KCCQ-CSS (45.84 [21.74] vs. 44.31 [17.70]) were similar. The enrollment salt taste recognition threshold was higher (1.19 [0.39]) vs. 0.76 [0.28] mg/cm2, p=0.001) and the 12-week threshold was lower (0.71 [0.16] vs. 0.86 [0.32] mg/cm2, p=0.042) in the group with increased salt taste sensitivity. The total number 12-week hospital days was 60 vs. 121 days, with an average number of hospital days of 5.45 [3.88] vs. 11.00 [6.74] (p=0.028) among those hospitalized in the groups with an increase vs. no increase in salt taste sensitivity, respectively (Figure 1). KCCQ-CSS at 12-weeks trended higher in the group with an increase in salt taste sensitivity: (64.24 [23.06] vs. 56.25 [24.80], p=0.195). Conclusions Changes in salt taste sensitivity occurred in some but not all subjects in a 12-week period following hospitalization for HF. Subjects with increased salt taste sensitivity over this time period were rehospitalized for fewer days. Improved salt taste sensitivity may represent a novel prognostic factor in post-discharge patients with HF.

Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department

ProblemSepsis, a life-threatening condition, can rapidly progress to death. The Hospital Inpatient Quality Reporting program has implemented bundled care metrics for sepsis care, but timely completion of these interventions is challenging. Best-practice interventions could improve patient outcomes and reimbursement. The purpose of this project was to improve the timeliness of sepsis recognition and implementation of bundled care interventions in the emergency department. MethodsThis evidence-based practice improvement project implemented a Detect, Act, Reassess, Titrate (DART)-based nursing protocol embedded within a checklist communication tool in the emergency department of a tertiary level-2 trauma center. Data comparisons between preintervention and post-DART protocol/checklist implementation included compliance with the individual Inpatient Quality Reporting 3-hour bundled elements, number of hospital days, and time to screen. Staff also completed a survey designed to assess their satisfaction with the DART algorithm/checklist. The Pearson χ2 test was used to assess bundled-care intervention variables. Wilcoxon rank sum tests were used to explore hospitalization outcomes. Staff satisfaction survey results were summarized. ResultsImprovement was statistically significant for lactate levels, blood cultures, and early antibiotic administration in the intervention period compared with baseline. Time to screen, ED length of stay, and number of hospital days improved between baseline and the intervention period, with an average number of hospital days decreasing by 2.5 days. Compliance with all Inpatient Quality Reporting metrics increased from 30% to 80%. DiscussionWhen the nurse-driven protocol and communication tool were implemented, compliance with time-sensitive sepsis bundled interventions improved significantly. The outcomes suggest nurse-driven protocols can improve sepsis outcomes.

Partial splenic embolization to alleviate thrombocytopenia in stage III and IV pancreatic ductal adenocarcinoma patients

Background: Thrombocytopenia may be a concern in treating pancreatic ductal adenocarcinomas (PDAC). Due to anatomic position these tumors commonly cause narrowing or occlusion of the splenic vein which may lead to hypersplenism and thrombocytopenia due to sequestration. PDAC patients with thrombocytopenia have limited options for treatment. Partial splenic embolization (PSE) is a procedure developed as an alternative to splenectomy in individuals with hypersplenism. The purpose of our study was to review outcomes of PSE on thrombocytopenia in stage III and IV PDAC patients. Methods: From November 2015 through January 2018, we conducted a retrospective chart analysis of 8 patients with stage III or stage IV pancreatic cancer who had undergone PSE. The primary objective of this retrospective study was to understand the utility of PSE in treating thrombocytopenia in pancreatic cancer patients by the effect on the individual’s platelet count and the subsequent exposure to chemotherapy treatment. Specific demographic data points were recorded including date of diagnosis, stage, location of primary origin, and site of metastasis. Other data including hospital days post-embolization, post-embolization syndrome (PES), days to return of chemotherapy, survival, and pre/post platelet counts at designated intervals were reviewed. Results: Seven-eighths patients were diagnosed with stage IV pancreatic adenocarcinoma with the pancreatic head being the most common primary site (50%). Most common site of metastasis was liver. PES was found in 5/8 patients with the average number of hospital days after the procedure 1.38 (SD =1.06). Mean platelet count pre-splenic embolization was 93.00 (SD =12.59). One-week post-embolization mean platelet count was 147.00 (SD =69.60). Four-week ( χ =183.60, SD =64.93), six-week ( χ =148.40, SD =40.58), and three-month ( χ =161.00, SD =79.07) intervals were used to further assess platelet change. The results of the ANOVA were significant, F (4) =3.65, P=0.027, =0.48. Post-hoc analyses revealed significant differences between one-week and four-week post-embolization (P=0.008). Time to restarting chemotherapy ranged from 1 to 129 days with an average day to restarting chemotherapy of 24.12 (SD =42.70). The median overall survival was 7.22 months. Conclusions: In considering our study’s small sample size, PSE should be considered a safe approach in managing thrombocytopenia long-term in stage III or stage IV PDAC patients. PSE may allow for further chemotherapy to improve overall survival.

Pulmonary tuberculosis in the immunocompromised patients

Background/Aim. During the last few decades, immunocompromising diseases led to an increase in the number of tuberculosis cases. The aim of this study was to examine the influence of immunocompromising diseases on the course of tuberculosis. Methods. The research included two groups, each consisting of 40 subjects with tuberculosis, who were treated at the Institute for Pulmonary Diseases of Vojvodina during 2010 and 2011. The first group had no immunocompromising diseases (the kontrol group), whereas the second group contained patients with accompanying immunocompromising diseases. The data from the patients? medical history, from the Center for Microbiology and from the Radiology Center were used. The two groups were compared according to the following characteristics: age, sex, bacteriological status, radiological presence of the disease, presence of adverse effects of drugs, presence of resistance to drugs, duration of the therapy regimen and the duration of hospitalization. Results. The group of immunocompromised patients was older in average than the control group and included a higher percentage of males. The immunocompromised group had statistically important longer average time required for the sputum smear conversion (p = 0.000) and for the conversion of sputum cultures to M. tuberculosis (p = 0.010), more frequent presence of cavity (p = 0.030), longer average therapy regimen duration (p = 0.000) and higher average number of hospital days (p = 0.000) compared to the control group. The most frequent localization of changes in the immunocompromised patients was in all lobes of both lungs (32.5%) whereas the changes in the control group were mostly localized in the upper lung lobes (62.5%). There was no statistically important difference in the finding of sputum smear positive acidfast bacilli on direct micoscropy, the presence of adverse effects of drugs and M. tuberculosis resistance to drugs between the two groups of patients. Conclusion. The immunocompromising diseases change the course of tuberculosis, primarily by affecting bacteriological status, radiological presentation, the length of therapy regimen and the duration of hospitalization.

2167. Predicting Carbapenem-Resistant Enterobacteriaceae (CRE) Carriage on Admission using Updated Statewide Hospital Discharge Data

BackgroundWe previously built a patient-level prediction model to assess an individual’s risk of Carbapenem-resistant Enterobacteriaceae (CRE) carriage upon hospital admission based on the following factors: past hospital visits (short- and long-term acute care (STACHs and LTACHs)), endoscopic procedures, infection-related diagnosis codes, and patient age and sex. Our model discriminated CRE cases relatively well (c-statistic = 0.86). In the hopes of operationalizing our results, we evaluated the distribution of predicted probabilities on an updated dataset using existing model parameters.MethodsWe used Illinois Hospital discharge data (CYs 2015–2016) with ICD-10 diagnosis and procedure codes to establish baseline exposure history (2015) and to generate predicted probabilities (2016). We calculated the number of hospital visits and the average number of hospital days in the past year (STACH and LTACH). We identified infection-related diagnosis codes using prior knowledge, and included procedure codes for endoscopic retrograde cholangiopancreatography (ERCP). We then used the model parameters from our previous work to generate predicted probabilities corresponding to each hospital visit.ResultsOur study year (2016) included 1,229,158 visits by 816,500 unique adult patients. Sixty-two percent of patients had no inpatient visits in the previous year. Among those with a prior hospitalization, the median STACH length of stay was 4 days (IQR: 2–6). Three thousand five hundred and sixty-six patients (0.4%) had previous LTACH exposure upon admission, with a median length of stay of 25 days (IQR: 13–40). Thirty-two percent of hospital visits had an infection-related diagnosis code, and 0.5% had an ERCP procedure code. Of the more than 1.2 million visits, our model predicted 10,614 visits associated with a CRE risk of over 1%, 946 visits of over 10%, and 96 visits by 63 unique patients with over a 50% risk. On average, highest risk patients were exposed to (median) 15 (7–97) STACH, 104 LTACH (37–174) days; 83% had infection codes.ConclusionUsing a large, de-identified statewide dataset, we were able to identify a small number of extremely high-risk individuals. Selective screening of these individuals upon admission could prove to be a valuable way to identify CRE-colonized patients in order to take proper precautions.Disclosures All authors: No reported disclosures.

Impact of an Antimicrobial Stewardship Program Led OPAT Program on Clinical Complications and Frequency of Hospital Readmissions

BackgroundTreatment of serious bacterial infections with Outpatient Parenteral Antibiotic Therapy (OPAT) has provided patients (patients) the opportunity to complete treatment safely and effectively, while avoiding complications, and prolonged hospitalization. Despite the benefits, considerable risks with drug-related and central venous catheter (CVC)-related complications exist. We sought to improve clinical outcomes of our program by implementing intensive monitoring in partnership with our antimicrobial stewardship program (ASP) with a goal of decreasing the frequency of complications as well as hospital readmission rates and lengths of stay (LOS).MethodsA retrospective study was conducted including all patients discharged from the Birmingham VA Medical Center on OPAT from January 1, 2015 to December 31, 2016. The start date coincides with ASP development of a physician and pharmacist led OPAT program, working closely with home health agencies. Data collection included baseline demographics, antibiotic indication, antibiotic therapy received, and laboratory monitoring. Clinical outcomes included frequency and types of drug-related complications, CVC complications, hospital admission rate due to complications, and hospital days avoided.ResultsIn the study period, 299 patients were discharged on OPAT. They were 96.9% male, and the average age was 64 (Table 1). The average number of hospital days avoided was 32.1. The most common indication was osteomyelitis (Table 1). There were 82 complications in 78 (26%) patients, almost half were acute kidney injury, defined as a rise in serum creatinine requiring a change in antibiotic dosing (Table 2). These led to 25 hospitalizations (32% of patients with complications, 8.3% overall) with another 5 patients being hospitalized for unrelated reasons.ConclusionOur medical center instituted an ASP led practice of closely monitoring and directing care with the local home health agencies due to concerns about patient safety. In doing so, we have realized a low rate of complications and an ability to manage the majority while remaining as an outpatient, with the exceptions of CVC-related complications and encephalopathy. Our data supports the center’s efforts and choice to dedicate resources to improving this increasingly popular treatment.Disclosures All authors: No reported disclosures.

Abstract 202: Impact of Diagnosis Name Changes in the Comprehensive Medical Expenses Payment System on Medical Expenses in Japan

In Japan, medical expenses are increasing, which has been shifting from 36.6 trillion yen in FY 2010 to 40.0 trillion yen in FY 2010. 1 The system changed to the conventional payment method, and a comprehensive medical expenses payment system (DPC) centered on patients (diseases) was introduced. Medical expenses according to this method are calculated from the main disease name diagnosed at the time of admission. Therefore, it depends on the accuracy of the diagnosis name. Regarding the relevance of this diagnosis, there is one lesson from the trend of the death cause statistic of our country. In this study, we aimed to estimate the effect on medical expenses when the diagnosis name change similar to the death causes statistics around 1995 occurred, using DPC data. The targeted DPC data relates to discharged patients from April 2013 to March, 2013 DPC Hospital Group I 80 DPC Hospital II Group 90 DPC Hospital III Group 1327 Hospital. Diagnosis group for each diagnosis group classification for each diagnosis group classification. Based on the average number of days of hospitalization for classification names, in-hospital medical points were calculated, multiplied by the number of cases and multiplied by 10 to make medical cost corresponding to the relevant diagnosis group classification name. Next, heart disease, cerebrovascular disease, and malignant tumor were defined for each diagnosis, and the number of medical cases, the medical expenses per capita, the total medical cost, and the average number of hospital days were calculated for each diagnosis. We estimated the change in medical expenses assuming that 20% of cases of heart disease were moved to cerebrovascular disease and malignant tumor by 10% each. This change in DPC medical expenses was estimated as the change in medical expenses by multiplying the total of DPC medical expenses by the ratio of medical expenses of 39.3 trillion yen in fiscal year 20 of medical expenses in Japan in fiscal year 2013. The sum total of DPC medical expenses for Heisei 20 years was 2.03 trillion yen. The DPC medical expenses were 2.21 billion yen lower after the movement than before the diagnosis was moved. Based on the above, it is estimated that medical expenses in Japan will decrease by 40.9 billion yen when the diagnosis of heart disease moves to cerebrovascular disease and malignant tumor by 10% each. It is necessary to examine the possibility of suppression of medical expenses in more detail by expensive treatment and aggregation by age group.

Costs of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients with Acute Lymphoblastic Leukemia (ALL) - an Analysis of German Claims Data

Allogeneic hematopoietic stem cell transplantation (HSCT) is a possible treatment option for pediatric patients with acute lymphoblastic leukemia (ALL). Typical patient groups eligible for HSCT are high-risk patients, refractory patients or patients with a relapse after initial chemotherapy treatment. Despite constituting a potentially curative treatment for pediatric ALL patients, HSCT is a complicated procedure that requires extensive medical care and can result in life-threatening complications. Furthermore, HSCTs are associated with significant costs, not only related to the procedure itself but also to follow-up medical care. The aim of this study is to provide estimates of health care expenditures for pediatric patients with ALL undergoing allogeneic HSCT in Germany. Costs are considered from the perspective of the German statutory health insurance (i.e. from a payers' perspective).In a retrospective observational study based on German claims data, health care expenses for allogeneic HSCTs in pediatric ALL patients were investigated. As a data source, we used the German Health Risk Institute (HRI) database - a representative database including approximately 7 million patient journeys over a continuous observation period of 6 years. The study population comprised pediatric patients (< 18 years) with an HSCT procedure between January 1, 2010 and June 30, 2014 and a diagnosis of ALL (ICD-10 code: C91.0*) in the same hospital case as the HSCT. Costs were analyzed for a time interval reaching from 2 quarters prior to the HSCT to 8 quarters after the HSCT (the analysis was done in quarters because outpatient diagnoses in German claims data are documented on a quarterly basis). The following health care costs were considered in the analysis: (1) costs for prescription medication, (2) outpatient treatment costs, (3) inpatient treatment costs, (4) costs for remedies and technical aids (e.g. physiological or occupational therapy). Other expenses such as costs for over-the-counter medication, patient transport or costs associated with the stem cell donor were not included in the analysis. In addition, we analyzed the health resource utilization of patients (hospitalization days, outpatient visits).A total of 1,687 individuals with an HSCT procedure in the identification period (January 1, 2010 to June 30, 2014) were identified. Of these, 30 pediatric patients (12 female) with a diagnosis of ALL were included in the final study population. Mean age at the time of the HSCT was 9.3 years (SD: 5.3). Mortality in the 4 (8) quarters following the HSCT procedure was 10.0 % (13.3 %). The average number of hospitalization days per patient in the time period from 2 quarters before the HSCT to 8 quarters after the HSCT was 291.5 (SD: 166.78) with an average of 45.5 days (SD: 42.4) for emergency hospitalizations. A mean of 43.2 outpatient visits (SD: 22.1) was observed in this time period.Average total costs per patient from 2 quarters before the HSCT to 8 quarters after the HSCT were € 290,125 (SD: 110,381) ranging from € 149,933 to € 597,774 €. The largest proportion of these costs were incurred in the hospital sector, followed by costs for medication and ambulatory treatment (see Table 1). Total costs per patient were highest in the index quarter with the HSCT procedure (€ 133,585). However, substantial costs were also observed in the quarters before and after the HSCT with costs gradually decreasing in the quarters following the HSCT procedure (see Figure 1).Our results provide first estimates for HSCT treatment costs in pediatric ALL patients for different health care sectors from the perspective of the German statutory health insurance. [Display omitted] [Display omitted] DisclosuresLehne:Elsevier: Employment. Hickstein:Elsevier: Employment; Health Risk Institute: Employment. Salimullah:Novartis Pharma AG: Employment. Su:Biogen: Employment, Equity Ownership; Novartis Pharmaceuticals Corporation: Employment. Prieur:Elsevier: Employment. Thomas:Novartis Pharmaceuticals Corporation: Employment.

The application of Lean Six Sigma methodology to reduce the risk of healthcare-associated infections in surgery departments.

Nowadays, the monitoring and prevention of healthcare-associated infections (HAIs) is a priority for the healthcare sector. In this article, we report on the application of the Lean Six Sigma (LSS) methodology to reduce the number of patients affected by sentinel bacterial infections who are at risk of HAI. The LSS methodology was applied in the general surgery department by using a multidisciplinary team of both physicians and academics. Data on more than 20 000 patients who underwent a wide range of surgical procedures between January 2011 and December 2014 were collected to conduct the study using the departmental information system. The most prevalent sentinel bacteria were determined among the infected patients. The preintervention (January 2011 to December 2012) and postintervention (January 2013 to December 2014) phases were compared to analyze the effects of the methodology implemented. The methodology allowed the identification of variables that influenced the risk of HAIs and the implementation of corrective actions to improve the care process, thereby reducing the percentage of infected patients. The improved process resulted in a 20% reduction in the average number of hospitalization days between preintervention and control phases, and a decrease in the mean (SD) number of days of hospitalization amounted to 36 (15.68), with a data distribution around 3 σ. The LSS is a helpful strategy that ensures a significant decrease in the number of HAIs in patients undergoing surgical interventions. The implementation of this intervention in the general surgery departments resulted in a significant reduction in both the number of hospitalization days and the number of patients affected by HAIs. This approach, together with other tools for reducing the risk of infection (surveillance, epidemiological guidelines, and training of healthcare personnel), could be applied to redesign and improve a wide range of healthcare processes.

Home care for antibiotic therapy in the management of maternal-fetal infection: Action research example

Introduction- Given the progress in medical care in neonatology, the development of neonatal medicine evaluation techniques and management of difficulties in our Moroccan context, the need to increase the alternative structures for complete hospitalization (CH) in this discipline, is clear. Purpose- Assess the economic and neonatal outcomes of neonatal infection in case of further outpatient care. Material and methods- This is a prospective, single-center including newborns hospitalized for infection between 1 January 2011 and 31 December 2013. Exclusion criteria were respiratory distress, birth defects, direct admission neonatal resuscitation. Results- 1060 neonates were included. The parturients had a preterm rupture of membranes PRM in 70% of cases. We had found a tinted amniotic fluid in 23% of cases. Mothers had chorioamnionitis in 20% of cases. We noted the presence of vaginal discharge with vaginal itching in 18% of cases. of mictional burns were found in 10% of cases. Breast laboratory tests (urinalysis, vaginal swabs, blood cultures, CRP) was positive in 3% of cases the mean birth weight was 3300.20 grams +/- 600. The average age was +/- 1.4 days 0.45. Thirty percent of the children were exclusively breastfed. 80% of patients were asymptomatic at admission. The clinical signs were found mainly respiratory distress. Mean CRP was 35,12mg / L +/- 3.5. The average duration of the PRM was 9.66 +/- 57.7 hours. The examination at the end of treatment was without abnormalities in 89.2% of cases. CRP control was below 6 mg / l in 48% of cases. The evolution of life on day 28 was favorable in 100% of cases. The average length of hospital treatment was 2.87 +/- 1.145 days; the average duration of treatment as outpatients was 2.74 +/- 1.31 days. 100% of newborns received treatment by parenteral perfusion according the protocol of the center. The average number of hospital days per patient spared protocol averaged 3.21 +/- 0.78 days. The average amount saved per patient was 82.65 +/- 5.51 Euros. Total amount saved over three years was 83,000 Euros. Conclusion- The partial hospitalization seems possible for infected newborns without aggravating their illness. It also contributes significantly to the health economy.

(714) - Comparison of 6 Month Hospitalizations in Mechanical Circulatory Support Patients vs Heart Transplant Patients

The benefit of Mechanical Circulatory Support (MCS) versus heart transplant is an ongoing debate. Outcomes can be measured by the number of re-hospitalizations in the first 6 months after each procedure discharge. Cost and quality of life are impaired with increasing number of hospitalizations post-procedure. We sought to assess this question by evaluating our MCS and heart transplant patients for hospitalizations 6 months after the procedure discharge. Between 2010 and 2013 we evaluated 51 MCS patients and 309 heart transplant patients who had at least 6 months follow up. After the initial hospitalizations, re-hospitalization was monitored including the cause for re-hospitalization. The average number of days of re-hospitalization was measured between both groups. There were significantly more re-hospitalizations and a longer average number of hospital days in the MCS group compared to the heart transplant group (see table). The most common cause for hospitalization in the MCS group included: bleeding, infection, GI problem, hematologic, neurologic, planned procedure and heart failure. The most common causes in the heart transplant group included: infection, GI problem, arrhythmia, rejection, neurologic, heart failure, hematologic and renal dysfunction. There was no difference seen in a subgroup comparison between LVAD and TAH patients for average number of readmission days (18.3 ± 16.9 vs. 32.5 ± 30.0, P=0.306) or readmissions in the first 6-months (63.6% vs. 85.7%, P=0.250). Re-hospitalization in the first 6 months in MCS patients is more prevalent compared to heart transplant patients. MCS appears to have greater morbidity leading to re-hospitalization compared to heart transplantation.Tabled 1EndpointsMCS Patients (N=51)Heart Transplant Patients (N=309)P-ValueAny Readmission within 6-Months Post initial Discharge (%)66.7% (34/51)35.9% (111/309)<.001Total Number of Readmissions, Mean ± SD1.4 ± 1.40.6 ± 1.0<.001Average Number of Readmission Days, Mean ± SD20.8 ± 20.011.0 ± 15.50.012 Open table in a new tab