Blaylock Risk Assessment Screening Score Research Articles

Continuity of care. Patient support from hospital-to-territory care plan: protected hospital discharges

PurposeTo facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.Design/methodology/approachHospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.FindingsPre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.Originality/valueThe analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.

Association between health literacy and nursing care in hospital: A retrospective study.

To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Retrospective study. The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single-Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.

Thirty-day mortality in hospitalised patients with lung cancer: incidence and predictors

ObjectivesPatients with lung cancer experience high rates of hospitalisation, mainly due to the high risk of complications that emerge during the natural history of the disease. We designed a retrospective,...

Green Line Hospital-Territory Study: A Single-Blind Randomized Clinical Trial for Evaluation of Technological Challenges of Continuous Wireless Monitoring in Internal Medicine, Preliminary Results.

Background: Wireless vital parameter continuous monitoring (WVPCM) after discharge is compared to regular monitoring to provide data on the clinical-economic impact of complex patients (CPs) discharged from Internal Medicine Units of Ospedale dei Castelli, Lazio. Primary outcome: Major complications (MC) reduction. Secondary outcomes: Patients who reached discharge criteria within the 7th day from admission; difference in MC incidence at the conclusion of the standard telemonitoring/clinical monitoring phase, 5 and 30 days after discharge; and conditions predisposing to MC occurrence. Methods: Open label randomized controlled trial with wearable wireless system that creates alerts on portable devices. Continuous glycemic monitoring is performed for patients with diabetes mellitus. Results: There were 110 patients enrolled (mean age: 76.2 years). Comorbidity: Cumulative Illness Rating Scale CIRS-CI (comorbidities index): 3.93, CIRS SI (severity index): 1.93. About 19% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. Globally, 48% of patients in the control group had major complications (27 out of 56 patients), in contrast to 22% in the intervention group (12 out of 54 patients). Conclusions: Since WVPCM detects early complications during the post-discharge CPs monitoring, it increases safety and reduces inappropriate access to the Emergency Room, preventing avoidable re-hospitalizations.

Henderson's approach in nursing discharge planning to improve patient satisfaction

The purpose of this study was to identify the effect of discharge planning management intervention on patient satisfaction and the role of nurses at the hospital. This study was a quasi-experimental study with 92 respondents. The intervention group was given a discharge planning management intervention by adding Blaylock Risk Assessment Screening Score (BRASS) and the control group was given discharge planning according to what was done in the hospital. Both groups measured patient satisfaction and role of nurses before and after the intervention. The results showed that discharge planning management intervention in the intervention group increasing patient satisfaction at the hospital (p=0.002) and the role of nurses especially in fulfilling 14 basic needs of humans (Henderson's Approach). Discharge Planning Management Intervention effectively increases patient satisfaction and the role of nurses.

Patients recovering from COVID-19 pneumonia in sub-acute care exhibit severe frailty: Role of the nurse assessment.

Aims and ObjectivesTo document the level of frailty in sub‐acute COVID‐19 patients recovering from acute respiratory failure and investigate the associations between frailty, assessed by the nurse using the Blaylock Risk Assessment Screening Score (BRASS), and clinical and functional patient characteristics during hospitalisation.BackgroundFrailty is a major problem in patients discharged from acute care, but no data are available on the frailty risk in survivors of COVID‐19 infection.DesignA descriptive cross‐sectional study (STROBE checklist).MethodsAt admission to sub‐acute care in 2020, 236 COVID‐19 patients (median age 77 years – interquartile range 68–83) were administered BRASS and classified into 3 levels of frailty risk. The Short Physical Performance Battery (SPPB) was also administered to measure physical function and disability. Differences between BRASS levels and associations between BRASS index and clinical parameters were analysed.ResultsThe median BRASS index was 14.0 (interquartile range 9.0–20.0) denoting intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). Significant differences emerged between the BRASS frailty classes regards to sex, comorbidities, history of cognitive deficits, previous mechanical ventilation support and SPPB score. Patients with no comorbidities (14%) exhibited low frailty (BRASS: median 5.5, interquartile range 3.0–12.0). Age ≥65 years, presence of comorbidities, cognitive deficit and SPPB % predicted <50% were significant predictors of high frailty.ConclusionsMost COVID‐19 survivors exhibit substantial frailty and require continuing care after discharge from acute care.Relevance to clinical practiceThe BRASS index is a valuable tool for nurses to identify those patients most at risk of frailty, who require a programme of rehabilitation and community reintegration.

Hospital discharge: testing the "Blaylock Risk Assessment Screening Score" in a surgical department.

Background and aim of the work Standardizing patients' assessment to identify individuals at greater risk in encountering difficulties at discharge may help to assist healthcare professionals in clinical decision making and address the gaps in quality that negatively affect continuity of care. We analyzed the predictive validity and the test-retest reliability of the BRASS index in surgical inpatients. Moreover, we evaluated the association between other variables and length of stay or location at discharge. Methods A prospective observational study was conducted. Four hundred twenty-eight patients (≥18 years old) hospitalized in the surgical department of Vimercate hospital were recruited. Data were collected using BRASS index within 48 hours from admission and before discharge. Results We found a high specificity for BRASS in identifying patients discharged to their home with assistance or to residential care. The hospital stay for medium and high-risk patients was significantly longer than those in the low-risk group. There was no statistically significant difference of the BRASS scores during hospitalization. Type of admission, pressure ulcers, ASA score, multidrug-resistant bacterial infections, medical complications and Intensive Unit Care stay showed a significant correlation with longer hospitalization and increased probability to be discharged to their home with assistance or to residential care. Conclusions The BRASS Index may support healthcare professionals to identify surgical inpatients requiring a discharge planning and needs to be completed just once at admission. The inclusion of other patient-specific factors in the assessment process could be valuable for targeting the at-risk population.

Innovation in health care: continuous wireless monitoring to improve management of critically ill atients: LIMS study preliminary results

Abstract Background Wireless vital parameter continuous monitoring (WVPCM) is compared to regular nurse monitoring in order to provide data on the clinical and economic impact of critically ill patients (CIPs) in Internal Medicine Units (IMU). Study Design Pilot prospective randomized controlled open-label multi-center study with WIN@Hospital wearable wireless system creating alerts on portable devices (ipad). Experimental Arm: CIPs with MEWS (Modified Early Warning Score) ≥3 and/or NEWS (National Early Warning Score) ≥5 at admission underwent WCPCM over the first 72 h. Active Comparator: CIPs with MEWS ≥3 and/or NEWS ≥5 at admission undergoing regular nurse monitoring. Method Primary outcomes: Reduction of major complications (MC) from 15% to 5%. Secondary outcomes: One day reduction in length of stay (LOS); reduced nurse monitoring time; accurate patient stratification and definition of end stage disease. Results Preliminary results: Enrolled 145 and evaluable 125 patients (51 M/74 F), mean age 80.5 years, Comorbidity: Cumulative Illness Rating Scale CIRS-CI: 4, CIRS SI: 1.8. About 38% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. More than 50% of patients present IIA index &amp;gt;3 indicating high dependency from nursing assistance. Nurses saved a minimum of 49,6 minutes to a maximum of 58,1 minutes on time spent monitoring each patient per day. A trend towards reduction of major complications in the experimental group appears to be seen (31% versus 45%). Decrease in re-admissions (7% versus 11%) and mortality (7.3% versus 23.9%) has been observed. Arrhythmic and ischemic complications detection doubled in the experimental arm. More than 30% of the patients meet the criteria defining end stage disease. Conclusion WVPCM, detecting early deterioration in CIPs, may facilitate timely response in at-risk patients, increasing safety and reducing costs. Telemedicine Network Funding Acknowledgement Type of funding source: None

Factors Associated With Discharge Destination in Community-Dwelling Adults Admitted to Acute General Medical Units.

General medical patients often present to the hospital with medical, social, cognitive, and functional issues that may impact discharge destination. The aim of this study was to investigate the association between patient factors at hospital admission and discharge destination in general medical patients. This was a prospective, single-site observational study conducted on the general medical wards at a tertiary hospital. Inpatients admitted to the general medical unit and referred to physical therapy were included. Patients admitted from residential care were excluded. Data were collected a median of 2 days (interquartile range: 1-3) from hospital admission and included demographics, comorbidities (Charlson Comorbidity Index), premorbid physical function (Blaylock Risk Assessment Screening Score, BRASS), current function (de Morton Mobility Index, DEMMI and Alpha Functional Independence Measure, AlphaFIM), and cognition (Rowland Universal Dementia Assessment Scale, RUDAS). Between July 2016 and August 2017, 417 patients were recruited (53% female, median age: 81 years (interquartile range: 76-86). Of these, 245 patients were discharged directly home; 172 were not discharged home of whom 140 were discharged to a subacute temporary facility providing further opportunity for therapy and discharge planning. Patients discharged directly home had higher functional, mobility, and cognitive scores. Data were partitioned into training, validation, and test sets to provide unbiased estimates of sensitivity, specificity, receiver operating characteristic curve, and area under the curve. Models best associated with discharge were "DEMMI and toilet transfers" (sensitivity 82.1%, specificity 66.2%, area under the curve 83.8%, 95% confidence interval: 76.4-91.2) and "AlphaFIM and walking independence" (sensitivity: 66.7%, specificity: 83.1%, area under the curve: 81.5, 95% confidence interval: 73.2-89.7). Two models were created that differentiated between discharge home and not home and had similar statistical measures of validity. Although the models require further validation, clinicians should consider whether identification of patients likely to be discharged home or not home is of greater relevance for their clinical setting.

A bio-psycho-social approach in elderly population: outcome of adapted physical activity in patients with osteoarthritis.

The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.

Barthel Index: creation and validation of two cut-offs using the BRASS Index.

Background and aim:Hospital discharge should be planned during the first days of stay to avoid an inappropriate length of stay and an early rehospitalization. Blaylock Risk Assessment Screening Score Index (BRASS index) evaluates the risk of difficult discharge, Barthel Index the level of autonomy in “activities of daily living” (ADL). This is a prospective observational study, performed in Padua’s Hospital (Italy), with the purpose of validating two cut-offs in the Barthel Index using the BRASS Index, in order to find three bands for difficult discharges: low, medium and high risk.Methods:Two studies have been conducted: a pilot study in 2017 with 153 patients and a validation study in 2018 with 253 patients, in order to validate data emerged from the pilot study. Using a statistical method, two cut-offs have been identified in the Barthel Index.Results:Both of study showed that the grade of autonomy is correlated with the risk of difficult discharge. A Barthel score between 0 and 35 corresponds to a high risk, between 35 and 70 to a medium and over 75 to a low.Discussion:This study suggests that, by the use of only Barthel Index, it may be possible to identify patients who may have difficulty in early discharge. This result suggests that the degree of functional dependence is predictive of the risk of difficult discharge. Further studies are needed to confirm the correlation between these data also in other realities (e.g. outside hospital departments).Conclusion:Nurses could use a single instrument to evaluate the autonomy and the risk of difficult discharge in order to identify early patients that need a discharge plan. (www.actabiomedica.it)

The assessment of planned discharges: agreement between BRASS index and clinical judgement

The BRASS (Blaylock Risk Assessment Screening Score) index is a risk screening tool for identification of patients at risk of difficult discharge. To assess the agreement of discharge options between the BRASS classification and the nurses' clinical judgement. Consecutive patients admitted to surgical wards of a large Italian hospital from November 2016 to June 2017 were assessed with the BRASS index within 48 hours from admission and 24 hours before discharge. After discharge a group of expert nurses, blind to the BRASS score and patient effective destination, planned the patients' discharge reviewing the clinical records. Patients were classified as needing ordinary discharge, with support or to hospital. The 90% of the 428 included patients remained in the same BRASS risk class; the agreement between BRASS score (K Cohen) at admission and clinical judgement was 0.474 and 0.533 at discharge. Of the 96 subject at need of discharge with support or to hospital, 60 were classified in the same class by the BRASS Index. Factors that impacted on the different classification were patients' age, presence of devices and availability and appropriateness of social support. Most patients remained in the same BRASS class. There is moderate agreement between BRASS index and clinical judgement, specifically for patients at medium/high risk of difficult discharge. Our data confirm the need for including new items in the Brass scale.

Short stay total joint arthroplasty program: patient factors predicting readmission

The aim of this study was to evaluate the effectiveness of our short stay arthroplasty program as measured by 30-day readmission rate and the rate of transfer to inpatient care. Risk factors for readmission/transfer were also evaluated and contrasted with current patient screening criteria. We retrospectively reviewed 297 charts for all primary total joint arthroplasties completed in the short stay program during an 18-month period. Data included readmission and patient characteristics such as age, sex, comorbidities, the American Society of Anesthesiologists (ASA) physical classification grade, body mass index (BMI) and the number of preoperative medications. The 30-day readmission rate was 2.6% (n = 8). With the inclusion of patients transferred to the inpatient hospital, the overall failure rate of our short stay program was 6.7% (n = 20). Multivariable modelling controlling for age, BMI and ASA suggested that those with an in-hospital complication were 11.4 times more likely to be readmitted or transferred to inpatient care (p < 0.001) with a trend for patients who were taking more medications (p = 0.09). The current readmission rate from this program is comparable to previously published data in the arthroplasty literature. However, several patients required transfer to inpatient care, which significantly impacted the effectiveness of the short stay program. Risk factors for readmission/transfer are not completely accounted for by current presurgical screening criteria. Further evaluation of the Blaylock Risk Assessment Screening Score is required to determine its value for predicting hospital readmission.

Qualitative experiential analysis of the BRASS scale.

Hospital discharge can potentially represent an issue. Therefore, it is important to early identify patients at higher risk. A valid tool in this field is the Blaylock Risk Assessment Screening Score (BRASS). The study aims to elaborate a simplified score system, throughout the contribution of healthcare professionals considering the single items of the original score. The study included a qualitative analysis, conducted in order to draft the synthetic tool. Alongside, a statistical analysis was carried out. The findings of these two works were compared and joined in the realization of the proposed evaluation tool. The synthetic tool, developed by the working team, is composed by 20 items. The qualitative analysis agrees with the statistical approach. Moreover, the qualitative analysis consented to redefine some items, especially considering social support, and to include some additional information e.g. clinical problems. The analysis considered only General Medicine wards, all located in the same Hospital. Therefore, generalisation to other settings or patients should be further tested. The synthetic tool, realized during the study, aims to improve the individuation of at-risk inpatients. The agreement between statistical and qualitative analysis can be considered a point of strength of our work. Our analysis consented to include some new items, improving overall organization. In conclusion, the working group aims to conduct further study in order to individuate the more appropriate cut-off of the new scoring method.

Efectividad del índice de Brass en la planificación del alta por enfermeras gestoras de casos

Classifying patients according to complexity and frailty during hospitalization allows efficient planning of the scope of care required by the patient at discharge. The aim of this study was to measure the screening validity of the Blaylock Risk Assessment Screening Score and its effectiveness in discharge planning.Methods: We analyzed the variables hospital stay, destination at discharge, use of healthcare resources and mortality in 370 patients. Results: Analysis of the relationship between mortality and the BRASS-Sp index with regard to gender and number of days of stay yielded a hazard ratio of 1.73 (95% CI 1.22-2.46; p=0.002) for male gender and 2.08 (95% CI 1.43-3.04; p<0.001) for the BRASS-Sp score. Patients who continued in case management in Primary Care had a mean BRASS-Sp of 20.97 (standard deviation 6.11), while in the other patients the mean was 19.35 (standard deviation 5.60), p=0.02. Conclusions: The BRASS-Sp proved easy-to-use with verified content validity that is effective for screening hospitalized patients by case management nurses

Caregivers' misperception of the severity of hip fractures.

PurposeThe aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient’s health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.Patients and methodsWe enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient’s caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.ResultsAnalysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland–Altman plot of −2.43, 95% CI=−2.93 to −1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.ConclusionThis study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient’s social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual’s care and assistance need to be assembled.

Development and validation of a simplified BRASS index to screen hospital patients needing personalized discharge planning

BackgroundDischarge planning is an important component of hospital care. The Blaylock Risk Assessment Screening Score (BRASS) index is an instrument used to identify patients requiring complex discharge planning.Objectives(1) Evaluate the ability of the original BRASS index to predict the risk of complex discharge and hospital mortality. (2) Develop and validate a simplified BRASS index by eliminating redundant variables and re-estimating the predictor weights.DesignProspective cohort study.ParticipantsPatients admitted at the general internal medicine wards of tertiary referral hospital in Turin, Italy, and screened within 48 h using the BRASS index.MethodsThe first phase of the study assessed the performance of the original BRASS index in predicting the risk of complex discharge and hospital mortality, then a simplified score was developed. In the second phase, temporal validation of the simplified BRASS index was performed. The probability of each discharge modality (discharged at home without complications, complex discharge, and dead in hospital) was modeled using polytomous logistic regression. The AUC was used to compare the performance of the different models.Key ResultsAmong 6044 patients in the first phase of the study, 63% were discharged at home without complications, 31% had complex discharge, and 6% died during the hospital stay. The AUC of the simplified BRASS index, compared with the original index were 0.71 vs. 0.70 for complex discharge and 0.83 vs. 0.80 for hospital mortality. In the validation set (3325 patients), the simplified BRASS index discriminates the outcome categories with an AUC of 0.69 and 0.81 for complex discharge and hospital mortality, respectively.ConclusionThe new, simplified BRASS index showed a slightly better performance in predicting the risk of complex discharge and hospital mortality than the original tool and takes less time to be applied. These results were also confirmed in the validation set.

Blaylock risk assessment screening score as a predictor of length of hospital stay

Blaylock risk assessment screening score as a predictor of length of hospital stay

Moderate efficiency of clinicians' predictions decreased for blurred clinical conditions and benefits from the use of BRASS index. A longitudinal study on geriatric patients' outcomes

ObjectivesAccurate prognosis is an essential aspect of good clinical practice and efficient health services, particularly for chronic and disabling diseases, as in geriatric populations. This study aims to examine the accuracy of clinical prognostic predictions and to devise prediction models combining clinical variables and clinicians' prognosis for a geriatric patient sample. Study Design and SettingIn a sample of 329 consecutive older patients admitted to 10 geriatric units, we evaluated the accuracy of clinicians' prognosis regarding three outcomes at discharge: global functioning, length of stay (LoS) in hospital, and destination at discharge (DD). A comprehensive set of sociodemographic, clinical, and treatment-related information were also collected. ResultsModerate predictive performance was found for all three outcomes: area under receiver operating characteristic curve of 0.79 and 0.78 for functioning and LoS, respectively, and moderate concordance, Cohen's K = 0.45, between predicted and observed DD. Predictive models found the Blaylock Risk Assessment Screening Score together with clinicians' judgment relevant to improve predictions for all outcomes (absolute improvement in adjusted and pseudo-R2 up to 19%). ConclusionAlthough the clinicians' estimates were important factors in predicting global functioning, LoS, and DD, more research is needed regarding both methodological aspects and clinical measurements, to improve prognostic clinical indices.

What is the course of behavioural symptoms and functional conditions in hospitalised older people with dementia? A multicentre cohort study in Italy

IntroductionDementia is one of the major causes of disability and dependency among older people worldwide, and hospitalization occurs frequently in demented patients. The present study examined the course of behavioural symptoms and functional conditions in hospitalised older people with dementia. Materials and methodsProspective cohort study of 179 demented patients (age > 64 years) admitted to four geriatric units, evaluated at admission, discharge and at 6 months after discharge. An analysis of predictors of functioning improvement was performed. ResultsPatients with no symptoms at NeuroPsychiatric Inventory baseline assessment did not show any changes at both discharge and follow-up, while patients with symptoms at baseline showed an improvement in every subscale from admission to discharge. Using Barthel Index as a measure of functioning, we found a significant improvement in both “admission-discharge” and “discharge-follow-up” timeframe for the most impaired patients. However, for the less impaired patients, no significant changes emerged from admission to discharge, while a significant worsening occurred from discharge to follow-up. The significant associated variables with improvement in Barthel Index from discharge to follow-up were age and Blaylock Risk Assessment Screening Score at admission. ConclusionInteresting trends in the course of hospitalized older patients with dementia have been found, and they were associated to different levels of functional impairment at admission. Further research is still needed to understand the predictors of improvement and worsening in such hospitalized patients.