Changes In Admission Rates Research Articles

Evaluating the effectiveness of a home treatment team for older adults and adults with dementia in a mental health crisis: A retrospective analysis

The demographic shift towards an aging population presents challenges in healthcare, notably in addressing frailty and dementia. Hospitalization risks, including out-of-area (OOA) admissions, are well-documented. This evaluation focused on the Intensive Support Team (IST), designed to reduce hospitalisations for older adults, usually over 75 years old, and adults with dementia facing mental health crises. The study assessed the effectiveness of IST within the Specialist Dementia and Frailty Service (SDFS) in West Essex. Using a retrospective comparative design, IST admission data from 2018 (pre-IST) and 2022 (post-IST) were analysed, covering 246 patients’ records. Objectives included evaluating changes in admission rates for patients under or eligible for SDFS and comparing with other community teams, as well as examining IST’s impact on hospital stay length. Chi-square analysis showed a significant reduction in SDFS admissions post-IST, though no significant change was found for other admissions. One-way ANOVA revealed no significant difference in admission length. The results support IST’s effectiveness in reducing hospital admissions, aligning with NHS long-term goals and informing policy and clinical decisions.

Changes in admission rates to an Aotearoa New Zealand hospital general medical service during COVID-19 lockdowns

aim: To better understand the reasons for reduced hospital admissions to a hospital general medicine service during COVID-19 lockdowns. methods: A statistical model for admission rates to the General Medicine Service at Wellington Hospital, Aotearoa New Zealand, since 2015 was constructed. This model was used to estimate changes in admission rates for transmissible and non-transmissible diagnoses during and following COVID-19 lockdowns for total admissions and various sub-groups. results: For the 2020 lockdown (n=734 admissions), the overall rate ratio of admissions was 0.71 compared to the pre-lockdown rate. Non-transmissible diagnoses, which constitute 87% of admissions, had an admission rate ratio of 0.77. Transmissible diagnoses, constituting 13% of admissions, had an admission rate ratio of 0.44. Reductions in admissions did not exacerbate existing ethnic disparities in access to health services. The lag in recovery of admission rates was more pronounced for transmissible than non-transmissible diagnoses. The 2021 lockdown (n=105 admissions) followed this pattern, but was of shorter duration with small numbers, and therefore measures were frequently not statistically significant. conclusions: The biggest relative reduction in hospital admission was due to a reduction in transmissible illness admissions, likely due to COVID-related public health measures. However, the biggest reduction in absolute terms was in non-transmissible illnesses, where hospital avoidance may be associated with increased morbidity or mortality.

The impact of non-pharmacologic interventions on respiratory syncytial virus hospitalization during the COVID-19 pandemic: A retrospective study from Saudi Arabia

BackgroundAcute respiratory tract infections (ARTIs) are frequently observed in infants and young children. The dynamics and transmission of ARTIs have been significantly impacted by the global COVID-19 pandemic. This study investigates the change in admission rates of Respiratory Syncytial virus (RSV) in a hospital in Saudi Arabia. MethodsThe study included hospitalized pediatric patients who underwent RSV testing in three periods: pre-pandemic (2019), during the pandemic (2020–2021), and the immediate post-pandemic (2022). RSV testing was conducted using either PCR or antigen tests. ResultsBetween January 2019 to December 2022, out of 927 tested patients, 173 (18.7%) were positive for RSV. The yearly positivity rates were as follows: 42 (35.6%) of 118, 24 (33.3%) of 72, 15 (18.5%) of 81, and 92 (14%) of 656, yearly from 2019 to 2022, respectively (P < 0.00001). Among all cases, 150 (16.2%) required hospitalization, including 94 (62.7%) males and 56 (37.3%) females. The admission rate to the intensive care unit (ICU) was 25 (16.7%), and mechanical ventilation was required for 10 (6.6%) patients. The overall case fatality rate was 0.7%. A Binary logistic regression analysis showed upper respiratory tract symptoms were more common in patients admitted in 2019 compared to 2022 (odd ratio:20.9, 95% CI: 4.2–104.1, P value < 0.0001). ConclusionThe study showed that there were differences in RSV infection before and after COVID-19. Understanding how COVID-19 mitigation measures affect RSV transmission can aid in the development of effective prevention and control strategies.

Sharp increase in self-poisonings among adolescent girls during the Covid-19 pandemic: Findings from Norwegian registry data.

Sharp increase in self-poisonings among adolescent girls during the Covid-19 pandemic: Findings from Norwegian registry data.

The Effect of Group-Based Family Orientation to Community Mental Health Services

INTRODUCTION A simple initial family orientation session (IGS) focusing on what families might expect by way of treatment and with provision of community resources if required was designed and implemented in a regional mental health service. The IGS effects were examined in terms of clinical measures that align closely with the provincially developed SMART goals for treatment and the nationally developed mental health theme of ‘recovery-oriented services’, as well as readmission rates, and cumulative lengths of stay. METHODS Employing clinical and registration data from a regional information and registration system, we examine readmission rates and cumulative lengths of both within and between groups exposed and unexposed to IGS over comparable time periods before and after November 2016. RESULTS The IGS-exposed group had a greater reduction in admissions and cumulative length stay compared to the unexposed group, with the greatest reduction in IGS-exposed emergency admissions. Clinical data indicated that both IGS-exposed and unexposed groups were similar. CONCLUSIONS The findings support the hypothesis that changes in admission rates and overall days in service was potentially an effect of the IGS. The clinical measurement system and the IGS align closely with the provincially developed SMART goals for treatment and the nationally developed mental health theme of ‘recovery-oriented services’.

The Effect of Group-Based Family Orientation to Community Mental Health Services

INTRODUCTION The effects of an initial family orientation session (IGS) were examined in terms of readmission rates and cumulative lengths of stay. METHODS We examine readmission rates and cumulative lengths of stay both within and between these groups over comparable time periods before and after November 2016. RESULTS IGS-exposed group had a greater reduction in admissions and cumulative length stay compared to the unexposed group, with the greatest reduction in IGS-exposed emergency admissions. CONCLUSIONS The findings support the hypothesis that changes in admission rates and overall days in service was potentially a direct effect of the IGS.

The Effect of Group-Based Family Orientation to Community Mental Health Services

INTRODUCTION The effects of an initial family orientation session (IGS) were examined in terms of readmission rates and cumulative lengths of stay. METHODS We examine readmission rates and cumulative lengths of stay both within and between these groups over comparable time periods before and after November 2016. RESULTS IGS-exposed group had a greater reduction in admissions and cumulative length stay compared to the unexposed group, with the greatest reduction in IGS-exposed emergency admissions. CONCLUSIONS The findings support the hypothesis that changes in admission rates and overall days in service was potentially a direct effect of the IGS.

The Effect of Group-Based Family Orientation to Community Mental Health Services

INTRODUCTION The effects of an initial family orientation session (IGS) were examined in terms of its effect on readmission rates and cumulative lengths of stay. METHODS We examine readmission rates and cumulative lengths of stay both within and between these groups over comparable time periods before and after November 2016. RESULTS IGS-exposed group had a greater reduction in admissions and cumulative length stay compared to the unexposed group, with the greatest reduction in IGS-exposed emergency admissions. CONCLUSIONS The findings support the hypothesis that changes in admission rates and overall days in service was potentially a direct effect of the IGS.

Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China

ObjectiveTo evaluate changes in admission rates for and quality of healthcare of ST-segment-elevation myocardial infarction (STEMI) during the period of the COVID-19 outbreak and postoutbreak.MethodsWe conducted a retrospective study among...

“13 Reasons Why”: An Analysis of Pediatric Psychiatric Visits Pre and Post Release of A Popular Netflix Show Detailing Pediatric Suicide

Background: Among Americans, child suicide is the second leading cause of death between the ages of 10-24 years. The release of “13 Reasons Why” (www.netflix.com/title/80117470), one of the most popular Netflix series, has caused controversy as proponents feel it serves as a catalyst for conversation for issues people with mental illness face. On the other hand, opponents state it may sensationalize or glamorize suicide. We hypothesized that after the release of “13 Reasons Why” on March 31, 2017, there may be an increase in the numbers of patients between 10 and 20 years of age presenting to Emergency Departments (EDs) with the chief complaint of suicide attempt (SA), suicide ideation (SI), self-harming (SH) and other psychiatric complaints. We hypothesize that admission rates for psychiatric illness during this time would simultaneously be higher. Methods: Retrospective cohort protocol comparing the number of presentations to 26 emergency departments in the Northeast and Southeast USA for a 60-day period before and after release of “13 Reasons Why”. Data was collected from a proprietary electronic charting system and examined for the numbers of patients seen for SI/SA/SH and for all psychiatric evaluations, with a separate comparison for admission rates and age differences. We examined data from the matching time periods in 2016 to determine if there was a difference in 2017. Results: 3362 patients met criteria for the 120-day period in 2017. 1880 (56%) were female, mean age was 15.9 (95% CI 15.7-16.2), IRQ of 14-17. The number of patients seen in the 60-day post release period was 1799 vs 1563 prerelease (proportion of 0.54 (95%CI 0.52 to 0.56); p value &lt;0.0001) representing a 15% increase post release. There was no significant change in presentations for chief complaints with regards to the combination of SI/SA/SH before (n 218) and after release (n 257) (p &lt;0.08). There was no difference in overall admission rates before and after release (p &lt;0.08) or in admission rates for those who had SI/SA/SH. There was no change in age before or after release: 16.5 years vs 16 years respectively, mean difference 0 (95% CI -0.4 to 0.7, p 0.65). There was a significant difference in total presentation for the 60-day pre vs the post March 31, 2017 time frame, however more patients presented in the pre March 31 period for 2016. While no change in admission rates or SI/SA/SH occurred, there was a 15% increase in overall psychiatric presentations to EDs after release of “13 Reasons Why”. Discussion and Conclusion: Although there was no increase in pediatric psychiatric visits specifically for SI/SA/SH after the release of “13 Reasons Why”, there was a significant increase in overall psychiatric visits in the pediatric ED after the release of this series. This is in line with our theory that media, and in particular this television show, may have a profound influence on young patients with regards to serious mental health issues. Whether these numbers represent a positive vs negative effect on the psychiatric health of children is unknown.

Relationship between Social Distancing and Admissions for Cerebrovascular Accidents at a Tertiary Medical Center during the COVID-19 Pandemic: A Retrospective, Community-Based Study.

We evaluated the trend of admission of patients with acute cerebrovascular accidents (CVAs) during social distancing measures implemented during the coronavirus disease 2019 (COVID-19) era. The data of patients admitted with transient ischemic attack, ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) to the emergency department of the Hanyang University Seoul Hospital were retrospectively analyzed. The data were compared between the pre-COVID-19 and COVID-19 periods. Poisson regression analysis was performed to evaluate changes in admission rates as a function of the year, social distancing level, and the interaction between the year and social distancing level. The number of admissions for CVAs dropped from 674 in the pre-COVID-19 period to 582 in the COVID-19 period. The decline in the number of admissions for ICH during social distancing measures was statistically significant, while the declines in SAH and ischemic stroke admissions were not. When the social distancing level was raised, admissions for CVAs dropped by 19.8%. The correlation between social distancing and decreased admissions for CVAs is a paradoxical relationship that may be of interest to the field of public health.

Trends and Demographic Disparities in Diabetes Hospital Admissions: Analyses of Serial Cross-Sectional National and State Data, 2008-2017.

To analyze national and state-specific trends in diabetes-related hospital admissions and determine whether disparities in rates of admission exist between demographic groups and geographically dispersed states. We conducted serial cross-sectional analyses of the National Inpatient Sample (2008, 2011, 2014, and 2016) and State Inpatient Databases for Arizona, Florida, Kentucky, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Utah, and Vermont for 2008, 2011, 2014, and 2016/2017 among adult patients with type 1 and type 2 diabetes-related ICD codes (ICD-9 [250.XX] or ICD-10 [E10.XXX, E11.XXX, and E13.XXX]. We measured hospitalization rates for people with diabetes (all-cause hospitalizations) and for admissions with a primary diagnosis of diabetes or diabetes-related complications (diabetes-specific hospitalizations) per 10,000 people per year. Nationally, all-cause and diabetes-specific hospitalizations declined by 3.1% (95% CI -5.5, -0.7) and 19.1% (95% CI -21.6, -16.6), respectively, over 2008 to 2016. The analysis of individual states showed that diabetes-specific admissions in individuals ≥65 years old declined during this time (16.3-48.8% decrease) but increased among patients 18-29 years old (10.5-81.5% increase) and that rural diabetes-specific admissions decreased in just over half of the included states (15.2-69.2% decrease). There were no differences in changes in admission rates among different racial/ethnic groups. Overall, rates of diabetes-related hospitalizations decreased over 2008 to 2016/2017, but there were large state-level differences across subgroups of patients. The rise in diabetes hospitalizations among young adults is a cause for concern. These state- and subpopulation-level differences highlight the need for state-level policies and interventions to address disparities in diabetes health care use.

Trends of perinatal mental health referrals and psychiatric admissions in Queensland.

Perinatal depression is often underdiagnosed; consequently, many women suffer perinatal depression without follow-up care. Screening for depressive symptoms during the perinatal period has been recommended in Australia to increase detection and follow-up of women suffering from depressive symptoms. Screening rates have gradually increased over the last decades in Australia. To explore trends in referrals of women to community mental health services during the perinatal period, and prenatal and postnatal admissions to psychiatric units, among those who gave birth in Queensland between 2009 and 2015. Retrospective analyses of data from three linked state-wide administrative data collections. Trend analyses using adjusted Poisson regression models examined 426,242 births. Outcome variables included referrals to specialised mental health services; women admitted with a mood disorder during the second half of their pregnancy and during the first 3 months of the postnatal period; and women admitted with non-affective psychosis disorders during the second half of their pregnancy and during the first 3 months of the postnatal period. We found an increase in mental health referrals during the perinatal period over time (adjusted incidence rate ratio, 1.07; 95% confidence interval, [1.06, 1.08]) and a decrease in admissions with mood disorders during the first 3 months of the postnatal period (adjusted incidence rate ratio, 0.95; 95% confidence interval, [0.94, 0.98]). We did not find any changes in rates of admission for other outcomes. Since the introduction of universal screening in Queensland, referrals for mental health care during the perinatal period have increased, while admissions for mood disorders in the first 3 months after delivery decreased.

Collateral Effects and Mortality of Kidney Transplant Recipients during the COVID-19 Pandemic.

Collateral effects and consequences of the coronavirus disease 19 (COVID-19) pandemic on kidney transplant recipients remain widely unknown. This retrospective cohort study examined changes in admission rates, incidences of diseases leading to hospitalization, in-patient procedures, and maintenance medication in long-term kidney transplant recipients with functioning graft during the early COVID-19 pandemic in Germany. Data were derived from a nationwide health insurance database. Analysis was performed from March 15 to September 30 and compared the years 2019 and 2020. Effects on mortality and adverse allograft events were compared with COVID-19-attributed effects. A total of 7725 patients were included in the final analysis. Admissions declined in 2020 by 17%, with the main dip during a 3-month lockdown (-31%) but without a subsequent rebound. Incidences for hospitalization did not increase for any investigated disease entities, whereas decreasing trends were noted for non-COVID-19 pulmonary and urogenital infections (incidence rate ratio 0.8, 95% CI, 0.62 to 1.03, and 0.82, 95% CI, 0.65 to 1.04, respectively). Non-COVID-19 hospital stays were 0.6 days shorter (P=0.03) and not complicated by increased dialysis, ventilation, or intensive care treatment rates. In-hospital and 90-day mortality remained stable. Incidences of severe COVID-19 requiring hospitalization was 0.09 per 1000 patient-days, and in-hospital mortality was 9%. A third (31%) of patients with calcineurin-inhibitor medication and without being hospitalized for COVID-19 reduced doses by at least 25%, which was associated with an increased allograft rejection risk (adjusted hazard ratio 1.29, 95% CI, 1.02 to 1.63). COVID-19 caused 17% of all deaths but had no significant association with allograft rejections. All-cause mortality remained stable (incidence rate ratio 1.15, 95% CI, 0.91 to 1.46), also when restricting analysis to patients with no or outpatient-treated COVID-19 (0.97, 95% CI, 0.76 to 1.25). Despite significant collateral effects, mortality remained unchanged during the early COVID-19 pandemic. Considerable temporary reductions in admissions are safe, whereas reducing immunosuppression results in increased allograft rejection risk.

Improving Code Status Documentation Rates Using Communication Skills Training in Vascular Surgery: A Quality Improvement Initiative.

Introduction: Code status discussions are poorly understood by patients and variably performed by admitting providers, yet they are used as a quality metric. Surgical specialties, such as Vascular Surgery, admit patients with urgent and life-threatening illness. Surgical trainees are less likely to receive communication skills interventions when compared with nonsurgical specialties. Without a documented code status, nurses and physicians lack guidance on patient preference in the case of cardiopulmonary arrest and may deliver unwanted measures, which may also result in poor outcomes. Methods: We conducted a before-after Plan-Do-Study-Act quality improvement project between May 2018 and May 2019. A needs assessment included baseline code status documentation rates for the Vascular Surgery department admissions. A communication skills training (CST) and documentation intervention was provided to all Vascular Surgery trainees and advance practice providers (APPs). Departmental e-mails were sent over the 12-month intervention period, which demonstrated the code status documentation rates and served as reminders to document code status. Results: A total of 29 vascular surgery trainees and APPs received the intervention. At completion of the intervention, learners reported increased comfort initiating a code status discussion, making a recommendation for cardiopulmonary resuscitation (CPR) status, and having a strategy to discuss code status. A total of 2762 patient admissions were reviewed, with 1562 patient admissions occurring during the 12-month intervention period. The average code status documentation rate for the three months before the intervention was 7.8%. At the end of the 12-month intervention, documentation rates were 44.9% and 6 months after completion of the study period, average rates remained 45.2%. There was no change in admission rates during the study period. Discussion: CST and regular reminders increased vascular surgery residents' and APPs' comfort in engaging in code status discussions. After intervention, documentation of code status discussions increased with persistence up to six months after the intervention.

Withdrawal: “Admissions for and quality of care of ST‐segment‐elevation myocardial infarction in the post COVID‐19 era in China” Junxiong Ma, Suduo Zhou, Na li, Xuejie Dong, Mailikezhati Maimaitiming, Yinzi Jin, Zhi‐Jie Zheng

To evaluate changes in admission rates for and quality of care of ST-Segment-Elevation Myocardial Infarction (STEMI) during the period of the coronavirus disease 2019 (COVID-19) outbreak and post COVID-19 era. We conducted a retrospective cohort study of patients with STEMI in the outbreak era (between January 23, 2020 and March 27, 2020), and the post era (between March 28, 2020, and July 31, 2020) in Suzhou Province, drawn from the China Chest Pain Center Database. 1965 STEMI admissions were enrolled. During the corresponding period of 2019 to the post COVID-19 era, there were a 53% and 38% fall in admissions in outbreak and the post era. There remained a gap in actual number of admissions at 306 and the predicted number that might be at 497. An estimated 26 deaths due to STEMI would have been caused by not seeking health care while no one died from COVID-19. The percentage of STEMI cases transferred by ambulance decreased from 9.3% to 4.2% (P=0.013). Door-to-balloon and the FMC-to-device median (q1, q3) time increased from 17.5 (10.0, 46.0) and 52.0 (12.0, 86.0) minutes to 34.0 (15.0, 48.0) and 63.0 (15.0, 94.0) minutes, respectively (p=0.001, p=0.005), and rate of PCI practice declined from 71.3% to 60.1% (p=0.002). The impact of public health restrictions in the post COVID-19 era is significant, and may lead to unexpected out-of-hospital deaths and compromised quality of STEMI care. Delay or absence in presentation in STEMI patients should be continuously considered to avoid the secondary disaster of the pandemic. System delay should be modifiable for reversing the worse clinical outcomes from the COVID-19 outbreak, by coordination measures with focus on the balance between timely PCI procedure and minimizing contamination of cardiac catheterization rooms.

Mental Health Services during the COVID‐19 pandemic in Abu Dhabi, UAE

United Arab Emirates is demonstrating a model to the world in its response to the crisis and dealing with a pandemic that has provoked unprecedented health care delivery changes. Here, the authors describe how services were remodeled to safely manage patients with mental disorders in the largest admitting psychiatric facility in the capital city Abu Dhabi, the Behavioral Science Pavilion in Sheikh Khalifa Medical City. The article illustrates the changes in admission rates, outpatient clinic and emergency room visits, paving the way for a pliable mental health service that copes with unpredictable circumstances.

Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh.

With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections. A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing. This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.

Unnecessary Inpatient Admissions at For-Profit Hospital Chains

A number of False Claims Act lawsuits have alleged that managers at for-profit hospitals pressured physicians, using feedback and manipulation of defaults, to admit patients unnecessarily from the emergency department. Using 100% hospital records from Florida for 2015-2017, we estimate that admission rates were 7 percentage points (20%) higher at for-profit hospitals. We additionally describe admission rate trends from 2007-2017 at two hospital systems that paid large penalties to the Department of Justice for unnecessary admissions. The timing of pre- and post-investigation changes in admission rates and our cross-sectional estimates are consistent with allegations that administrators influenced physicians’ admission decisions.

Changes in Clinical Characteristics among Febrile Patients Visiting the Emergency Department before and after the COVID-19 Outbreak.

PurposeConsidering the risk of coronavirus disease (COVID-19) transmission through infected droplets, emergency department (ED) operations in response to febrile patients should be planned. We investigated the general and clinical characteristics of febrile patients visiting the ED and changes in admission rates via the ED during the COVID-19 outbreak.Materials and MethodsWe performed a retrospective analysis of prospectively collected patients who visited 402 EDs in the Republic of Korea with febrile symptoms between January 27 and May 31, 2020 and compared them to those enrolled before the COVID-19 outbreak. The primary outcome was admission rate; the secondary outcome was length of stay (LOS) in the ED.ResultsIn total, 266519 patients had febrile symptoms at ED presentation after the COVID-19 outbreak. In 2019, before the outbreak, there were 437762 patients. The rate of ED visits among pediatric patients (aged <15 years) decreased to 21.4% after the COVID-19 outbreak, compared with 41.8% in 2019. The proportion of patients admitted after ED management was higher after the outbreak (31.3%) than before (25.2%). The adjusted odds ratio for admission was 1.04 (95% confidence interval: 1.02–1.05) after the outbreak. Compared to before the COVID-19 outbreak, the median ED LOS increased by 16 min after the outbreak.ConclusionThis study confirmed that admission rates and ED LOS increased for febrile patients visiting the ED after the COVID-19 outbreak. This could provide evidence for developing ED-related strategies in response to the ongoing COVID-19 outbreak and other infectious disease pandemics.