Ward Characteristics Research Articles

Motif discovery in hospital ward vital signs observation networks

Vital signs observations are regular measurements used by healthcare staff to track a patient’s overall health status on hospital wards. We look at the potential in re-purposing aggregated and anonymised hospital data sources surrounding vital signs recording to provide new insights into how care is managed and delivered on wards. In this paper, we conduct a retrospective longitudinal observational study of 770,720 individual vital signs recordings across 20 hospital wards in South Wales (UK) and present a network modelling framework to explore and extract behavioural patterns via analysis of the resulting network structures at a global and local level. Self-loop edges, dyad, triad, and tetrad subgraphs were extracted and evaluated against a null model to determine individual statistical significance, and then combined into ward-level feature vectors to provide the means for determining notable behaviours across wards. Modelling data as a static network, by aggregating all vital sign observation data points, resulted in high uniformity but with the loss of important information which was better captured when modelling the static-temporal network, highlighting time’s crucial role as a network element. Wards mostly followed expected patterns, with chains or stand-alone supplementary observations by clinical staff. However, observation sequences that deviate from this are revealed in five identified motif subgraphs and 6 anti-motif subgraphs. External ward characteristics also showed minimal impact on the relative abundance of subgraphs, indicating a ‘superfamily’ phenomena that has been similarly seen in complex networks in other domains. Overall, the results show that network modelling effectively captured and exposed behaviours within vital signs observation data, and demonstrated uniformity across hospital wards in managing this practice.

Association Between Serum Levels of Vitamin D and Biochemical Markers Among Hematopoietic Stem Cell Transplantation Candidates: A Cross-Sectional Study

Background: Although vitamin D has been known as an effective substance in bone homeostasis, recent studies indicated a number of other biological properties attributed to vitamin D. Patients, who are candidates for hematopoietic stem cell transplantation (HSCT), were shown to be at high risk of vitamin D deficiency. Objectives: This study aimed at exploring the association between serum levels of vitamin D and biochemical markers among HSCT candidates. Methods: Totally, 214 patients, aged 18 to 65 years, were recruited in the current cross-sectional study. Within 24 hours of admission to the Bone Marrow Transplant ward, baseline clinical and demographic characteristics of study participants, serum levels of vitamin D, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, albumin, total protein, CRP-albumin ratio (CAR), and body mass index (BMI) were assessed. Participants were divided into 4 groups based on their serum vitamin D levels: subjects with deficient, insufficient, sufficient, and optimal levels of vitamin D. Results: Across the 4 defined categories of serum vitamin D levels, there was no significant difference in terms of BMI, laboratory parameters, inflammatory factors, and biochemical markers. This lack of significant variation remained in both unadjusted and adjusted models. Conclusions: These observations indicate a lack of significant association between serum vitamin D levels and BMI, inflammatory factors, and biochemical markers in individuals undergoing evaluation for HSTC.

Spatial experience of cancer inpatients in the oncology wards: A qualitative study in visual design aspects

PurposeThis paper aims to explore how the visual characteristics of cancer wards' interior spaces can be improved based on the combined visual design themes to help cancer inpatients’ spatial experience and relieved state of mind. Accordingly, we present a visual design framework that can be applied in oncology wards. MethodThis study adopts the Ulrich-supportive design theory as a theoretical framework using two main methodological phases: observation of cancer wards and interviews with professional caregivers. The first phase critically explores hospital cancer wards' interactive aesthetical and visual interior characteristics. Next, we adjusted the visual criteria based on the Post Occupation Evaluation (POE) method to develop the interview questions. Interviews were conducted with experienced nurses, oncologists, and a general physician, all from a cancer ward at McGill University Health Center (MUHC) in Montreal, Canada. ResultsWe presented 11 main themes in the categories of color and light, natural/artistic images, way-finding, and visual clutter. To present and justify our visual design framework, these main themes were then classified based on the common goals, resulting in four combined themes: applying simplicity and usability; developing naturality; creating homeyness and respecting patients’ agency; and promoting trustworthiness. ConclusionOur findings suggest that—apart from the last theme, promoting trustworthiness, the rest are in line with Ulrich's supportive design theory. Therefore, further research is needed to investigate “promoting trustworthiness” in the context of cancer wards. In addition, each aspect of the visual design framework can offer practical design recommendations for future studies.

Transferring inpatients between wards drives large nosocomial COVID-19 outbreaks, Wales, 2020–22: a matched case–control study using routine and enhanced surveillance data

The role of the hospital environment in the spread of COVID-19 is unclear. To measure associations between ward characteristics and outbreak size to inform mitigations. Wards with large (case wards) and small (control wards) outbreaks in three acute hospitals were compared. Cases were healthcare-associated COVID-19 inpatients (positive polymerase chain reaction test ≥8 days post admission). Case wards were adult medical/surgical wards with ≥10 cases within rolling 14-day periods, between April 1st, 2020 and April 30th, 2022. Control wards were equivalents with 2-9 cases. Demographic and laboratory data were extracted from routine surveillance systems. Continuous data were aggregated fortnightly and analysed as binary variables according to median values. Each case ward was compared with two control wards matched on outbreak start date (±14 days) to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) using univariable and conditional multivariable logistic regression. From 170 outbreaks (median: 5 cases; interquartile range: 2-9), 35 case wards were identified. Community admissions were lower in case wards vs control wards (5 vs 10 median admissions; P<0.01, respectively), whereas transfers between wards within the same hospital were higher (58 vs 29 median transfers; P<0.01, respectively). Wards with more transfers in the preceding fortnight were significantly more likely to experience a large outbreak (≥35 vs <35 transfers; adjusted OR: 9.08; 95% CI: 2.5-33). We recommend safely minimizing patient movements, such as by asking clinicians to record the rationale for transfer, to reduce the likelihood of disease transmission.

2329. What Causes a Cluster to Grow? Factors Associated with a Nosocomial COVID-19 Cluster at a University Hospital in Central Tokyo

Abstract Background Coronavirus disease 2019 (COVID-19) remains a significant threat to hospital infection control. Despite the decrease in severity and mortality associated with changes in the variants of concern and increased vaccination, SARS-CoV-2 transmissibility remains high, and nosocomial clusters continue to be reported in various countries. Although COVID-19 may be detected in multiple patients and healthcare workers (HCWs) in a given ward within a few days, it is uncertain whether these cases will develop into a large cluster. Methods The present, retrospective cohort study of nosocomial COVID-19 clusters was conducted at Tokyo Medical and Dental University Hospital from January 2022 to January 2023 using data from the hospital’s infection prevention and control team. A nosocomial COVID-19 cluster was defined as consisting of more than 2 COVID-19 cases occurring within 5 days in the same ward. Cases with a clear epidemiological link and clusters outside the ward were excluded. We collected information regarding community trends, the index case details, and each cluster's ward profile. Predictors of cluster expansion to more than 5 cases were also examined. Results 66 clusters were identified at the hospital during the study period. The median number of COVID-19 cases per cluster was 3 (range: 2-22), and their median duration was 5 days (range: 1-27). 37 (56.1%), 25 (37.9%), and 4 (6.1%) clusters comprised both inpatients and HCWs, only HCWs, and only patients, respectively. The index case of 51 clusters (77.3%) was a HCW. 18 (27.3%) and 47 (72.7%) clusters contained &amp;gt; 5 and &amp;lt; 5 cases, respectively. No significant intergroup difference was found in terms of community prevalence, index case and ward characteristics, the rate of close contact or history of previous clusters. However, “clusters occurring during the non-epidemic period” and “infections &amp;gt; 3 occurring within 3 days” tended to develop into clusters containing more than 5 cases. Conclusion Nosocomial clusters can occur anywhere, and predicting them is challenging. Further research is needed to identify the factors leading to cluster development and to establish effective infection prevention and control measures. Disclosures All Authors: No reported disclosures

The nurses' perception of the factors influencing professional misconduct: A qualitative study.

Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. This study aimed to explain the factors influencing professional misconduct in nurses. This qualitative study was conducted using the conventional content analysis method. Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

Physical Activity in People With Dementia Living in Long-Term Care Facilities and the Connection With Environmental Factors and Behavior.

This study is conducted in order to gain a better understanding of the relationship between physical activity and agitated behavior among older people with dementia, and physical activity and characteristics of long-term care wards. Data were collected among people with dementia living in long-term care facilities (N = 76) by conducting observations at the wards and distributing questionnaires among professional caregivers. The results show that participants are largely inactive (82.8%) and a significant relation was found between the degree of physical activity and characteristics of the ward such as "taking sufficient time," which relates to the time caregivers take when interacting with residents. This study supports the existing knowledge about the degree of physical activity among people with dementia in long-term care and adds information about the potential influence of organizational factors that could be valuable for daily practice.

Integrating TB screening into house-to-house polio vaccination campaigns.

In July 2019, the Anambra State (south-east Nigeria) TB Control Programme implemented the integration of TB case-finding with the polio vaccination campaign with the support of the WHO. To improve TB case-finding from communities leveraging already existing polio structures. Vaccination teams were trained to ask for symptoms of TB in each household and to document details of people presumed to have TB. Community TB workers subsequently tracked those identified for subsequent sample collection. We report the numbers detected, and the proportion of wards that reported people with TB. Regression analyses were used to estimate the relationship between ward characteristics and reporting. Odds ratios (ORs) with associated 95% confidence intervals (CIs) are also reported. Of 281 people with presumptive TB, 32 were diagnosed with TB; 21% (70/330) of wards identified at least one presumptive, while 5% (18/330) of the people were identified with TB. Peri-urban slums were most likely to identify presumptives (adjusted OR [aOR] 11.52, 95% CI 1.62-81.79), while Riverine areas were most likely to identify a person with TB (aOR 3.59, 95% CI 1.16-11.01). Integrating community TB case-finding into house-to-house vaccination campaigns can boost case detection. This approach proved effective in areas perennially underserved by routine healthcare services.

Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU

Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.

Implementation fidelity of a multifactorial in-hospital fall prevention program and its association with unit systems factors: a single center, cross-sectional study

BackgroundFalls are a common, costly global public health burden. In hospitals, multifactorial fall prevention programs have proved effective in reducing falls’ incidence; however, translating those programs accurately into daily clinical practice remains challenging. This study’s aim was to identify ward-level system factors associated with implementation fidelity to a multifactorial fall prevention program (StuPA) targeting hospitalized adult patients in an acute care setting.MethodsThis retrospective cross-sectional study used administrative data on 11,827 patients admitted between July and December 2019 to 19 acute care wards at the University Hospital Basel, Switzerland, as well as data on the StuPA implementation evaluation survey conducted in April 2019. Data were analysed using descriptive statistics, Pearson’s coefficients and linear regression modelling for variables of interest.ResultsThe patient sample had an average age of 68 years and a median length of stay of 8.4 (IQR: 2.1) days. The mean care dependency score was 35.4 points (ePA-AC scale: from 10 points (totally dependent) to 40 points (totally independent)); the mean number of transfers per patient -(e.g., change of room, admission, discharge) was 2.6 (range: 2.4– 2.8). Overall, 336 patients (2.8%) experienced at least one fall, resulting in a rate of 5.1 falls per 1’000 patient days. The median inter-ward StuPA implementation fidelity was 80.6% (range: 63.9–91.7%). We found the mean number of inpatient transfers during hospitalisation and the mean ward-level patient care dependency to be statistically significant predictors of StuPA implementation fidelity.ConclusionWards with higher care dependency and patient transfer levels showed higher implementation fidelity to the fall prevention program. Therefore, we assume that patients with the highest fall prevention needs received greater exposure to the program. For the StuPA fall prevention program, our results suggest a need for implementation strategies contextually adapted to the specific characteristics of the target wards and patients.

Interprofessional weaning boards for invasively ventilated patients in intensive care units: Qualitative interview study with healthcare professionals in Germany.

Numbers of mechanically ventilated patients are increasing worldwide. Weaning Boards could support weaning from the ventilator by facilitating interprofessional consultations between Weaning Centers and nonpneumological intensive care units. This study, which is linked to the project Prevention of invasive Ventilation, aimed to explore the design and implementation of future Weaning Boards. Semistructured interviews were conducted with physicians, nurses, respiratory therapists, and physiotherapists of intensive care units and Weaning Centers in Baden-Wuerttemberg, Germany. Participants were asked to share their views on (a) required characteristics of Weaning Boards and (b) the current care of weaning patients in their wards. Qualitative data analysis included inductive and deductive steps referring to the Template for Intervention Description and Replication checklist and the Consolidated Framework for Implementation Research. The 14 interviewed healthcare professionals addressed characteristics of future Weaning Boards including (a) preconditions, (b) procedure, (c) interprofessional participants, (d) type of performance, and (d) time frame. Identified determinants for successful implementation were related to (a) individual characteristics of healthcare professionals, (b) ward characteristics, and (c) healthcare system characteristics. Weaning Boards could be a useful tool to advance knowledge sharing between professionals, improve education about weaning protocols, and support patient-oriented care. The implementation of Weaning Boards can be influenced by individual characteristics of participating professionals, difficulties in the interaction between professional groups, the present workplace culture, and the current coronavirus disease 2019 (COVID-19) pandemic.

Depressive symptoms and violence exposure in a population-based sample of adult women in South Africa.

Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women's elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17-1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54-2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.

Application Model of Nurse Electronic Rostering Software (NERS) In Hospital Ward

Introduction: Good scheduling arrangements are needed so that there is no physical, emotional and psychological fatigue to nurses, which will have a negative impact on the performance of nurses in providing services to patients. This study aims to develop an application model for the electronic rostering of nurses in the ward. Methods: The design in this study was Research and Development (R&amp;D). The population of this study was all nurses who worked in the inpatient room. The sampling technique used was simple random sampling. Data for the assessment of scheduling characteristics were collected using questionnaire based on formulation of the problem and Focus Group Discussion (FGD). Data analysis is in descriptive form. Results: Most of the respondents considered that ward scheduling characteristics were sufficient (80.2%). The development of electronic rostering model emphasizes on optimizing the needs and distribution of nurses, equalizing shift and off, and reducing time for preparing schedules. The development of an electronic rostering model was also adjusted to the policies of the hospital regarding the nurses’ work scheduling method so that it can be implemented appropriately in the ward. Conclusion: The development of an electronic work scheduling model for nurses in the inpatient room includes: division based on the level of patient dependence, scheduling flexibility by proposing early holidays and leave, and reducing the duration of nurses' rostering preparation.

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature.

IntroductionOn psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards.MethodIn Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included.ResultsThe prevalence of aggressive behaviour on psychiatric wards varied (8–76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy.ConclusionDespite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.

Ward-level factors associated with methicillin-resistant Staphylococcus aureus acquisition-an electronic medical records study in Singapore.

Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years. Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders. Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.

Aggressive patient behaviours and unplanned nursing staff leave - is there an association?

Mental health nurses are exposed to high levels of aggressive and challenging patient behaviours. This can cause stress and burnout which is associated with poor staff, patient, and organization outcomes, including unplanned nursing staff leave (UNSL). This study explores the correlation between a patient behaviour tool (RAGE), variations of which are frequently used in mental health and psychogeriatric nursing, and the staff outcome of UNSL. The study is reported according to the STROBE Statement for reporting of observational studies. RAGE scores and ward characteristics were recorded weekly for 26weeks on an Australian metropolitan psychogeriatric ward and correlated with UNSL for the same week and the following week (allowing for any 'lag effect' behaviours may have on leave). There was a moderate negative correlation between mean RAGE score and UNSL for the same week (r=-0.34) and no correlation the following week (r=0.08). Similarly, there was low to no correlation between ward characteristics and UNSL. The trends seen in this exploratory study should be further interrogated in adequately powered future studies. UNSL is likely influenced by complex factors including staff experience, coping mechanism, and specific patient behaviours such as physical or verbal aggression and whether the behaviours resulted in injury, which should be included in future studies. The novel strategy of utilizing patient-centred tools to predict staff outcomes is feasible and warrants further exploration.

Does location matter? Investigating the spatial and socio-economic drivers of residential energy use in Dar es Salaam

Africa is set to become a key contributor to global energy demand. Urban growth and the energy use of city residents will drive much of the region’s changing energy picture. However, few studies have assessed residential energy use among African cities, and the heterogeneity in energy use at the sub-city scale. We use the case of Dar es Salaam, which is among Africa’s fastest-growing cities, and to our knowledge, present the first disaggregated estimates of residential energy use at the ward level. We show three main findings. First, we find a statistically significant difference in mean residential energy use among the surveyed wards, which group into four clusters representing distinct levels of household and transport-related energy use. These results show that mean residential energy use (the sum of household and transport-related energy use) is not always correlated with the socio-economic or spatial characteristics of wards—e.g. Msasani (high-income, formal ward) showed similar residential energy use as Keko (low-income, informal ward). Second, we show differences in energy use and fuel switching that occur between low-income and high-income wards: wood fuel (i.e. charcoal) is a majority contributor to residential energy use in low-income wards (Buguruni, Keko and Manzese), compared to gas, electricity and transport oils in high-income wards (Msasani and Kawe). Finally, regression models indicate that ward density has a statistically significant effect on transport-related energy use, while fuel stacking and proxies for household wealth have a statistically significant effect on household-related energy use. To conclude, we recommend that policymakers account for ward level differences in residential energy use when crafting energy sector strategies for Dar es Salaam (e.g. electrification, energy-efficient cooking, or public transportation initiatives). Policymakers may also anticipate possible convergence towards higher levels of energy use and a shift towards modern fuels, as wards develop socio-economically over time.

Factors associated with involuntary admissions: a register-based cross-sectional multicenter study

BackgroundDespite the EU recommendations on mental health, involuntary admission has been under researched in Italy for a long time and the overall picture of involuntary admission still appears fragmentary. The aims of this study are to evaluate involuntary admission rates in the Piedmont Region (Italy) and to investigate clinical and service-related variables associated with involuntary admission.MethodsThis is a cross-sectional retrospective multicenter study involving all psychiatric inpatients units of the general hospitals of Piedmont Region. Data on hospitalizations during 2016 were collected by consulting hospital discharge registers. The analyses were performed on two samples: 6018 patients (data analysis was run on first hospitalization during the study period for those with multiple admissions) and 7881 inpatient episodes. The association between involuntary admission and socio-demographic and clinical characteristics was examined through t-test for continuous variables, and Pearson’s Chi-square test for categorical variables. Multilevel modeling was applied in logistic regression models with two levels: for the first model center and participants and for the second model center and inpatient episodes.ResultsOf 6018 inpatients, 10.1% were admitted involuntarily at first hospitalization, while the overall compulsory treatment rate was slightly lower (9.1%) in the inpatient episodes sample (n = 7881). The involuntary admission rates ranged from 0.8 to 21% among study centers. Involuntary admissions were primarily associated with younger age, diagnosis of schizophrenia or substance use disorders, longer duration of hospital stay, mechanical restraint episodes, and fewer subsequent hospitalizations during the study period.ConclusionsThe rate of involuntary admission in the Piedmont Region was lower than the mean rate across countries worldwide. There were noteworthy differences in rates of involuntary admission among psychiatric units, although no relationship was found with characteristics of the psychiatric wards or of the areas where hospitals are located.

Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital.

In the UK, it is recommended that hospital patients have their nutritional status assessed within 24h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments. A single-centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2years, matched to ward nurse staffing levels. We used mixed-effects logistic regression to control for ward characteristics and patient factors. Of 43451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24h of admission. Missed assessments varied between wards (8-100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR)=1.09, P=0.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR=0.80, P<0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR=0.97, P=0.011). Despite a written hospital policy requiring a nutritional assessment within 24h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.

Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey

ObjectiveTo delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes.DesignCross-sectional analytical...