Current Hospital Research Articles

Abstract 4136509: Children in Foster Care with Heart Disease Have Greater Resource Utilization and Mortality

Background: While children and youth in foster care (CYFC) have greater healthcare needs generally, data are lacking in heart disease. We characterize CYFC with heart disease, assess the impacts of being in foster care on outcomes, and examine validity of ICD-10 code Z62.21 for identification of CYFC in administrative data. Methods: In this single-center, retrospective cohort study of all cardiac surgical patients (<18yo) admitted 2017-2022, CYFC were identified using institutional Electronic Medical Records via natural language processing or ICD codes, with confirmation by chart review. Demographics, medical characteristics and outcomes of CYFC were compared to children not in foster care. Generalized linear models assessed associations with primary outcomes of mortality at current follow-up (logit link) and total hospital days (log link), controlling for clinical factors and length of follow-up. We separately added Child Opportunity Index (COI) and payer to models. This cohort was then studied in the administrative pediatric health information system (PHIS) dataset to calculate ICD code sensitivity and specificity. Results: Of 4,431 cardiac surgical patients, 67 (1.5%) were in foster care. CYFC did not have significantly higher mortality (9% vs 5.8%), 30-day readmission or cardiac reoperation, number of complex chronic conditions (CCC), RACHS-2, or distance from center compared to non-CYFC. CYFC had lower COI (median 61 vs 72, p=0.016) and more Medicaid coverage (87% vs 40%, p<0.001). Length of stay after index surgery was similar; however, cumulative hospital days during the study were significantly higher for CYFC (median 22 [IQR 10,45] vs 12 [6,27], p<0.001). Adjusting for RACHS-2, CCC, age, readmission, reoperation, and follow-up duration, CYFC had higher odds of mortality (2.7 [95%CI 1.0,6.9] p=0.046) and more total hospital days (p=0.008). With COI or payer in the model, CYFC was not associated with mortality but remained an independent risk factor for more total hospital days. Only 16/67 (23.9%) of CYFC were coded with the Z62.21 in PHIS, yielding sensitivity of 21.9% (95%CI 13.1,33.1), and specificity of 100% (99.9,100). Conclusion: CYFC with heart disease have a relative social disadvantage, greater hospital resource utilization, and long-term mortality despite similar illness severity. Improved capture of foster care status in administrative data is needed to guide future studies and reduce health disparities for the vulnerable population of CYFC.

Envisioning the sustainable and climate resilient hospital of the future

ObjectivesThis study aims to create a vision of the future hospital to help healthcare leaders understand how changes in society and the healthcare system, compounded by climate change, could affect future hospital estate. Study designThe study is part of a larger project based on participatory backcasting aimed at providing integrated strategies for transitioning to a zero-carbon future and adapting to existing climate change through improved asset management. MethodsThe data presented in this paper were collected during a full-day workshop to construct the vision of the future hospital in 2050. A multidisciplinary team of 19 participants participated in the discussions. A six-phase thematic analysis was applied to the data to develop the narrative vision and graphic recording. ResultsThe healthcare system is undergoing transformative changes due to evolving healthcare delivery, patient expectations, emerging technologies, climate change, and sustainability. However, current hospital strategies often fail to consider the interrelationship between the hospital estate and its socio-environmental context. Policymakers, healthcare system leaders, and hospital leaders need a clear vision of the hospital of the future to implement transformational strategies. ConclusionsHealthcare transformations require shifting from traditional centralised hospitals to a more flexible, distributed model. Healthcare leaders need to proactively assess how hospitals respond to current and future hazards and consider the impacts within the context of integrated and dispersed healthcare delivery. To address this, a systematic approach to modelling hazards and evaluating design or upgrading options is essential to mitigate the transfer of climate-related risks within healthcare systems.

Out-of-Pocket Expenditure in Patients admitted to Cardiology Department under ABPMJAY scheme in a Tertiary Care Hospital in Delhi: A Cross-Sectional Study

Introduction: The recent National Health Accounts 2019-20 data reveals that Out-of-Pocket Expenditure (OOPE) as a percent of Total Health Expenditure is more than 47% which is still higher compared to out-of-pocket health spending in other developing nations. Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), the world’s largest public-funded social health insurance scheme is a by-product of National Health Policy 2017 recommendations to achieve Universal Health Coverage and reduce OOPE in health. The present study was conducted to know the OOPE among the patients admitted to the Cardiology department under AB-PMJAY scheme in a tertiary care hospital in New Delhi. Methods: A descriptive cross-sectional study was carried out from January 2021 to April 2022 among the patients admitted under the PMJAY scheme in the Cardiology Department of Tertiary Care Hospital in New Delhi. A total of 320 patients were interviewed using a structured questionnaire divided into eight sections. The collected data was tabulated in Microsoft Excel and analyzed. Results: The study investigated out-of-pocket expenditure (OOPE) for patients, finding the scheme covered doctor consultations, bed charges, physiotherapy, implants, and oxygen, but some patients still faced OOPE for diagnostics (15%), medicines (22.5%), blood transfusions (8.75%), and ambulance with an average direct medical expenditure of approximately Rs. 1511 during the hospital stay at the current hospital. Compared to previous hospitalizations, OOPE for diagnostics, medicines, and blood transfusions significantly decreased under PMJAY. Overall, 60.3% of respondents were satisfied with the PMJAY scheme. Conclusion: The PMJAY scheme helped the beneficiaries to reduce the financial burden of health to a great extent. However, few of the beneficiaries continued to make some payments from their pockets for diagnosis, medication, etc. The main reason for this was a lack of knowledge and awareness about the scheme among the beneficiary population.

From Cord to Cure: Repurposing Biological Waste for UAE's Health Revolution with Umbilical Cord Stem Cell Therapy

In the UAE, current hospital policies mandate the disposal of biological waste, such as umbilical cords. However, this tissue represents a valuable source of therapeutic material like mesenchymal stem cells (MSCs) and their secretome. The disposal of this valuable therapeutic material imposes a significant burden on public health. In the United States alone, approximately 18,000 people per year are diagnosed with diseases that could be ameliorated with stem cell therapy. These individuals often remain untreated due to the lack of available stem cells, as current methods for MSC obtention, such as Bone Marrow-MSCs, require an invasive bone marrow aspirate procedure, which is painful and can pose risks to donors, including infection and prolonged recovery times. This paper advocates for policy reform to facilitate the collection, storage, and utilization of umbilical cords. By addressing regulatory barriers and implementing standardized protocols, hospitals in the UAE can not only contribute to advancements in regenerative medicine but also solidify the nation’s position as a leader in this emerging field, ultimately improving patient outcomes and reducing the disease burden both locally and regionally. This is particularly relevant given the significant burden of cardiovascular diseases and type 2 diabetes mellitus (T2DM) in the UAE, where 17.3% of the population aged 20 to 79 is affected with T2DM. Cardiovascular diseases and T2DM are few of the many disorders that can benefit from MSC therapy. Utilizing umbilical cord biowaste for such diseases can further build the UAE’s status as a hub for medical tourism and accentuate it’s growing prominence in the field of regenerative medicine.

Counter Accounting and Counter Accountability: A Post‐COVID‐19 Study of England's Hospital Infrastructure Crisis

Post‐COVID‐19 England's health‐care system remains in crisis, with growing waiting lists for elective care and rising backlog maintenance in its hospital infrastructure. The government indicates that its delivery plan issued in 2022, involving additional funding and greater use of the private sector, will tackle this problem. Framed as a consequence of the pandemic, in England, such a framing denies the historic problem of underfunding as well as the rise of financialization. Notably public accountability for health care has received little prominence over the past decade. This study uses an approach based on counter accounting to challenge the prevailing hegemony of English National Health System (NHS) health‐care infrastructure policy and offers a counter‐explanation of the current hospital infrastructure crisis. It examines an alternative set of evidence drawn from publicly available financial statements and other documents to make visible data relating to hospital infrastructure capital and revenue costs. This shows that health care has been systematically underfunded since the start of austerity in 2010, and that even additional funding during COVID‐19 was insufficient to make up the shortfall. Previously weakened accountability mechanisms have been further displaced from the public eye by the rhetoric around COVID‐19, meaning there is little challenge of private sector legitimacy in public health‐care provision, despite its financialized nature. The study considers that instigating strong oversight and evaluation of hospital infrastructure policy is necessary as over the next decade many private sector contracts will terminate and funding is likely to be in short supply.

Radiographs are of limited use and low cost-effectiveness when combined with ultrasound for abdominal restaging in dogs with solid, soft tissue tumours.

The purposes of this study were to assess the frequency of detection of clinically relevant findings by abdominal radiographs and abdominal ultrasound during restaging of solid, soft tissue tumours in dogs and to determine the cost per clinically relevant finding for both modalities. The medical records of 159 dogs which underwent a total of 223 restaging episodes following a diagnosis of a solid, soft tissue tumour within, or with potential for metastasis to, the abdomen were reviewed. Data collected from the sample dogs were reviewed for clinically relevant findings, including local recurrence, lymph node or intra-abdominal metastasis, and other changes that would influence prognosis or management. The clinically relevant findings were compared between abdominal radiographs and abdominal ultrasound. The cost per clinically relevant finding was calculated per modality based on current hospital costs. Clinically relevant findings were observed in 158 restaging episodes. Ninety-two clinically relevant findings were detected with ultrasound alone, and 65 clinically relevant findings were detected with a combination of both modalities. Only one dog had a clinically relevant finding detected with radiographs alone. Findings were identified significantly more frequently with ultrasound than radiographs. Cost per clinically relevant finding was 495 USD (approx. 373 GBP/448 EUR) for abdominal radiographs and 323 USD (approx. 242 GBP/292 EUR) for abdominal ultrasound. Abdominal radiographs were of minimal use beyond abdominal ultrasound for restaging in this study, despite a higher cost per clinically relevant finding than abdominal ultrasound. This study does not support routine use of abdominal radiographs during routine restaging of solid, soft tissue tumours.

Antimicrobial resistance profiles of and associated risk factors for Pseudomonas aeruginosa nosocomial infection among patients at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia.

Antimicrobial resistance (AMR) of pathogens such as Pseudomonas aeruginosa is among the top 10 threats to global health. However, clinical and molecular data are scarce in Zambia. We, therefore, evaluated the AMR profiles of P. aeruginosa nosocomial infections (NIs). A year-long hospital-based cross-sectional study was conducted at two large tertiary-level hospitals in Zambia. Patients with current or previous hospital contact were screened for NIs. The current study focused on patients diagnosed with P. aeruginosa NIs. Clinical specimens were collected for bacteriological culture, and PCR amplification of 16S rRNA gene fragments was performed on pure isolates. Hospital or NIs were defined as infections that arise during hospitalization, occurring at least 48 h after admission. The Kirby-Bauer's disk diffusion method was used to evaluate antibiotic resistance patterns. The association between AMR and risk factors was analysed using the χ2 test. Eight hundred and forty-one patients were screened, and clinical specimens were collected and analysed. Of them, 116 (13.7%) were diagnosed with P. aeruginosa NIs. The participants' ages ranged from 15 to 98 years, with a mean of 51 (SD ± 18). Catheter-associated urinary tract infections (57%) were the most common, followed by pressure sores (38.7%). P. aeruginosa isolates were primarily susceptible to amikacin, which had the highest resistance to FEP. We observed a high prevalence of multidrug resistance (73.6%). The AMR was associated with carbapenem-hydrolysing β-lactamase gene blaOXA-51 and surgical care. This study has demonstrated that multidrug-resistant P. aeruginosa is prevalent in hospitals in Zambia's Lusaka and Ndola districts and possibly countrywide.

All On One Page: Getting Daily Meal Ordering Right In A Rehabilitation Setting

Abstract Background Recently the rehabilitation hospital expanded to over 100 beds providing improved access to rehabilitation for older persons in the area. During this time, an increase in incident report forms occurred due to the incorrect provision of diet/fluid to patients at ward level. In collaboration with relevant stakeholders, the Speech and Language Therapy (SLT) and Dietetic teams reviewed the current hospital meal ordering form and process in order to standardise a new system. The aim of this project was to reduce risk for patients and improve collaborative team working and communication. Methods A multidisciplinary team (MDT) approach was adapted involving; SLT, dietitians, catering department, nursing team and the patient quality and safety department. The HSE change framework provided scaffolding for this work. A new Daily Meal Order form was created and approved by the Nutrition Steering Committee and the process was agreed using input from all stakeholders. A pilot was carried out, reviewed and rolled out across the campus. The number of incidents recorded at ward level was used to measure if risk was reduced. A staff survey was conducted to gather feedback on the new system. Results The new Daily Meal Order form is now being used across the campus. Additional checks are completed each day via email to reduce the risk of errors. No incident reports were filed since launching the new form and process. A staff survey showed that all staff feel the new system and form constitutes an improvement, that it saves clinical time and that they would recommend it to others. Conclusion The project aims have been met in reducing patient risk, in line with the HIQA Safer Better Healthcare Programme. It has also improved MDT working and communication. This project is easily replicable to other settings and staff would recommend this approach to others.

Comparative analysis of learning motivation, strategies, and effectiveness between medical interns and PGY during the pandemic.

In the post-pandemic era, medical education faces significant shifts in learning modes. This study, employing cross-sectional research from 2021 to 2022, surveyed 214 participants, including 104 medical interns and 110 Post-Graduate Year trainees in Taiwan. Findings revealed notable differences between the groups in age and current internship hospital. Medical interns spent significantly more time in daily self-directed learning, with a higher proportion exceeding 3 hours post-work. Although weekly self-directed learning hours did not show statistical significance, more medical students studied over 7 hours weekly. In terms of learning attitudes and motivations, medical interns outscored Post-Graduate Year trainees, indicating a substantial contrast. The study suggests strategic integration of online and traditional education, tailored to course characteristics. Future research should further explore the effectiveness of online learning, aiming to optimize digital learning while preserving traditional education values.

A protocol for enhancing the diagnostic accuracy and predictive validity of neonatal opioid withdrawal syndrome: The utility of non-invasive clinical markers.

Every 15 minutes in the US, an infant exposed to opioids is born. Approximately 50% of these newborns will develop Neonatal Opioid Withdrawal Syndrome (NOWS) within 5 days of birth. It is not known which infants will develop NOWS, therefore, the current hospital standard-of-care dictates a 96-hour observational hold. Understanding which infants will develop NOWS soon after birth could reduce hospital stays for infants who do not develop NOWS and decrease burdens on hospitals and clinicians. We propose noninvasive clinical indicators of NOWS, including newborn neurobehavior, autonomic biomarkers, prenatal substance exposures, and socioeconomic environments. The goals of this protocol are to use these indicators shortly after birth to differentiate newborns who will be diagnosed with NOWS from those who will have mild/no withdrawal, to determine if the indicators predict development at 6 and 18 months of age, and to increase NOWS diagnostic sensitivity for earlier, more accurate diagnoses.

Indirect bypass surgery as a line of management of pediatric moyamoya disease

Moyamoya disease (MMD) is a chronic, rare cerebrovascular disorder of unknown cause featured by extensive narrowing of the terminal internal carotid artery (ICA) and its main branches. As a compensatory mechanism, perforators dilate forming fragile collateral vessels that appear as an abnormal vascular network resembling ‘puff of smoke drifting in the air’ observed via angiography around stenotic area in the brain.Patients and methodsThe database of the current hospital was retrospectively studied. All patients with ischemic strokes owing to MMD treated with surgical revascularization between January 2015 and December 2022 were included. MMD was identified on catheter-based digital subtraction angiography (DSA) by the presence of stenosis at the terminal portions of both internal carotid arteries and the development of abnormal collateral “moyamoya vessels” around the base of the brain. Clinical, radiological and follow-up data were retrospectively analyzed.ResultsDuring the mentioned time window, nine patients were diagnosed with moyamoya disease among all pediatric patients with established diagnosis of ischemic stroke in our institute; six of them underwent surgery. Unilateral EDMS was performed in 5 cases (83.3%), while one patient (16.67%) underwent staged bilateral surgeries with no added neurological deficit.ConclusionIndirect revascularization surgery for pediatric moyamoya-related stroke patients has high rates of reperfusion and promising outcomes.

The Effects of Health Expenditures on Health Outcomes in Türkiye

Aim: In this study, time series and regression analyses were conducted to understand and explore the impact of both public and private health expenditures on health outcomes in Türkiye. Methods: In the study, life expectancy at birth, human development index, disability-adjusted life years per 100,000 people, and share of total health expenditures in Gross Domestic Product (GDP) were employed as dependent variables. Total public and private health investments, current health expenditures for hospitals, current health expenditures for retail sales, and other medical equipment providers were used as independent variables. The data included the period between 2002 and 2019. Results: The results confirm the positive impact of health expenditures in Türkiye, especially public and private health investments, and hospital current expenditures on the burden of disease. However, surprisingly, the results revealed that both public and private health expenditures had no impact on life expectancy at birth, the Human Development Index, or the share of total health expenditures in GDP. As a significant finding, this study demonstrated that public and private health investments and current hospital expenditures in Türkiye have shown improvements in disease burdens, indicating that investment decisions in this area are crucial in terms of both short-term and long-term benefits. Conclusion: These results support the efforts of the country to create a sturdy, objective, and proof-based decision-making process.

What are the benefits of the hospital reform for the care of patients with cancer?

One of the main aims of the current hospital reform is to increase the quality of care by concentrating complex treatments on appropriately qualified service providers. In this context, a concentration of oncological treatment is also planned. The National Cancer Plan adopted in 2008 calls for all people suffering from cancer to receive high-quality care in accordance with evidence-based treatment guidelines in uniformly qualified centres. In order to implement the National Cancer Plan, the German Cancer Society (DKG), in cooperation with all oncological societies, has set up a certification system that ensures these requirements are met. The WiZen study, funded by the Innovation Fund, was able to show by means of controlled cohort studies for 11 cancer entities based on nationwide SHI routine data and regional data from clinical cancer registries that the initial treatment of people with cancer in hospitals with DKG certification is associated with longer overall survival and recurrence-free survival (Fig. 1) [1]. The Innovation Committee of the Joint Federal Committee (G-BA) considered the WiZen study to be evidence that treatment in certified oncology centres can significantly increase the chances of survival for patients and asked the G-BA to examine whether the findings from the WiZen study could be taken into account in a timely manner, e.g. when defining minimum requirements for structural, process and outcome quality [2]. The recommended implementation of the results of the WiZen study in standard care has not yet materialised. Furthermore, a high proportion of patients in numerous entities are treated outside of certified centres.

Rethinking hospital postoperative resource use: A national analysis of pediatric appendectomy patients admitted to children’s hospitals

BackgroundThe increased use of remote monitoring and telemedicine support may help alleviate the need for some of the postoperative inpatient hospital care and reduce health care costs, but little is known about current postoperative hospital resource use patterns. We aim to describe hospital resources use patterns in pediatric patients postappendectomy for complicated appendicitis and to evaluate the potential of earlier discharge with remote monitoring. MethodsThis was a retrospective cohort study using the Pediatric Health Information System database for patients who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Health care use/costs (antibiotics, intravenous fluids [proxy for diet], analgesics, laboratory studies, and imaging tests) were determined using administrative billing data. Potentially avoidable days were defined as nondischarge days without codes for intravenous opioid pain medication or intravenous fluids. Descriptive statistics and logistic regression were used. ResultsIn total, 24,165 patients were included: 8,300 patients (34.3%) had at least 1 potentially avoidable hospitalization day, totaling 13,970 days or 14.2% of all hospitalization days. Median hospitalization cost was $19,434 [$15,658–$25,157], with accommodation and operating room being the greatest contributors. Public insurance and minority races and ethnicities were associated with greater odds of potentially avoidable days. More than 80% of hospitalized patients had intravenous antibiotics through 10 days postoperatively. More than 20% received opioids daily. ConclusionsMore than one third of the patients who underwent laparoscopic appendectomy for complicated appendicitis could have had at least 1 potentially avoidable hospitalization day. Remote monitoring and telemedicine support should be explored and could help with earlier discharge and lower costs.

A cross-sectional study on the self-management of asthma and asthma control among adult asthmatic patients in the Aseer region, KSA

Proper management of asthma is crucial for maintaining control over the disease and has a significant impact on the patient’s overall condition. The purpose of this study was to determine the extent of self-management and the level of Asthma control in the patients from the Aseer region of Saudi Arabia, as well as to investigate determinants of illness control. A study was conducted using quantitative cross-sectional methods. Researchers utilised a web-based, self-administered structured questionnaire to gather data. The questionnaire included three sections: a socio-demographic section, an Asthma Self-Management Questionnaire (ASMQ), and Asthma Control Test (ACT). An analysis using the chi-square test was conducted to determine if there was a notable connection between the socio-demographic characteristics of the participants and the level of asthma control. A total of 305 responses were collected. The average score for the Asthma Self-Management Questionnaire was 5.72, which corresponds to 40.9%. Based on the scores from the Asthma Control Test, it was found that 60 patients (20.0%) had asthma that was not under control, 94 (30.0%) had asthma that was partially controlled, and 151 (50.0%) had asthma that was well controlled. Factors such as gender, non-smoking status, and having asthma for over 10 years (p ˂0.05) were found to be strongly correlated with improved disease control. Significant gaps were found in patients’ awareness of the most important and critical aspects concerning the condition, medications, and preventative actions that limit asthma aggravation. To address the current situation, hospitals and clinics must make substantial efforts.

Surgical Site Infections in Gastrointestinal Surgeries: Estimation of Prevalence, Risk Factors and Bacteriological Profile.

Surgical site infections (SSIs) are one of the leading causes of operation-related adverse effects.To create an effective hospital infection program, information about a local pattern is essential. The ever-changing pattern of infections and inappropriate use of antibiotics has predisposed to the development of drug-resistant strains and has made the management of SSIs arduous. The purpose of this study is to estimate prevalence and identify risk factors and commonest organisms associated with SSIs. In this analytical cross-sectional study, the relationship between various risk factors and the development of SSIswas evaluated in patients undergoing elective surgery and staying at least seven days postoperatively in the Department of Surgical Gastroenterology and Liver transplant for a study duration of two months. Diagnosis of SSIs was based on modified CDC criteria. Wound pus was followed by blood collection in suspected secondary septicemia. MacConkey and blood agar were used to culture pus; brain heart infusion broth was used for blood samples. Antimicrobial susceptibility testing was carried out using Mueller-Hinton agar by the Kirby-Bauermethod. Twelve out of 50 had developed postsurgical wound infections where Gram-negative organisms prevailed over Gram-positive ones. The associated risk factors identified in this study are age, BMI, wound class, American Society of Anesthesiologists (ASA) score, preprocedural WBC count >10,000, and the duration of surgery. Escherichia coli is the causative microbe for the majority of infections (35.7%). Gram-negative bacteria isolated in this study were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant organisms were predominant. Conclusion: The present study identified an SSI rate of 24% in gastrointestinal surgeries. The sensitivity and resistance pattern of the organisms isolated will help in measures to be taken to devise a proper and effective current hospital antibiotic prophylaxis policy.

Assessment of visual problems after acquired brain injury: a survey of current practice in Danish hospitals.

To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury. A survey study. A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey. The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury. Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations. The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.

Strategies for Comprehensive Immune Monitoring of Clinical Trials to Advance Human Immunotherapy in Remote Settings

Abstract Comprehensive immune monitoring of clinical trials relies on the ability to generate high-quality data to gain insights into disease detection and treatment. Execution of longitudinal clinical trials in flow cytometry is complex due to logistical challenges in high-quality sample collection. Our group has developed a novel blood “immune signature” of cancer nonresponsiveness that predicts failure to make a clinical response to checkpoint immunotherapies targeting the PD-1/PD-L1 pathway. Recent advances in CyTOF™ technology allow us to expand clinical implementation to remote settings with a 50-plus-marker panel. CyTOF is the only technology that allows remote asynchronous sample collection with the largest immunophenotyping panel yielding reproducible results. This approach is uniquely enabled using a stable lyophilized large-scale staining panel and achieving comprehensive marker coverage in one panel minimizes blood sample required. CyTOF enables a simplified workflow including blood collection and processing in remote locations to enable the simplest clinical trial infrastructure complexity and cost, easily implemented in current hospital labs. This study is designed to demonstrate the clinical impact and utility of CyTOF for a highly simplified workflow for multi-site clinical trials. We report on the first phase of this project that implements this simplified workflow across remote clinical collection sites, data integration, and analysis.

A Granular Approach to Optimal and Fair Patient Placement in Hospital Emergency Departments

Prolonged emergency department (ED) length of stay (LOS) is associated with detrimental effects on patient care quality and outcomes. There is evidence that certain groups of patients experience longer LOS based on their gender or race, especially with regard to the part of LOS that is attributable to waiting to be seen by a clinician. This work tackles the patient prioritization and placement aspects of ED operations with the goal of improving throughput and wait time in a fair, equitable way. We present a novel Mixed Integer Linear Programming (MILP) predictive-prescriptive formulation that incorporates a breakdown of predicted patient ED LOS into actionable pieces. We incorporate considerations for fairness and reformulate the MILP formulation into a compact and computationally tractable formulation that can be solved efficiently in real time. To deal with uncertainty, we propose a sampling-based solution, and provide provable guarantees regarding its convergence, stability and sample complexity. The proposed solution increases the throughput of the ED by [Formula: see text] and decreases the average wait time by [Formula: see text] compared to current hospital practice. In addition, the method is near-optimal in terms of throughput, and produces high-quality solutions in terms of average wait time compared to a clairvoyant oracle. Our proposed approach demonstrates desirable properties when it comes to fairness in patient prioritization, illustrating a path for addressing hidden biases in patient ED wait times and hospital operations as a whole. This work was conducted in collaboration with a large US academic medical center. Data from more than 40,000 patient visits were used to shape and evaluate the predictive-prescriptive models. An important practical contribution is translating a complex algorithm’s output into recommendations that can be operationalized in the context of existing processes in the ED. Specifically, we develop an interpretable metamodel that is trained to mimic the predictive-prescriptive algorithm’s decisions and provides a transparent set of rules for patient placement. The method will be used by the hospital to improve patient flow and quality of care as well as to support more fair and consistent bed allocation decisions.

Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit.

Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated. In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model. One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7-27.1) for observation and 43.2 hours (95% CI, 37.8-48.6) for inpatient ( P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0-38.6) for observation and 48.1 hours (95% CI, 42.2-54.0) for inpatient ( P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07-2.42) fold shorter time to discharge among children admitted to observation compared with inpatient ( P = 0.02) and a 1.70 (95% CI, 1.07-2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses ( P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department. These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.