Decrease Readmission Rates Research Articles

Readmission Rate, Predictors, Outcomes, and Burden of Readmission of Hepatorenal Syndrome in the United States: A Nationwide Analysis.

Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30-day readmission rates after HRS-related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States. We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The primary outcome was all-cause 30-day readmission rate. Secondary outcomes were inpatient mortality rate, predictors of readmission, and resource utilization. We identified 245 850 hospitalizations of patients admitted for HRS in the United States from 2016 to 2019. Of these, 214 890 met the inclusion criteria. Mean age was 59.16 years, and 61.31% were males. Medicare was the most common primary payer (44.82%) followed by Medicaid (25.58%). The readmission rate was 24.6% within 30 days of discharge from index hospitalization. The most common cause of readmission was alcoholic cirrhosis with ascites (14.87%), followed by sepsis (9.32%) and unspecified hepatic failure (9%). The in-hospital mortality rate for index hospitalization was 29.52% and 14.35% among those readmitted within 30 days. The mean length of stay (12.33 days vs. 7.15 days, p < 0.01) and hospitalization costs ($44 903 vs. $22 353, p < 0.01) were higher for index hospitalizations than readmissions. Our study demonstrated that all-cause 30-day readmission and in-hospital mortality rates after the development of HRS were strikingly high. This warrants health policies and interventions at the institutional level, including close post-hospital discharge follow-up, to decrease readmission rates, improve patient outcomes, and reduce cost burden.

Implementation of Enhanced Recovery After Surgery (ERAS) Protocols and Return to Intended Oncologic Therapy: Where We Were and Where We are Going?

Objective: Enhanced recovery after surgery (ERAS) utilizes a multimodal, evidence-based approach to improvepatient postoperative recovery and return to functional baseline. Among gynecologic oncology patients, ERAS protocols are associated with a decrease in complication rate and shorter hospital stays. With the improved return to baseline function recovery times, oncology patients are able to begin adjuvant therapy within the recommended timeframe as to not impact overall survival. We performed a cohort study at the initiation of our gynecologic Oncology ERAD program to determine if this decreased time to planned adjuvant therapy among gynecologic oncology patients after laparotomy. Secondary endpoints included protocol adherence, length of stay, complication rates, and readmission. Methods: We performed a retrospective chart review of 137 pre-ERAS and 73 post-ERAS patients diagnosed at a NCI-designated comprehensive care center in NJ to compare gynecologic oncologic and peri-operative outcomes before and after implementation of ERAS protocols. The protocols were based on recommendations from the ERAS society for management of gynecologic and gynecologic oncologic patients. Twenty-five interventions were analyzed and 12 were included in the final analysis. Pre-ERAS patients were identified by ICD-10 diagnosis code and CPT laparotomy codes. Patient characteristics, length of hospital stay, and complications rates were recorded. Institutional review board approval was obtained from Rutgers University and the Scientific Review Board approval from the Cancer Institute of New Jersey. Results: Twenty-five protocol elements were investigated, with an overall decrease in readmission rate and complication rate between the pre- and postERAS cohorts. There was no difference in length of hospital stay (median, interquartile range of 5 [4-7] and 5 [3-7] in the pre-ERAS and post-ERAS groups, respectively (P=0.91). Similarly, the two groups did not differ based on time to intended oncologic therapy (38 [29-55] versus 37 [29-53]; P=0.94). Conclusions: This study highlights the need for further research on ERAS protocol on return to intended oncologic therapy which is known to improve overall oncologic outcomes

Patient outcomes after implementation of transitional care protocols in elective neurosurgery: a systematic review and meta-analysis.

30-day readmissions are a significant burden on the healthcare system. Postoperative transitional care protocols (TCPs) for safe and efficient discharge planning are being more widely adopted to reduce readmission rates. Currently, little evidence exists to justify the utility of TCPs for improving patient outcomes in elective neurosurgery. The objective of this systematic review was to determine the extent to which TCPs reduce adverse outcomes in patients undergoing elective neurosurgical procedures. A systematic review and meta-analysis was conducted after PROSPERO registration. Pubmed, Embase, and Cochrane review databases were searched through February 1, 2024. Keywords included: "transitional care AND neurosurgery", "Discharge planning AND neurosurgery". Articles were included if they assessed postoperative TCPs in an adult population undergoing elective neurosurgeries. Exclusion criteria were pediatric patients, implementation of Enhanced Recovery After Surgery (ERAS) protocols, or non-elective neurosurgical procedures. The primary outcome was readmission rates after implementation of TCPs. 16 articles were included in this review. 2 articles found that patients treated with TCPs had significantly higher chances of home discharge. 7 articles found a significant association between implementation of TCP and reduced length of stay and intensive care unit stay. 3 articles reported an increase in patient satisfaction after implementation of TCPs. 3 found that TCP led to a significant decrease in readmissions. After meta-analysis, TCPs were associated with significantly decreased readmission rates (OR: 0.68, p < 0.0001), length of stay (mean difference: -0.57, p < 0.00001), and emergency department visits (OR: 0.33, p < 0.0001). This systematic review and meta-analysis found that an overwhelming majority of the available literature supports the effectiveness of discharge planning on at least one measure of patient outcomes. However, the extent to which each facet of the TCP affects outcomes in elective neurosurgery remains unclear. Future efforts should be made to compare the effectiveness of different TCPs.

Which individual components of a colorectal surgery enhanced recovery program are associated with improved surgical outcomes?

BackgroundEnhanced recovery programs improve surgical outcomes. However, the association of adherence to individual components and outcomes in a comprehensive enhanced recovery program remains unclear. MethodsWe performed a retrospective study of all elective colorectal surgery patients at our institution from 2019 to 2022 (n = 1,175). Data were acquired from our institution’s enhanced recovery program dashboard and American College of Surgeons National Surgical Quality Improvement Program database. Traditional analyses and machine-learning classification trees were used to identify enhanced recovery program components associated with length of stay, readmissions, and complication rates. ResultsThe average length of stay was 5.0 days, readmission rate was 12.3%, and complication rate was 32.6%. On linear regression analysis, adherence to preoperative education, regional analgesia, pre- and postoperative multimodal analgesia, no nasogastric tube, early mobilization, early regular diet, early discontinuation of maintenance intravenous fluids, postoperative venous thromboembolism prophylaxis, and early Foley catheter removal were associated with an decrease in length of stay by 0.7–7.1 days (P < .05). Patients who adhered to no prolonged fasting had a 4.1% decrease in readmission rate (P = .04). Patients who adhered to no nasogastric tube, early mobilization, early regular diet, postoperative multimodal analgesia, and discontinuation of maintenance intravenous fluids had decreases in complication rates ranging from 7.0 to 28.2% (P < .001). Machine learning demonstrated that no nasogastric tube and discontinuation of maintenance intravenous fluids were significant predictors of shorter length of stay and no nasogastric tube and early mobilization were significant predictors of reduced complication rates. ConclusionsAlthough multiple components were associated outcomes, no nasogastric tube, early mobilization, early regular diet, postoperative multimodal analgesia, and early discontinuation of maintenance intravenous fluids were associated with more than 1 outcome. Focusing on these components may make enhanced recovery program implementation more feasible for resource-limited hospitals.

A Comprehensive Guide to Long-Acting Injectable Antipsychotics for Primary Care Clinicians.

We propose a paper that provides education on commonly used long-acting injectable antipsychotics (LAIs) to improve primary care based mental health interventions in patients with severe mental illnesses (SMIs) such as schizophrenia, schizoaffective disorder, and bipolar disorders. With the expanding interface of primary care and psychiatry across all healthcare settings, it has become increasingly important for primary care clinicians to have a broader understanding of common psychiatric treatments, including LAIs. Long-acting injectable antipsychotics have been shown to be helpful in significantly improving treatment adherence, preventing disease progression, improving treatment response, decreasing readmission rates, and reducing social impairment. We discuss evidence-based indications and guidelines for use of long-acting injectable antipsychotics. We provide an overview of the treatment of SMI with LAIs, mainly focusing on the most commonly used long-acting injectable antipsychotics, advantages and disadvantages of each, along with outlining important clinical pearls for ease of practical application. Equipped with increased familiarity and understanding of these essential therapies, primary care clinicians can better facilitate early engagement with psychiatric care, promote more widespread use, and thus significantly improve the wellbeing and quality of life of patients with severe mental illness.

Enhancing recovery and reducing readmissions: The impact of remote monitoring on acute postoperative care in outpatient total joint arthroplasty

IntroductionOutpatient total joint arthroplasty (TJA) is gaining popularity in the United States. With a shift towards value-based healthcare and bundled payment models, the importance of safe discharge after TJA is pertinent in reducing readmissions and subsequent cost of care. However, many acute issues or complications may not occur until after discharge which can result in emergency department visits and readmission. Our study aims to characterize the effect of remote monitoring devices on acute postoperative recovery in TJA discharged within 24 h. We hypothesized there would be a decreased readmission rate in the remote home monitoring cohort. MethodsThis prospective cohort compared 50 outpatient TJAs (primary total hip and total knee replacements) defined as discharged within 24 h with a remote home monitoring device to 50 outpatient TJAs who did not receive remote monitoring. Demographics, hospital length of stay, American Society of Anesthesiology scores, and Charlson Comorbidity Index were compared with no significant difference observed between cohorts (p > 0.05). Patients’ vital signs were transmitted to a virtual response center for up to 48 h after discharge. An on-call medical team reviewed the transmissions and if prompted, would contact the patient to troubleshoot and triage. Primary outcome was 30-day hospital readmissions rates, while 30-day ED visits and patient satisfaction scores for the remote home monitoring were measured as secondary outcomes. ResultsWithin the remote monitoring cohort there was a 20 % incidence (10 patients) of abnormal vitals captured and 2 patients visited the ED, however there were no readmissions attributed to this group. Readmission rates and ED visits in the control non-monitored group were significantly higher at 12 % (p = 0.03), secondary to syncope, uncontrolled postoperative pain, cellulitis, hip dislocations, and postoperative fever. Of the patients who received remote monitoring, 14 % had trouble connecting the device to their smartphone, 44 % felt home monitoring helped in their care while recovering at home, 52 % made them feel safer, and 70 % would recommend this program. ConclusionsRemote home monitoring with a virtual response team after outpatient TJA is a feasible way to mitigate readmissions in the acute postoperative period and increase patient satisfaction. Efforts to minimize costs should not be implemented at the expense of patients’ health outcomes with a goal to find an appropriate balance between both agendas. Level of evidenceTherapeutic Level III.

Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways.

Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs.

Impact of the COVID-19 Pandemic on Therapy and Outcome of Acute Exacerbations of Chronic Obstructive Lung Disease at the Emergency Department.

This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the noticeable decline in the total number of AECOPD cases during the pandemic. The marked increase in the utilization of non-invasive ventilation (NIV) was particularly important, soaring from 12% to 18% during the pandemic. Interestingly, this heightened reliance on NIV stood in contrast to the stability observed in other therapeutic modalities, including oxygen insufflation alone, high-flow nasal cannulas, and invasive ventilation. This distinctive treatment pattern underscores the adaptability of healthcare providers in the face of novel challenges, with a discernible emphasis on the strategic utilization of NIV. The shift in patient acuity during the pandemic became evident as the data showed a cohort of individuals presenting with AECOPD who were more severely ill. This was reflected in the increased use of NIV and, notably, a statistically significant rise in one-year mortality rates-from 32% before the pandemic to 38% during the pandemic (p = 0.046). These findings underscore the intricate balance healthcare providers must strike in navigating the complexities of patient care during a public health crisis. A closer examination of the longitudinal trajectory revealed a subtle decrease in re-admission rates from 65% to 60%. The increased reliance on NIV, a key finding of this investigation, reflects a strategic response to the unique demands of the pandemic, potentially influenced by both medical considerations and non-medical factors, such as the prevalent "fear of aerosols" and the imperative to navigate transmission risks within the healthcare setting. These insights contribute to understanding the evolving dynamics of AECOPD management during public health crises.

Predictive Value of LACE Scores for Pediatric Readmissions.

Hospital readmissions are recognized as a prevalent, yet potentially preventable, personal and economic burden. Length of stay, Acuity of admission, Comorbidities, and number of Emergency Department visits in the preceding 6 months can be quantified into one score, the LACE score. LACE scores have previously been identified to correlate with hospital readmissions within 30 days of discharge, but research specific to the pediatric population is scant. The objective of the present study was to investigate if LACE scores, in addition to other factors, can be utilized to create a predictive pediatric hospital readmission model that may ultimately be used to decrease readmission rates. This study included 25,616 hospitalizations of patients under the age of 18 years. Data were extracted from a hospital network electronic medical record. Demographics included LACE scores, age, gender, race/ethnicity, median household income, and medical centers. The primary exposure variable was LACE score. The main outcome measures were readmissions within 7, 14, and 30 days. The area under the curve (AUC) was used to assess the predictive capability of the regression model on patient 30-day admission. LACE scores, age, gender, race/ethnicity, median household income, and medical centers were examined in a multivariable model to assess patient risk of a 30-day readmission. Only age and LACE score were observed to be statistically significant. The AUC for the combined model was 0.69. As only age and LACE score were observed to be statistically significant and the AUC for the combined model was 0.69, this model is considered to have poor predictive capability. In this study, LACE scores, as well the other factors, had a poor predictive capability for pediatric readmissions.

Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach.

To explore the meaning of healthcare self-management support for post-discharged stroke patients. Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.

Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study.

The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.

Association of hospital and market characteristics with 30-day readmission rates from 2009 to 2015.

The US government implemented the Hospital Readmission Reduction Program on 1 October 2012 to reduce readmission rates through financial penalties to hospitals with excessive readmissions. We conducted a pooled cross-sectional analysis of US hospitals from 2009 to 2015 to determine the association of the Hospital Readmission Reduction Program with 30-day readmissions. We utilized multivariable linear regression with year and state fixed effects. The model was adjusted for hospital and market characteristics lagged by 1 year. Interaction effects of hospital and market characteristics with the Hospital Readmission Reduction Program indicator variable was also included to assess whether associations of Hospital Readmission Reduction Program with 30-day readmissions differed by these characteristics. In multivariable adjusted analysis, the main effect of the Hospital Readmission Reduction Program was a 3.80 percentage point (p < 0.001) decrease in readmission rates in 2013-2015 relative to 2009-2012. Hospitals with lower readmission rates overall included not-for-profit and government hospitals, medium and large hospitals, those in markets with a larger percentage of Hispanic residents, and population 65 years and older. Higher hospital readmission rates were observed among those with higher licensed practical nurse staffing ratio, larger Medicare and Medicaid share, and less competition. Statistically significant interaction effects between hospital/market characteristics and the Hospital Readmission Reduction Program on the outcome of 30-day readmission rates were present. Teaching hospitals, rural hospitals, and hospitals in markets with a higher percentage of residents who were Black experienced larger decreases in readmission rates. Hospitals with larger registered nurse staffing ratios and in markets with higher uninsured rate and percentage of residents with a high school education or greater experienced smaller decreases in readmission rates. Findings of the current study support the effectiveness of the Hospital Readmission Reduction Program but also point to the need to consider the ability of hospitals to respond to penalties and incentives based on their characteristics during policy development.

Effect of implementing of the IDEAL discharge model on satisfaction of patient referred to trauma emergency department.

Patient education at the time of discharge is one of the most important challenges in the emergency department. This study aimed to evaluate the Effect of implementing the IDEAL, or integrated discharge model, on the satisfaction of patients referred to the trauma emergency department. This quasi-experimental study was conducted on the patients referred to the trauma emergency department of Imam Hossein Hospital in Tehran. Eighty-six patients were recruited from January 20, 2023, until July 30, 2023. In the intervention group, the educational content was taught using the IDEAL (Inclusion, Discussion, Education, Assessment, Listening) or integrated discharge model, and in the control group, it was taught using the emergency department routine method. The satisfaction questionnaire of the emergency department was completed before and after the education in both groups and compared between the two groups. The data were analyzed by using SPSS (version 20) software. The results showed that out of the 86 participating patients, 52 (60.5%) were male and 34 (39.5%), with a mean (Standard Deviation) of 39.14 (10.89) years old. Demographic characteristics were homogeneous between the two groups (P > 0.05). The mean (standard deviation) of satisfaction of the participants after education, totally was 63.56 (16.21), in the intervention group it was 77.37 (7.95), and in the Control group it was 49.74 (8.84). The mean (SD) participants satisfaction on arrival at the emergency department in the intervention group was 19.16 (2.75) and in the control group was 13.51 (2.51), during hospitalization in the intervention group was 10.72 (1.77) and in the Control group 6.74 (1.81), discharge time in the intervention group 14.51 (2.93) and in the control group 2.93 (2.04), Overall satisfaction with nursing care in intervention group 13.85 (2.46) and in the control group 8.46 (2.41), Overall satisfaction with medical procedures in the intervention group 12.81 (2.73) and in the control group 8.58 (3.20) and Overall patient satisfaction in the intervention group 2.27 (1.81) and 41.4 (1.66) in the control group. An independent T-test was used to compare satisfaction and its dimensions in two groups, and there was a statistically significant difference between the two groups (P<0.01). The study results showed a statistically significant difference in the satisfaction in the intervention and control groups, so it can be concluded that conducting the integrated discharge model is effective in increasing the satisfaction of trauma patients. Therefore, it is recommended to use this educational method to increase patient satisfaction and decrease readmission rates.

1324. Impact of Implementation of CSF PCR Panel in Patients with Meningitis

Abstract Background Cerebrospinal fluid (CSF) Polymerase chain reaction (PCR) panel is routinely used for etiologic diagnosis of meningitis. While its role in this setting has been proven, there is no data on its benefits on duration of antibiotic use and hospital length of stay. Methods Retrospective cohort study was performed to compare meningitis patients who received the CSF PCR panel versus those who did not in a large database of HCA hospitals across the United States. Data was collected from January 2014 to May 2022 on all patients diagnosed with meningitis with a CSF WBC greater than 10. Using logistic regression and negative binomial regression, the study compared utility of CSF PCR panel use versus non-use with regards to length of stay, antibiotic duration, resolution of fever and leukocytosis, and hospital readmission rate. Demographics by Panel Use A total of 4895 patients were included in the study, of which 379 received the CSF PCR Meningitis Panel. Results A total of 4895 distinct patient encounters were included, of whom 379 patients had the CSF PCR panel. CSF PCR use was associated with a significant decrease in readmission rates within 30 days (x2 5.64, p&amp;lt; 0.05) and had decreased log count days of antibiotic duration (x2 17.56, p&amp;lt; 0.0001) with a mean duration of antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. Panel use was not significantly associated with length of stay (x2 0.96, p 0.328). The likelihood of fever resolution and leukocytosis resolution was the same for those who received the CSF PCR Panel versus those who did not. Antimicrobial Medications Received by Panel Use Antimicrobial Duration and Clinical Presentation by Panel Use There was a decrease in antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. There was also a significant decrease in hospital readmission rates within 30 days Conclusion CSF PCR panel benefits included reduced antibiotic duration of use and reduced 30-day readmission rates. Fever resolution and leukocytosis or leukopenia resolution was not impacted by CSF PCR panel use. Disclosures All Authors: No reported disclosures

Effect of extended pharmacist involvement in discharge transitions of care on hospital readmission rates: Prospective, randomized, parallel arm design trial

AbstractPharmacist involvement in transitions of care has been shown to improve patient outcomes and reduce readmission rates. Pharmacists reduce medication errors at discharge by ensuring all home medications continued are appropriate, provide pharmacist discharge patient medication education on new and existing medications therapies, and evaluate the safety and efficacy of the patient's medication therapy in order to decrease readmission rates. Results from this study may provide a financial benefit for hospital reimbursement by reducing 30 day readmission rates. The primary outcome was the comparison of composite emergency department (ED) and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus standard of care. Patients 18 years of age and older with a readmission risk score of 25 or greater, and admitted on general medicine floors from November 1, 2022 through February 28, 2023 were included. Patients were randomized into a standard of care (SOC) or extended SOC group. The primary outcome was the comparison of composite ED and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus SOC. A key secondary outcome included number of drug‐related problems identified and resolved. The primary outcome was analyzed using chi‐squared analysis (alpha of 0.05) and secondary outcomes as descriptive statistics. Data was analyzed using Stata® 16.1 statistical software. Two hundred and ninety‐six patients were included for analysis with 148 patients in both extended SOC and SOC groups. Extended SOC decreased the composite 30 day ED visit and hospital readmission rate by 7% (p = 0.63). Extended SOC group decreased 30 day ED visits by 4.9% and inpatient 30 day readmissions by 8.2% analyzed using descriptive statistics. Patients in extended SOC group resulted in a non‐statistical decrease in ED visits and inpatient readmissions 30 days after discharge compared to SOC group.

Early readmission of exclusively breastmilk-fed infants born by means of normal birth or cesarean is multifactorial and associated with perinatal maternal mental health concerns.

Late preterm and full-term infants comprise the majority of births in our hospital which serves a multicultural lower socioeconomic community. Patients give birth vaginally (normal birth, NB) or by cesarean birth (CB), and the majority of neonates are exclusively breastmilk fed until discharge. In this study we examined what factors within these two birth modes and feeding regimes of exclusive breast milk were associated with early postnatal readmission. Ideally, findings will aid initiatives to decrease readmission rates. A retrospective cohort study was performed on maternal-infant pairs. All neonates from 2016 to 2018, exclusively breastmilk fed at discharge, born by NB (n = 4245) or CB (n = 1691), were grouped as non-Readmitted (Reference) or Readmitted within 30 days of discharge. Readmission reason was determined, and potential associations were identified using univariate analysis and multivariable logistic regression. Rates of readmission were similar for both NB and CB infants (6.8% vs. 7.3%). In order, NB concerns were jaundice, infection, and feeding-this was reversed for the CB Group. NB readmission bilirubin levels were higher (293 ± 75 vs. 236 ± 112, μmol/L, NB:CB, p < 0.001). Factors associated with readmission for both groups were similar to previously published studies. Edinburgh Postnatal Depression Score (EPDS) was higher for Readmitted infant mothers. Importantly, for non-jaundice readmission EDPS categories indicated that both CB and NB mothers were more likely to have depression. Early readmission of exclusively breastmilk-fed infants born by means of NB or CB is multifactorial. Early pregnancy mental health issues are associated with readmission, highlighting the potential effects of perinatal depression on neonatal health.

Enhancing Quality of Life (QOL) And Cardiac Function in Heart Failure Patients Through Integrated Tele-Cardiopulmonary Rehabilitation And Psychological Support: A Prospective Study

Introduction: Herat failure (HF) is one global pandemic affecting millions of people across the globe. Patients with HF report decreased functional capacity, increased dyspnea and weariness, and a diminished ability to do daily tasks. In previous years there was much advancement in pharmacological therapy against heart failure. Several studies have shown that cardiopulmonary rehabilitation programs are safe and effective in improving functional capacity and quality of life while decreasing readmission rates and all-cause death in heart failure patients. However, heart failure patients' psychological status is often unknowingly neglected, leading to poor quality of life. Methods: This prospective Study was initiated in May 2022, was conducted for 18 months, and was completed in October 2022. This study is a prospective study of heart failure patients, the effect of an integrated approach of tele-cardiopulmonary rehabilitation along with psychologist-guided psychological support enhancing the quality of life. The patients satisfying the inclusion criteria without exclusion criteria were randomized to intervention and control groups. Results: The age group of the mean (years)+/- SD(67+/-14.4) in the Intervention Group and (66+/- 14) in the Control group. Both the groups comprised female participants, 63% in the Intervention group and 68% in the control group. The initial evaluation was done at the beginning of this prospective study. The follow-ups were done in 6 weeks, 12 weeks, and 24 weeks. Clinical examination, 6-Minute Walk Test, peak VO2 evaluation in a cardiopulmonary exercise test, and echocardiography with LVGLS measurements. During the study period, it was noted that there were substantial improvements in LVGLS, 6-Minute Walk Test distance, peak VO2, and Quality of Life. Conclusion: In Conclusion, based on the findings of this prospective study, the integrated approach of tele- cardiopulmonary rehabilitation and psychological support in heart failure patients has tremendous benefits and remarkable improvement in Quality of Life. As the life span improves, that leads to more heart failure patients presently and in the future. Along with pharmacotherapy against heart failure, telerehabilitation, and psychological support should be emphasized from the beginning of heart failure treatment to achieve a better quality of life. Considering the importance of Rehabilitation, through this study, it would not be wrong to suggest an additional pillar of heart failure treatment along with four other robust pillars in the guidelines

The role of concomitant vitamin D3 and K2 treatment after laminectomy in spinal stenosis surgery of patients with osteoporosis

Background: Readmission because of ongoing pain and complaints who undergone spinal surgery with osteoporosis is increasing. This study investigated the efficacy of concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis. The aim of the study was to treatment strategy is to reduce the patient’s low back pain and decrease readmission rates due to ongoing pain. Methods: A total of 22 patients with osteoporosis included in the study who had lumbar decompression via laminectomy surgery with posterior instrumentation for spinal stenosis. Patients were divided into groups according to use additional supplement of vitamin D3+K2. Group 1 was control group who received only vitamin D3 and group 2 was patients who received vitamin D3+K2 treatment. Patients were called to their sixth month check-up and their pre-and post-treatment VAS scores and Roland-Morris scores were filled in and readmission rates due to ongoing pain were compared. Results: 9 male and 13 female participants with a mean age of 64.4 were in the study. The mean T-score in bone mineral density (BMD) was -2.7 in group 1 and -2.6 in group 2. A significant difference was found when the pre-operative and post-operative VAS and RM scores of all patients were compared (p&lt;0.05). The mean readmission rates due to ongoing pain is 4 in group 1 and 7 in group 2. A significant difference was found when readmission rates due to ongoing pain were compared (p&lt;0.05). Conclusions: Concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis is a valuable treatment option to reduce the rate of admission to the hospital because of ongoing pain.

A Risk-Prediction Platform for Acute Kidney Injury and 30-Day Readmission After Colorectal Surgery

IntroductionFew known risk factors for certain surgical complications are prospectively analyzed to ascertain their influence on outcomes. Health systems can use integrated machine-learning-derived algorithms to provide information regarding patients' risk status in real time and pair this data with interventions to improve outcomes. The purpose of this work was to evaluate whether real-time knowledge of patients’ calculated risk status paired with a stratified intervention was associated with a reduction in acute kidney injury and 30-d readmission following colorectal surgery. MethodsUnblinded, retrospective study, evaluating the impact of an electronic health record-integrated and autonomous algorithm-based clinical decision support tool (KelaHealth, San Francisco, California) on acute kidney injury and 30-d readmission following colorectal surgery at a single academic medical center between January 1, 2020, and December 31, 2020, relative to a propensity-matched historical cohort (2014-2018) prior to algorithm integration (January 11, 2019). Results3617 patients underwent colorectal surgery during the control period and 665 underwent surgery during the treatment period; 1437 historical control patients were matched to 479 risk-based patients for the study. Utilization of the risk-based management platform was associated with a 2.5% decrease in the rate of acute kidney injury (11.3% to 8.8%) and 3.1% decrease in rate of readmissions (12% to 8.9%). ConclusionsIn this study, we found significant reductions in postoperative acute kidney injury (AKI) and unplanned readmissions after the implementation of an algorithm based clinical decision support tool that risk-stratified populations and offered stratified interventions. This opens up an opportunity for further investigation in translating similar risk platform approaches across surgical specialties.

Quality improvement collaborative to optimize heart failure care inpatients from a network ofclinics inArgentina during the COVID-19 pandemic.

Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.