General Inpatient Setting Research Articles

Characteristics of the clinical pharmacists' interventions at the main general tertiary care hospital in Qatar.

Medication-related problems (MRPs) are prevalent throughout healthcare systems, whereby pharmacy-based interventions are pivotal to reducing occurrence. In the Middle East, including Qatar, the professional roles of pharmacists have been expanding to improve patient safety. This study aimed to characterize and analyze pharmacist-led interventions among hospitalized patients in the leading general hospital in Qatar. A retrospective analysis of pharmacist interventions in the internal medicine ward, critical care unit, and emergency department (ED) was conducted. Data were extracted from three periods of 1 month (March 1-31, 2018, July 15-August 15, 2018, and January 1-31, 2019). A descriptive type of analysis was undertaken. A total of 340 patients with 858 interventions were analyzed. The average age of the study participants was 51 years (SD ± 17.7). The study population was predominantly male (65%). The prevailing pharmacist intervention was adding drug therapy (27%), followed by medication discontinuation (18%) and dosage adjustments (16%). This pattern was maintained across all subpopulations, e.g., gender, age, and ward, except for the ED, where cessation of medication was the most frequent intervention (4%). The two pharmacological classes associated with most interventions were anti-infective and cardiovascular agents. Pharmacist interventions effectively identify, prevent, and resolve MRPs in general inpatient settings in Qatar.

TAX4U Pilot Trial: Addressing Material Needs in the Pediatric Hospital Setting.

Interventions to address poverty and food insecurity in pediatric hospital care have been scarce. Access to government support is based on the completion of taxes. Medical-financial partnerships are defined as novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing financial stress. The objective of our pilot study was to assess the feasibility of implementing a "free tax service" within a pediatric academic hospital setting. A pilot randomized controlled trial "TAX4U" was conducted from November 2020 until April 2021 in the general inpatient setting of an academic pediatric hospital. Eligible families were randomly assigned to receive either "free tax services" according to the Canada Revenue Agency-funded Community Volunteer Income Tax Program (CVITP) or "care as usual." A total of 140 caregivers filled in the 8-question recruitment survey. We found that 101 (72%) families were not eligible to participate in the study. Reasons for ineligibility were not meeting CVITP criteria (n = 59, 58%), already filed tax (n = 25, 25%), and families did not sign the consent form (n = 17, 17%). Thirty-nine families were randomly assigned, with 20 (51.3%) families assigned to the intervention and 19 (48.7%) families receiving care as usual. Ultimately, 7 (35%) families received the tax intervention. Offering free tax services may be feasible and reached vulnerable families in a pediatric hospital setting; however, the inclusion criteria of the CVITP program did not meet the needs of caregivers. Further research should explore offering a full-scope medical-financial partnership that meets the needs of low-income families in a hospital setting.

Prednisone and Nebulized Epinephrine for Severe Bronchiolitis

Prednisone and Nebulized Epinephrine for Severe Bronchiolitis

Optimal clinical setting, tutors, and learning opportunities in medical education: A content analysis.

INTRODUCTION:As an integral and the most important part of medical education, clinical education provides the opportunity to prepare medical students as professionals. This study explores the standpoints of informants concerning the optimal conditions for clinical education and its components, including learning opportunities, clinical settings, and clinical tutors, with the aim to improve clinical teaching and standards.METHODS:The study design is built on qualitative content analysis with the directed approach. The participants were selected using purposive sampling with maximum variation, and the data were collected through online focus group discussion (FGD) and semi-structured individual interviews conducted either face-to-face or on the telephone.RESULTS:Twenty vice-chancelleries of education and medical education planners from across the country participated in this study. Concepts resulted in four main categories: educational settings, tutors, creating learning opportunities, and learning situations. The concepts were sorted into 15 subcategories, also 21 subclass 1 and 14 subclass 2. The most extensive subcategories comprised variety of educational settings, teaching team conditions, and learning strategies.CONCLUSION:Optimal conditions for clinical education are associated with the use of educational settings close to the real workplace of general practitioners such as general inpatient settings, outpatient settings, and emergency department. Moreover, optimal conditions require the provision of learning opportunities by organized team of tutors and team member empowerment along with policy-making and planning on the national scale by the Ministry of Health in consideration of local conditions.

Shared Decision Making: A Multi-Site Educational Bundle Improves Patient Engagement and Communication During Inpatient Rounds

Shared decision-making (SDM) has been shown to be an important tool for improving patient engagement and health care outcomes. Despite the demonstrated value of SDM across disciplines, little is known about how to increase SDM occurring in general inpatient settings.

PWE-005 The True Cost of Ulcerative Colitis (UC) in The UK – 24 Months Following The First Non-Elective Admission: Abstract PWE-005 Table 1

Introduction Inflammatory Bowel Disease (IBD) has a prevalence of around 400 in 100,000 in the UK, with the prevalence of UC specifically of around 243 per 100,000. This gives a figure of 146,000 people in the UK living with UC. Around 30% of IBD patients are under regular hospital follow-up. Around 20–30% of patients with UC will undergo surgery at some point. Healthcare costs in terms of admissions and endoscopic assessment associated with Ulcerative Colitis remain poorly researched. Our objective was to calculate the costs associated with both in and outpatient attendances and endoscopies in the 24 months following the first non-elective (NE) admission for ulcerative colitis in a UK population. Methods Hospital Episode Statistics data for 2011/2 for all clinical commissioning groups in England were analysed to calculate the cost of UC. The data used in this study were obtained from the AXON Database. AXON is a health data warehouse that provides interrogative analysis and health intelligence on Hospital Episode Statistics (HES). Each HES record has a Healthcare Resource Group (HRG) code that is linked to the national tariff. International Classification of Diseases – 10 (ICD-10) diagnosis codes related to UC were used to identify patients. Results In the 24 months following the first NE admission for UC, there were 20444 spells in a general inpatient setting with a cost of £30,767,953.07. The cost of endoscopies from the inpatient spells was £3,535,965.45. There were 4557 inpatient gastroenterology spells with a total cost of £4,068,759.40. Cost of endoscopies during these gastroenterology specific spells amounted to £3,546,993.42. The cost of general outpatient attendances was £9,424,953.22 in comparison to £5,918,472.64 for gastroenterology outpatient attendances. Outpatient endoscopies and gastroenterology endoscopies cost £33,574.83 and £40,006.90 respectively. General A&E attendances totalled £872,666.30 with emergency gastroenterology attendances totalling £119,354.31. Conclusion Inpatient attendances make up the greatest proportion of the total cost associated with UC in the 24 month period following the first NE admission. Episodes of severe colitis, by definition require admission for inpatient management. The lifetime risk of acute severe colitis in a person with UC is between 15–25%.2,3We have demonstrated a huge cost burden associated with these admissions. This may reflect poor access to specialist and emergency care during flares as well as delays in carrying out diagnostic investigations. There is potential for significant cost savings by way of rapid access specialist clinics and 7 day a week advice helplines run by IBD specialist nurses to enable timely review and management of patients, thus preventing the need for inpatient admissions. References 1 Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, George B, Mortensen NJ, Travis SP. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010 Oct;4(4);431–7. 2 Edwards FC, Truelove SC. The course and prognosis of Ulcerative Colitis Gut. 1963 Dec;4:299–315. Disclosure of Interest None Declared

Patient factors associated with incidents of aggression in a general inpatient setting

To determine patient factors associated with aggressive (code grey) events in the setting of a metropolitan hospital during a six-month period, to inform screening and prevention practices. Patient aggression continues to place nurses and patients at risk. Nurses need to be able to identify situations that are likely to escalate into aggression in order to ensure their own safety and the quality of care they can provide. Research has focussed on emergency departments and psychiatric units. Approaches that are appropriate for these settings may not fit for the general inpatient setting. A structured audit and epidemiological analysis of hospital population, regarding incidence of aggression. A retrospective audit of code grey event reports and medical records of patients admitted to 16 general medical-surgical wards, during a six-month period. All available records of 121 code grey events were audited. Demographic factors for patients with code grey events were compared with factors for 6472 patients admitted. Statistical tests included chi-squared, bivariate and logistic regression. Diagnoses associated with increased risk of code grey were the following: delirium (11 times more likely) and dementia (seven times). Patients were more likely to have a code grey event if they were over 65 years of age (more than twice), were male (more than twice), were a recipient of Veterans' Affairs pension (four times), had never been married or had been admitted through the emergency department (almost twice). This study adds to the current knowledge of the distinctive profile of patients in medical-surgical settings who are associated with aggressive events. It is recommended that nurses increase their focus on assessment of identified risk factors and documentation of behaviours, to help predict aggressive events, and that this focus be supported by hospital safety and care policy.

Non-Pharmacologic Interventions to Improve the Sleep of Hospitalized Patients: A Systematic Review

Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among acutely ill inpatients. Behavioral interventions are recommended as first-line therapy prior to using pharmacologic therapy due to the side effects of sedative hypnotics. The objective of this systematic review was to identify non-pharmacologic interventions that have been used to improve sleep quality and quantity of non-intensive care unit (ICU) inpatients. PubMed, Embase, Web of Science, CINAHL, and Cochrane Library through January 2013; manual searches of reference lists. Any study in which a non-pharmacologic intervention was conducted in a general inpatient setting, and nighttime sleep quantity or quality was assessed. Information on study design, populations, interventions, comparators, outcomes, time frame, and risk of bias were independently abstracted by two investigators. 13 intervention studies with 1,154 participants were included. Four studies were randomized controlled trials. Seven studies had a low to medium risk of bias, and there was significant heterogeneity in the interventions. Relaxation techniques improved sleep quality 0-38%, interventions to improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5%, and daytime bright light exposure improved sleep quantity 7-18%. The heterogeneity in the types and dose of interventions, outcome measures, length of follow-up, differences in patient populations, and dearth of randomized trials may dilute effects seen or make it more difficult to draw conclusions. There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.

Medicaid Beneficiaries Using Mental Health or Substance Abuse Services in Fee-for-Service Plans in 13 States, 2003

This study identified Medicaid beneficiaries using mental health or substance abuse services in fee-for-service plans in 13 states in 2003 (N=1,380,190) and examined their use of medical services. Administrative and fee-for-service claims data from Medicaid Analytic eXtract files were analyzed to identify mutually exclusive groups of beneficiaries who used either mental health or substance abuse services and to describe patterns of medical service use. Overall, 11.7% of Medicaid beneficiaries were identified as using mental health or substance abuse services (10.9% and .7% used each of these services, respectively), with substantial variation across age and eligibility groups. Among beneficiaries using mental health services, 47.4% had visited an emergency room for any reason, 7.8% were treated for their disorder in inpatient settings, 13.8% received inpatient treatment for problems other than their mental or substance use disorders, and 70.4% received prescriptions for psychotropic medications. Among beneficiaries using substance abuse services, 60.7% had visited an emergency room, 12.6% were treated for their disorder in inpatient settings, 24.7% received other inpatient treatment, and 46.1% received prescriptions for psychotropic medications. Among beneficiaries not using either mental health or substance use services, 29.0% had visited an emergency room, 12.7% received inpatient treatment, and 10.1% received prescriptions for psychotropic medications. Beneficiaries who used mental health or substance abuse services entered general inpatient settings and visited emergency rooms more frequently than other beneficiaries.

Mental health of children and young people in hospital

It is estimated that one in ten children and young people have mental health problems such as emotional or conduct disorders. Acute and chronic physical illnesses also have consequences for mental health and well being. In acute settings, physical health problems are well addressed but provision for mental health needs generally falls short of the holistic care that is necessary for optimum health. The Common Assessment Framework supports early identification of children's additional needs and provides for timely and co-ordinated support to meet those needs. However, it is not yet widely implemented in general inpatient settings. Staff need to work closely with child and adolescent mental health staff, addressing the challenges of information sharing and interagency working, if they are to provide more holistic care and support.

Inpatient Diabetes Management in Non-ICU Settings: Evidence and Strategies

The epidemic of diabetes and results from several recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on inpatient glycemic control on general hospital wards, where over 25% of patients have diabetes. Current management of inpatient glycemia is haphazard, relying on corrective doses of insulin after hyperglycemia has occurred (the insulin "sliding scale"). Although data to guide evidence-based management of inpatient glycemia in non-critically ill patients are scant, the American College of Endocrinology and the American Diabetes Association have advocated more intensive therapy in the general inpatient setting, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has followed suit, launching an initiative on inpatient glycemic control. Extrapolation from basic and clinical studies suggests that improved diabetes management in general medical settings is likely to be beneficial, though the appropriate intensity of glycemic control in non-ICU settings has yet to be determined. Independent of the acute impact of inpatient glycemia, inpatient diabetes management is also important because hospitalization offers an opportunity to optimize care upon discharge for patients with poorly controlled diabetes. Finally, systems-level strategies likely to improve inpatient diabetes management are reviewed.

Inpatient diabetes management in general medical and surgical settings: evidence and update

A quarter of patients who are hospitalized for any reason have diabetes as a comorbid condition. Despite this, management of diabetes among inpatients has historically been a low clinical priority. Since the publication of several landmark trials demonstrating the benefits of intensive glycemic control in the surgical intensive care unit, inpatient glycemic control on general hospital wards has received increased attention. Physicians and healthcare organizations in the USA have recently advocated more aggressive treatment of inpatient hyperglycemia despite the lack of data to guide evidence-based management in general (non-intensive care unit) settings. These calls to action have prompted a series of studies that demonstrate effective systems-based strategies for measuring and improving inpatient glycemic control, even though it is not yet clear how aggressively this goal should be pursued. While the data on improved long-term outcomes related to improved glycemic control in general inpatient settings are sparse, at the very least, inpatient diabetes management is likely to be beneficial if it prevents extremes of hyper- and hypoglycemia, decreases medication error, and facilitates improved outpatient medication regimens and self-management skills, which, in turn, may lead to improved glycemic control after discharge.