Higher Admission Rates Research Articles

Population-based Influenza and Respiratory Syncytial Virus Hospitalizations and In-hospital Mortality Rates Among Mexican Children Less Than Five Years of Age.

Population-based information regarding the impact of respiratory syncytial virus (RSV) and influenza on hospital admissions and mortality is scant for many countries. Prospective testing of RSV and influenza virus was undertaken in patients <5 years old admitted to hospital with acute respiratory infection (ARI) between July, 2014 and June, 2015, and mortality rates for children living in 3 municipalities in the state of San Luis Potosí were calculated. During the 12-month study period, 790 children living in these municipalities were admitted with ARI. RSV was detected in 245 (31%) and influenza in 47 (5.9%). History of preterm birth was recorded for 112 children on admission. For children <5 years old, ARI-, RSV- and influenza-associated admission rates were 23.2, 7.2 and 1.4 (per 1000 population), respectively. The corresponding admission rates per 1000 infants <1 year old were 78, 25.2 and 4.4. Preterm infant admission rates were 2 times higher than those of term infants. Six children died; RSV was detected in 4 (66.6%) of the deceased, while no deaths were associated with influenza. ARI and RSV in-hospital mortality rates for children <5 years were 0.18 and 0.12 per 1000 population. ARI and RSV mortality rates in preterm infants were 7 and 14 times higher than in term infants, respectively. RSV was associated with both high admission and in-hospital mortality rates in children <5 years old. Specific interventions, such as active or passive immunization, to prevent RSV infections are required to reduce ARI-associated infant mortality.

Re-hospital admission, morbidity and mortality rate in patients undergoing tunnelled catheter implantation for haemodialysis

Despite the effort to increase the proportion of patients starting dialysis on native accesses, many of them are still dialyzed on tunnelled catheter. Catheter-related complications are often serious and responsible for re-hospital admission, high morbidity and mortality. Several multicenter trials have reported results in the use of tunnelled dialysis catheter (TDC). However, few single-center studies have been published to verify the outcome from real-world experience. This study presents our center's experience in managing such patients in the context of relevant literature. Demographics and operative data were retrospectively collected from medical charts. A prospective follow-up was performed to investigate complications, number of re-hospitalizations and mortality. Kaplan-Meier estimate was used to evaluate catheter primary patency and patients' overall survival. Among a total 298 haemodialysis accesses interventions, 105 patients (56 men, 53.3% and 49 women, 46.7%) with a median age of 65 years (range 32-88 years) were included in the study. All insertions were successful with an optimal blood flow achieved during the first session of dialysis in all cases. A catheter-related complication was detected in 33.3% (n=35) patients (48.6% infections; 28.6% TDC dysfunction; 14.3% local complications; 5.7% accidental catheter retractions; 2.8% catheter migrations). At a median follow-up of 10.5±8.5 months, a total of 85 patients (80.9%) was re-hospitalized, in 28 cases (26.7%) for a catheter-related cause. The median catheter patency rate was 122 days. At the last follow-up, 39 patients (37.1%) were still dialyzed on catheter, 30(28.6%) were dialyzed on an arteriovenous fistula and 7(6.7%) received a kidney transplantation. Two patients (2%) were transferred to peritoneal dialysis and two patients (2%) recover from renal insufficiency. Mortality rate was 23.8% (25 patients). Causes of death were myocardial infarction (n=13, 52%), sepsis (n=9, 36%); one patient (4%) died from pneumonia, one (4%) from uremic encephalopathy and one (4%) from massive hematemesis. TDCs may represent the only possible access in some patients, however they are burned with a high rate of complications, re-hospital admission and mortality. Results from this institutional experience are in line with previously published literature data in terms of morbidity and mortality. The present results reiterate once more that TDC must be regarded as a temporary solution while permanent access creation should be prioritized. Strict surveillance should be held in patients having TDC for the early identification of complications allowing the prompt treatment and modifying the catheter insertion site whenever needed.

Age-related and Gender-related Differences in Hospital Admission Rate and Hospital Costs of People Covered by the Iran Health Insurance Organization: A Retrospective Study

Objectives The impact of population aging on health expenditure is inevitable. It affects health expenditure by causing changes in people’s health status and the demand for health care services. In this study, we aim to investigate the age-related and gender-related differences in hospital admission rate, length of stay, and hospital costs of people in Iran. Methods &amp; Materials This is a quantitative, descriptive-analytical study with a cross-sectional design conducted on data of 41 million Iranian people covered by the Iran Health Insurance Organization in 2020. Hospital admission rate, length of stay, and hospital costs were dependent variables. Hospital costs included insurance payments, patients’ out-of-pocket spending, and government subsidies. Age and sex of the patients, ownership of the hospital, type of patients’ medical files were descriptive variables. The Mann-Whitney U test was used to compare hospital costs between elderly (&gt;60 years of age) and non-elderly (&lt;60 years of age) groups and between females and males. Spearman’s correlation test was used to find the correlation between age and dependent variables. Results During the study period, there were about 3,800,000 hospital admissions. The rate of hospital admission in the elderly was 3.7 times higher than that of non-elderly groups. The average length of stay was 1.3 days for the elderly, and 2.2 days for the non-elderly. In the elderly group, men had a higher hospital admission rate than women, while in non-elderly groups, women had a higher admission rate. The average hospital cost was 28 million IRR for the non-elderly and 45 million IRR for the elderly. The average cost of surgery, hospitalization, medicine and medical consumables for the elderly was 1.5 times more than that of the non-elderly. There was a positive and significant relationship between the hospital admission rate and age of the patients (r=0.879, P&lt;0.001). As the age of the patients increased, the length of stay in the hospital increased significantly (r=0.582, P&lt;0.001). The relationship between patients’ age and the average hospital cost was also positive and significant (r=0.582, P=0.006). Conclusion Hospital admission rate, length of stay, and average hospital costs are significantly higher for the elderly in Iran.

Morbidity pattern and drug utilization study in cancer patients in a tertiary care hospital

Background: Cancer is a set of diseases that include the unchecked proliferation and spread of abnormal body cell types. The primary treatment modalities are surgery, radiation, chemotherapy, immunotherapy, and hormones. As it describes the scope, nature, and causes of drug exposures, drug use research is a key and vital component of pharmacoepidemiology. Aim and Objectives: Utilization study seeks to encourage communities to use medications rationally. Materials and Methods: A prospective, cross-sectional, observational study was conducted in indoor patients of the radiotherapy department of a tertiary care teaching hospital. Six hundred patients of different types of cancers were involved in the study. At the end of data collection, the data were entered and analyzed with Microsoft Excel 2019. Descriptive statistics were used to analyze the results. Results: Buccal mucosa, tongue, and breast cancers had the highest admission rate with 24.17%, 13.33%, and 12.83%, respectively. The average number of drugs per encounter was 13.58 with a range of 5–17. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Out of 32 drugs used, 30 drugs were prescribed from the World Health Organization Model List of Essential Medicines, 2021, and National List of Essential Medicines, 2022, and 8 drugs were by brand name. Conclusion: Compared to other systems such as the pulmonary, breast, genitourinary, and gastrointestinal tract, oral malignancies were more common. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Prescribing drugs were mainly from Essential Drug List with generic names.

Active herpesviruses are associated with intensive care unit (ICU) admission in patients pulmonary infection and alter the respiratory microbiome.

The Herpesviridae family contains several human-related viruses, which are able to establish colonizing and latency in the human body, posing a significant threat to the prognosis of patients. Pulmonary infections represent one of the predominant infectious diseases globally, characterized by diverse and multifaceted clinical manifestations that have consistently attracted clinician's concern. However, the relationship of herpesviruses on the prognosis of pulmonary infections and the respiratory microbiota remains poorly understood. Here, we retrospectively analyzed respiratory samples from 100 patients with pulmonary infection detected by metagenomic next-generation sequencing (mNGS). Employing mNGS, five herpesvirus species were detected: Human alphaherpesvirus 1 (HSV-1), Human gammaherpesvirus 4 (EBV), Human betaherpesvirus 5 (CMV), Human betaherpesvirus 7 (HHV-7), and Human betaherpesvirus 6B (HHV-6B). Regression analysis showed that the age and positivity of herpesviruses in patients were independently correlated with ICU admission rates. In addition, positivity of herpesvirus was related with increased ICU days and total hospital stay. The herpesvirus-positive group demonstrated markedly higher incidences of co-infections and fungi-positive, predominantly involving Pneumocystis jirovecii and Aspergillus fumigatus. Analysis of respiratory microbiota revealed a substantially altered community composition within the herpesvirus-positive group, and herpesviruses were significantly positively correlated with the diverse respiratory opportunistic pathogens. Overall results substantiate that the active herpesviruses in patients with pulmonary infections were significantly associated with high ICU admission rate. Moreover, the herpesviruses promotes the dysbiosis of the respiratory microbiota and an increased proportion of co-infections. These insights could contribute to unraveling the underlying mechanisms connecting active herpesviruses to the progression of severe illnesses.

Implementation of pharmacy-led preoperative medication reconciliation in surgical oncology patients

BackgroundPharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical. ObjectivesThe purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program. Practice descriptionThe service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks’ time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students’ findings. Practice innovationA standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients’ procedures and upon potential postoperative admission. Evaluation methodsA retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program. ResultsForty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete. ConclusionPreoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.

Integrated Primary Care Model Prevents Hospitalizations for People Living with Dementia

AbstractBackgroundPeople living with dementia (PLWD) have high rates of total and ambulatory care sensitive hospital admissions and emergency department utilization. Ambulatory care sensitive hospital admissions are those that could be avoided by robust outpatient care. The Integrated Memory Care (IMC) is a comprehensive dementia care model where patients and their family caregivers access dementia‐sensitive geriatric primary care.MethodsWe conducted a retrospective observational study of adult patients of IMC, Cognitive Neurology (CN), and Primary Care (PC) clinics aged 65 and older with a diagnosis of dementia in 2019‐2021. We matched patients by age, gender and race and measured the risk of hospitalization using logistic regressions controlling for clinic. Additionally, we conducted a regression adjusted for state of illness (proxied by activities of daily living (ADL)) for the IMC and CN clinics.ResultsOverall 509 patients seen in IMC were matched with 490 CN patients and 509 PC patients. Most patients were female and white and aged 70‐85. IMC patients had higher overall ADL scores than CN indicating more functional dependence. CN [PN] had 10% [2 times] higher odds (Odds Ratio (OR): 1.107; 95% Confidence Interval (CI): 0.87‐1.41; OR: 2.037; 95% CI: 1.440‐2.882), when compared to IMC patients in unadjusted models. After adjusting for ADL scores, CN patients had 66% higher odds (OR: 1.662; 95% CI: 1.260‐2.193) of having a hospital admission during the study period.ConclusionsDementia‐sensitive primary care reduces the rate of total and ambulatory‐sensitive hospitalizations reducing healthcare costs and causing less disruption to care.

COVID-19 Admission Rates and Changes in US Hospital Inpatient and Intensive Care Unit Occupancy

The COVID-19 pandemic had unprecedented effects on hospital occupancy, with consequences for hospital operations and patient care. Previous studies of occupancy during COVID-19 have been limited to small samples of hospitals. To measure the association between COVID-19 admission rates and hospital occupancy in different US areas and at different time periods during 2020. This cross-sectional study used data from the Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for patients in nonfederal acute care hospitals in 45 US states, including the District of Columbia. Data analysis was performed between September 1, 2022, and April 30, 2023. Each hospital and week in 2020 was categorized based on the number of COVID-19 admissions per 100 beds (<1 [low], 1-4.9, 5-9.9, 10-14.9, or ≥15 [high]). The main outcomes were inpatient and intensive care unit (ICU) occupancy. We used regression analysis to estimate the average change in occupancy for each hospital-week in 2020 relative to the same hospital week in 2019. This study included 3960 hospitals and 54 355 916 admissions. Of the admissions in the 40 states used for race and ethnicity analyses, 15.7% were for Black patients, 12.9% were for Hispanic patients, 62.5% were for White patients, and 7.2% were for patients of other race or ethnicity; 1.7% of patients were missing these data. Weekly COVID-19 admission rates in 2020 were less than 4 per 100 beds for 63.9% of hospital-weeks and at least 10 in only 15.9% of hospital-weeks. Inpatient occupancy decreased by 12.7% (95% CI, 12.1% to 13.4%) during weeks with low COVID-19 admission rates and increased by 7.9% (95% CI, 6.8% to 9.0%) during weeks with high COVID-19 admission rates. Intensive care unit occupancy rates increased by 67.8% (95% CI, 60.5% to 75.3%) during weeks with high COVID-19 admissions. Increases in ICU occupancy were greatest when weighted to reflect the experience of Hispanic patients. Changes in occupancy were most pronounced early in the pandemic. During weeks with high COVID-19 admissions, occupancy decreased for many service lines, with occupancy by surgical patients declining by 43.1% (95% CI, 38.6% to 47.2%) early in the pandemic. In this cross-sectional study of US hospital discharges in 45 states in 2020, hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions, with the largest changes occurring early in the pandemic. These findings suggest that surges in COVID-19 strained ICUs and were associated with large decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.

Variables associated with admission rates among cancer patients presenting to emergency departments: a CONCERN group study

BackgroundPatients with cancer visit the emergency department often and have a high rate of admission compared to other patients. Admission rates by institution may vary widely, even after accounting for patient and hospital-specific characteristics.ObjectivesTo review the variables that affect admission rates among patients with cancer in the emergency department.MethodsWe performed a secondary analysis of a prospective cohort study of patients with cancer at 18 emergency departments between March 1, 2016, and January 30, 2017, to examine differences in patient populations between hospitals with varying admission rates. We calculated the percentage admitted by hospital and used it to categorize hospitals into quartiles. We compared outcomes, patient demographics, and disease characteristics between the admission quartiles using linear or logistic regression.ResultsA total of 1075 patients were included. The median age of our sample was 64, and 51% of patients were female, 84% were white, and 13% were Black. Of the 1075 patients, 615 (57.2%) were admitted as inpatients with a range from 21.2 to 81.7% by hospital. Differences between admission quartiles were found for education, mode of arrival, and recent chemotherapy (p < 0.05). There were no significant differences among quartiles in age, gender, race, or ECOG score. We found significant difference between admission quartiles in 30-day emergency department revisits. Differences in readmission rates and mortality did not appear to be significant between the various quartiles.ConclusionsIn our study, we observed several differences among patients with cancer receiving care at hospitals with different admission rates. These included patients’ education level, mode of arrival, and whether they had received recent chemotherapy. Emergency Severity Index (ESI) score may have also contributed to admission rate variability. Further study into unmeasured factors influencing hospital admissions, such as local culture, resources, and pathways, could identify generalizable findings to reduce avoidable admissions and reduce variation among similar patients in different hospitals.

Unraveling the Link: Cannabis Use Disorder and Pulmonary Embolism-Related Hospital Outcomes in Female Breast Cancer Survivors

Background: The use of cannabis in cancer patients has gained significant attention due to its analgesic properties, which help alleviate cancer-related pain. Studies have also shown the interference of cannabis with the coagulation system. We aimed to study the impact of cannabis use disorder (CUD) and Pulmonary embolism (PE) on outcomes in female breast cancer survivors, considering reports suggesting significant overlap between recreational and medicinal use. Our objective was to compare outcomes in CUD+ (with cannabis use disorder) and CUD- (without cannabis use disorder) cohorts to gain critical insights into this group and understand the impact of CUD on PE-related hospitalization and outcomes. Methods: National Inpatient Sample (NIS) data from 2020 was utilized in order to analyze inpatient cohorts of PE hospitalizations. The International Classification of Diseases 10 (ICD 10) codes for pulmonary embolism, cannabis use disorder, and female breast cancer were utilized to classify cohorts. All cases of female breast cancer and pulmonary embolism with an age &amp;gt;18 years were included in the final analysis. The primary outcome was the impact of CUD on PE-related hospitalizations in female breast cancer survivors. We also compared demographic correlations and comorbidities affecting outcomes between cohorts. Results: This study included a total of 508065 admissions among breast cancer survivors, with a median age of 74 years for the entire cohort. The prevalence of PE admissions was lower in CUD+ cohort compared to CUD- cohort (1.3% vs. 2.1%). The CUD+ cohort was relatively younger (median 66 vs 74 years, p&amp;lt;0.001). Overall, admission rates were higher among white patients (77%) and this trend was statistically significantly higher in the 76-100 th percentile household income group (p&amp;lt;0.002) compared to CUD+(50%) and CUD-(26.5%). Most admissions were non-elective (95.4%), with no statistical significance between CUD- and CUD+ patients (p=0.16). The majority of readmissions occurred in urban teaching hospitals (75.5%), with no significant difference observed between CUD- and CUD+ patients (p=0.111). Regionally, the South had a higher admission rate (37.2%) compared to other regions and this difference was statistically significant (p&amp;lt;0.001) between CUD- and CUD+ patients. Among the coexisting comorbidities, hypertension showed a significant difference between CUD- (70%) and CUD+(37.5%) patients (p&amp;lt;0.001). Alcohol use disorder (p&amp;lt;0.001) and cancer (p&amp;lt;0.001) had significant associations with CUD+, along with prior myocardial infarction (p=0.005) and drug use (p&amp;lt;0.001) were significantly associated with CUD+.Furthermore, there was difference in routine patient disposition between between CUD-(45.3%) and CUD+(37.5%),(p=0.033) and length of stay (4 VS 2 days), (p=0.033) and cost of stay (47033 vs 27668 $), (p=0.017). The multivariable logistic regression analysis showed that the odds of PE-related hospitalization in CUD+ vs CUD- cohorts among female breast cancer survivors were not statistically significant, with an OR of 0.79 (CI: 0.38-1.62, p=0.512). Subgroup analysis by age demonstrated no statistically significant differences in odds for PE-related hospitalization between CUD+ and CUD- cohorts. For the age group of 18-44 years, the OR was 1.37 (CI: 0.18-10.60, p=0.762). In the 45-64 years age group, the OR was 0.48 (CI: 0.15-1.53, p=0.215), and for those aged ≥65 years, the OR was 1.32 (CI: 0.48-3.67, p=0.590). Furthermore, the analysis by race indicated that the odds of PE-related hospitalization did not reach statistical significance in both white and black female breast cancer survivors with CUD. For white patients, the OR was 0.64 (CI: 0.23-1.73, p=0.375), while for black patients, the OR was 1.15 (CI: 0.38-3.46, p=0.804). Conclusion: Among female breast cancer survivors, the presence of CUD did not show a statistically significant impact on the odds of PE-related hospitalization. Subgroup analysis by age and race also revealed no significant differences in the odds of PE-related hospitalization between CUD+ and CUD- cohorts. These findings underscore the importance of considering CUD when managing pulmonary embolism in breast cancer survivor females and emphasize the need for further research to understand the complex interplay between these factors.

Emergency Department Utilization for Heavy Menstrual Bleeding (2016-2020): An Opportunity to Improve Care

Introduction: Heavy Menstrual Bleeding (HMB) is one of the most common indications for ambulatory gynecological visits amongst reproductive aged women. It can have significant physical, social, emotional, and economic impact. Two thirds of women who report HMB develop anemia. While the outpatient setting may represent the optimal setting for management of this condition, it is known that many patients are treated in the emergency room or inpatient setting. We sought to evaluate Emergency Department (ED) utilization and the associated health care charges of patients who present to the ED with HMB. We hypothesized that marginalized groups are more likely to use the ED for HMB and are more likely to be admitted for this condition. Methods: The Nationwide Emergency Department Sample (NEDS) Database of the Health Cost and Utilization Project (HCUP, Rockville, MD) was queried for all visits with primary ICD-10 diagnosis codes of N92.0 (Excessive and Frequent Menstruation with Regular Cycle) or N92.4 (Excessive bleeding in the premenopausal period) among females 21-50 years of age. Variables assessed included age, hospital type, medical insurance, household income quartile, visit charges, disposition, and race. Race data were only available for 2019 and 2020. Z-test and Chi-square analyses were performed to compare counts and proportions across groups and years. All analyses were performed using SAS 9.4 (Cary, NC). Results: Between 2016 and 2020, 195,499 emergency room visits with a primary diagnosis of HMB were identified out of 164,441,890 total ED visits (0.12% of visits). The patient mean (SD) age was 33.7 (0.1) years. Total ED visits per year for HMB declined from 42,462 in 2016 to 33,718 in 2020. Self-pay represents a disproportionately high share of admissions. Approximately 6% of patients who presented to the ED with HMB were admitted which was stable from 2016-2020. Patients age 21-25 years represented the highest proportion of ED visits for HMB with 21.5% versus 12.2% among those ages 46-50 years. However, patients age 46-50 years accounted for 24.6% of admissions versus 6.3% of admissions for those aged 21-25 years. Patients 46-50 years had the highest admission rate (13.2%) versus 1.9% for ages 21-25 years. HMB related charges were over $150,000,000 per year, with a median charge per visit of over $3,000. For the two years for which race data were available, White women (WW) represented 41.2% of HMB visits versus 50.6% of all other diagnoses visits; Black women (BW) represented 28.6% of HMB ED visits versus 25.6% of all other diagnoses, and Hispanic women (HW) 22.1% of HMB ED visits versus 17.2% of all other diagnoses. Of the patients that were admitted for HMB, 31% were White versus 51% of all other diagnoses admissions, 33% were Black compared to 23% of all other diagnoses admissions, and 28% were Hispanic versus 18% of all other diagnoses admissions. Admission rates were higher for Black/Hispanic/Asian-Pacific Islanders (7.6%, 8.2%, 9.1%) vs. WW (4.9%). Percentage of ED visits for HMB for BW and HW were 29% and 22% respectively which compared to 25.6% and 17.2% of visits for all other diagnoses. Conclusion: ED visits with HMB as a primary diagnosis represent a small percent of visits overall and are decreasing. However, Black and Hispanic patients make up a disproportionate percentage of HMB patients. In addition, there is an inverse relationship with respect to age between ED visits and admissions. Younger adults ages 21-25 years make up the highest percentage of ED visits by age, but they are the least likely to be admitted with an admission rate of 1.9% suggesting an opportunity to better leverage an outpatient visit setting for this demographic. This analysis serves as a first step to understand ED utilization for HMB, and suggest potential disparities in ED utilization and/or admissions for HMB by age and race. Given the overall low admission rate, there may be an opportunity to improve outpatient services for HMB in younger women and in Black and Hispanic women.

Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece.

Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with "F20-29 schizophrenia, schizotypal and delusional disorders" were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor's Office of regions that are located far from the psychiatric department of UGHA (Fisher's exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an "F20-29 schizophrenia, schizotypal and delusional disorders" diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.

Investigating the association between characteristics of local crisis care systems and service use in an English national survey.

In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.

A descriptive cross sectional study of job satisfaction among pharmacists in a clinical setting

Background: Job satisfaction has been linked to improved job performance. Pharmacists as key healthcare providers with the ultimate duty of improving and maintaining the quality of life through the responsible provision of drug therapy, are expected to be highly productive. Low performance by Pharmacists can result to loss of lives especially through undetected actual and potential drug therapy problems which have been documented to be associated with high mortality and high rate of hospital admissions. Job satisfaction is the feeling of fulfilment that employees derive from their job which has a significant deal on their productivity. Assessing Pharmacists’ job satisfaction is therefore very paramount. Objective: This study accessed job satisfaction among Pharmacists working in a tertiary hospital and identified factors affecting job satisfaction among the study population Method: The study was a descriptive cross sectional study that employed the use of questionnaires as a research instrument for data collection with 30 participants completing the questionnaires. Simple percentages were used to analyse demographic characteristics and level of satisfaction. Relationship between variables was tested using chi square. Level of significance was measured at 95% confidence interval (p=0.05) Result: There was male participants’ preponderance (76.7%). Majority of the participants had practice years between 11-20 years (56.7%). 63.3% had Masters Degrees, 93.3% were Christians and 80% married. Level of job satisfaction was 33.3% among the participants. Hospital culture (76.7%), work environment (60%), reward system (60%) and remuneration (53.3%) were found to be factors recorded with the highest level of dissatisfaction. The Pharmacists were some-what satisfied with how their contribution were valued and the value placed on them by the organisation (53.3% each). However, satisfaction with their position was moderate (40.0%). Conclusion: Hospital pharmacists are important healthcare professionals that play critical roles in determining the effectiveness, efficiency, and sustainability of health care systems vial the delivery of pharmaceutical services. Showing concerns for Pharmacists welfare is an important factor to enhancing their job satisfaction with resultant improvement in the quality healthcare delivery. It is paramount that Government of Nigeria upgrades the remuneration of Pharmacists and provides conducive work environment as these would enhance productivity and effective pharmaceutical delivery to our teeming patient population.

Suburban Blues: Urbanicity, healthcare service mix and spatial patterns of admissions for depression

Abstract Objectives Medical practice variation is a key target for policy makers aiming to improve the efficiency of healthcare delivery. Studies point to strong regional variation in healthcare utilization in Austria which seems to be a by-product of institutional rules and healthcare service mix rather than variance in epidemiology. Methods We use a set of routine healthcare data on hospital admissions for depressive episodes (ICD-10 F320-F329) of adult Austrian patients from 2009 to 2014 on the municipality level to explore spatial patterns of supply-induced demand by nearby hospitals (“Roemer's law”) in hospital admission rates. The dataset covers 99,844 hospital episodes of 69,555 patients in 2,114 municipalities. We estimate a random effects spatial autoregressive model to regress log hospital admission rates on hospital supply and urbanicity as proxies for the municipalities’ healthcare service mix alongside a set of relevant socio-economic/-demographic characteristics. Preliminary results Hospital admission rates per 1,000 inhabitants in the population for depressive episodes vary strongly between municipalities (min=0, max=37.7, mean=1.9, SD = 1.8). We find higher admission rates in the population of suburban municipalities (0.10, 95%-CI: 0.58 - 0.13) and municipalities with hospitals (0.07, 95%-CI: 0.01 - 0.1), regardless of hospital type and size. The spatial structure suggests positive spill-over effects on the hospital admission rates between neighbouring municipalities. Conclusions Our results suggest that high admission rates are a seemingly suburban phenomenon and that healthcare service mix is a driving factor for admission rates. Though it is not clear whether the regional variation in medical practice reflects under- or oversupply of hospital care, promoting timely access to primary care and early-stage treatments may reduce the burden of avoidable hospitalizations for patients and public budgets, and close a gap of unmet need for care of vulnerable populations. Key messages • Hospital admission rates for depression of adults per 1,000 inhabitants in the population for depressive episodes vary strongly between municipalities. • Hospital supply and urbanicity are major driving factors of the spatial patterns in regional varation of hospital admissions.

SAT351 Utilization of Emergency Services by Transgender People in the United States, 2006-2018

Abstract Disclosure: D. Stroumsa: None. E.E. Marsh: None. P.N. Pfeiffer: None. C. Jiang: None. A. Vrolijk: None. M.B. Moravek: None. Bridging the Gap: Utilization of Emergency Services by Transgender People in the United States, 2006-2018Introduction: Transgender or nonbinary (Trans) people face significant health disparities, including in access to primary and preventive care. These disparities are driven by structural, interpersonal, and individual stigma, which lead to barriers accessing care and avoidance of primary care, and to increased reliance on emergency care. We aimed to characterize ED use by Trans patients, and changes in such use over time. Methods: Data was obtained from the Nationwide Emergency Department Sample (NEDS) , which is a weighted stratified sample of hospital-based ED visits. Using gender-dysphoria related ICD-9 and ICD-10 diagnostic codes, we compared visits among trans people to those without such a diagnosis, adjusting for age, region, urbanicity, primary payer, and income quartile. We evaluated rates of chronic condition and mental health conditions as primary diagnosis at presentation and at admission. Presence of chronic conditions was assessed using the ICD-9 Chronic Condition Indicator for 2006-2014. Results: There was a rapid temporal increase in the proportion of visits with a trans-related diagnosis, from 0.001% of visits in 2006 to 0.016% in 2018. There were significant demographic differences between trans people and others. Trans people were significantly more likely to be admitted, adjusting for payment, age group, region, income and mental health condition (overall 52.4% vs. 17.3%, adjusted OR= 7.368 95% CI (6.771, 8.017)). A large proportion of ED visits by trans individuals was associated with a mental health diagnosis (28.7%, compared with 3.9% for others, p&amp;lt;0.001; adjusted OR =2.01, 95% CI 1.91-2.11) and/or with a chronic condition (58.2% vs. 19.2%, p&amp;lt;0.001; adjusted OR =3.65, 95% CI 3.61-3.69). Similarly, hospital admission among trans people was much more likely to be linked to a mental health condition (37.2% vs. 5.3% , p&amp;lt;0.001; adjusted OR = 2.78, 95% CI 2.44-3.16) or chronic condition (67.3% vs 41.3%, p&amp;lt;0.001; adjusted OR = 2.21, 95% CI 1.78-2.75) Discussion: The high admission rates, and high proportion of trans people with a chronic condition or with mental illness, may represent worse overall health due lack of primary care, or a delay in seeking emergency care among Trans people. Lastly, these findings could be a manifestation of a higher likelihood of a trans-related diagnostic code being charted among trans people at admission, or bias towards higher likelihood of trans people receiving a mental-health related diagnosis. There is a need for increasing access to affirming primary and mental health care among trans people, and increased training of emergency clinicians. Presentation Date: Saturday, June 17, 2023

Protocolo terapéutico de la agudización de la EPOC en urgencias

Chronic obstructive pulmonary disease (COPD) is a chronic disease that requires a multidisciplinary approach. It has a big impact in terms of morbidity and mortality as well as healthcare costs. It is one of the main causes of mortality worldwide and accounts for 2% of emergencies attended to. COPD exacerbation has a high admission rate: around 40%. Management of exacerbations in emergency departments have implications not only on time-dependent care of the disease itself, but also on the prognosis. In addition to being aware of its seasonal variability and risk factors, this training update through clinical practice guidelines is fundamental in caring for patients who have COPD exacerbations.

The relationship between corona phobia and burnout in critical care nurses during the COVID-19 pandemic: A narrative review

Corona phobia is a term used to explain apprehension and fear associated with COVID-19. Meanwhile, nurses, particularly those working in intensive care units, have a higher frequency of corona phobia and related consequences. Due to the significant prevalence of burnout during the COVID-19 pandemic, this narrative review was conducted to summarize all published articles about the relationship between corona phobia and burnout in critical care nurses during the COVID-19 pandemic. A literature search was conducted using keywords extracted from medical subject headings such as “Corona Phobia”, “Burnout”, “Critical Care Nurses”, and “COVID-19” through online electronic databases including PubMed, Scopus, Web of Science, and Embase from December 1, 2019 to May 12, 2023. Finally, 15 studies met our inclusion criteria. Fainting, tonic immobility, sleeplessness, despair, traumatic stress, hopelessness, and suicidal thoughts are all symptoms associated with corona phobia. Among the reasons for the high incidence of corona phobia among intensive care nurses the high rate of patient admission, workload, and death were mostly mentioned. With these interpretations and considering that several studies pointed to a positive relationship between corona phobia and job burnout, it can be said that the rate of job burnout in nurses in intensive care units during the COVID-19 era was higher than in other nurses. As stated in the research results, a strong correlation exists between corona phobia and occupational burnout. Corona phobia was significantly associated with job positions, professional experience in caring for infectious patients, hospital resources, age, marital status, duration of employment, and degree of education.

The burden of hospital admissions for skeletal dysplasias in Sri Lanka: a population-based study

BackgroundSkeletal dysplasias are a diverse group of rare disorders in the chondro-osseous tissue that can have a significant impact on patient’s functionality. The worldwide prevalence of skeletal dysplasias at birth is approximately 1:5000 births. To date, disease burden and trends of skeletal dysplasias in the Sri Lankan population have not been described in any epidemiological study. Our aim was to evaluate the burden and the current trends in hospital admissions for skeletal dysplasias in the Sri Lankan population. A retrospective evaluation of hospital admissions for skeletal dysplasia during 2017–2020 was performed using population-based data from the eIMMR database which covers government hospitals in the entire country. The trends in hospital admissions for skeletal dysplasias by calendar year, age, and types of skeletal dysplasia were described using appropriate summary statistics.ResultsRespective crude admission rates of skeletal dysplasias in the years 2017, 2018, 2019 and 2020 were 5.2, 8.1, 8.0, and 6.5 per million population. A female predominance (1.4:1) was noted during the studied period. Of all reported cases the majority (n = 268; 44.2%) were children less than 4 years. Each year, 0–4 years age group represented 40–47% of the total hospital admissions. More than half of the cases were reported from Colombo (28.1%) and Kandy (25.4%) districts combined. 60% of cases were diagnosed as osteogenesis imperfecta (OI). Rising trends were observed in the hospital admissions for osteogenesis imperfecta, achondroplasia and osteopetrosis, while other skeletal dysplasia types collectively showed a relatively stable trend.ConclusionThis preliminary study revealed a female predominance of skeletal dysplasias and a relatively high admission rate of osteogenesis imperfecta in the Sri Lankan population. A distinct trend was not visible in the studied years probably due to the impact on hospital services due to COVID- Pandemic. Future research on the healthcare burden on families affected by skeletal dysplasia is required to better understand the overall cost of care and identify therapies that reduce admission rates. This study highlights the value of analysing population-based data on rare diseases to improve healthcare in low-resource countries.

Prevalence and predictors of admission at the time of presentation in first episode psychosis.

Individuals presenting with first episode psychosis (FEP) constitute a population with high admission rates. Across psychiatric services, community based treatment is aimed for where appropriate. Therefore, further knowledge on predictors of admission is required. The objectives were to: (i) determine the proportion of individuals with FEP admitted at time of presentation (voluntarily and involuntarily) (ii) identify associated demographic and clinical factors. This study included all young people (aged 15-24) who presented with FEP to the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia from 01.01.11 to 31.12.16. Binary logistic regression was used to determine unadjusted and adjusted odds ratios. Of 1208 participants, 58.6% were male and the median age was 20years (I.Q.R.17-22). At time of presentation, 50.2% were admitted. On multivariate analysis, the following factors predicted admission: being a migrant (OR = 1.75, 95% CI [1.17, 2.62]), aggression (OR = 1.42, 95% CI [1.02, 1.99]), and more severe psychotic symptoms. Longer duration of untreated psychosis was associated with lower admission rates. 70.1% of admissions were involuntary (33.7% of the cohort). Risk factors for involuntary admission were consistent with any admission, other than aggression, and with the addition of older age and male sex. There remains a high admission rate for FEP, even in an established early intervention service, with severity of psychopathology being the strongest predictive factor. There is an independent association between migrancy and admission. Potential reasons for these findings are discussed, and initiatives to reduce admission rates including (i) interventions to prevent admission and (ii) alternative care pathways.