Higher Hospital Readmission Rates Research Articles

The effect of social deprivation on hospital utilization following shoulder arthroplasty

BackgroundDisparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following shoulder arthroplasty. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty. MethodsA retrospective review was performed from of a single institution’s experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared. ResultsA total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls. ConclusionPatients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery.

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.

COMPREHENSIVE MALNUTRITION ASSESSMENT IMPROVES HEALTH OUTCOMES AMONG HOMEBOUND OLDER ADULTS

Abstract Approximately 30 percent of older adults are malnourished upon hospital admission while others develop malnutrition during hospitalization and subsequent discharge. High hospital readmission rates are associated with malnutrition. Malnutrition is common among older adults discharged to home and receiving home delivered meals. However, there is limited research on the appropriate malnutrition care for this population. The aim of this study was to investigate the effectiveness of a novel social determinants of health (SDOH)-based comprehensive malnutrition assessment (CMA) on malnutrition treatment and functionality. A pilot study of 46 participants recruited from northern Utah Area Agencies on Aging Nutrition Programs was conducted. The SDOH-CMA was performed during home visitations by a registered dietitian nutritionists for both the intervention and control groups over a six-month period. Logistic regression was then conducted to compare the effect of the SDOH-based CMA on malnutrition as assessed by the Nutrition-Focused Physical Exam (NFPE) between intervention and control groups. Odds ratios (OR) with p values were reported. At baseline, 91.4% of participants were white, 54% were female, 76% were unmarried, 67% lived below the federal poverty level, 61% lived alone, 51% received home health, 51% had anxiety, 33% had PHQ-2 screened depression, 22% were unable to cook, and 13% were unable to shop. The intervention group had significant improvements in the NFPE (OR=10.1, p=.02), calorie intake (OR= 19.6, p=.02), protein intake (OR=36.7, p =.007) and the Timed Up and Go test (OR=7.7, p=.05) than the control group. The intervention was significantly effective in improving nutritional status and functionality.

Characteristics and Percentage of 30 Days All Cause Hospital Readmissions in Mongolia

Objective: This study aimed to estimate the 30 days readmissions and predictors of readmission at selected referral hospitals in Mongolia. Methods: We studied the electronic medical recording database of patients admitted to The State First Central Hospital of Mongolia, The State Second Central Hospital of Mongolia, and The State Third Central Hospital of Mongolia, from January 01, 2023, to June 30, 2023. The Institute for Healthcare Improvement’s Whole system measures white paper adopted the measurement methods for hospital readmission percentages. A descriptive analysis was conducted to calculate the percentage of hospital readmissions. We examined principal diagnoses, length of stay and age and gender are variables. Results: 31,675 hospital discharged data were recorded in hospitals over the 6-month study period. The average readmission percentage across the three hospitals were 1988 (6.3%). Most of the principal diagnosis leading to readmissions were cancer and chronic diseases.Conclusion: The highest hospital readmission rates were observed in patients with cancer and chronic diseases, particularly among individuals aged 46-64 years in the referral hospitals.

Timing of Pediatric Incarcerated Inguinal Hernia Repair: A Review of Nationwide Readmissions Data

IntroductionIn pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in appropriate patients, repair may be safely deferred. MethodsThe Nationwide Readmissions Database was used to identify pediatric patients (aged < 18 y) with incarcerated inguinal hernia from 2010 to 2014. Patients were stratified by management approach (Early Repair versus Deferral). Overall frequencies of these operative strategies were calculated. Propensity score matching was then performed to control for patient age, comorbidities, perinatal conditions, and congenital anomalies. Outcomes including complications, surgical procedures, and readmissions were compared. Outpatient surgeries were not assessed. ResultsAmong 6148 total patients with incarcerated inguinal hernia, the most common strategy was to perform Early Repair (88% versus 12% Deferral). Following propensity score matching, the cohort included 1288 patients (86% male, average age 1.7 ± 4.1 years). Deferral was associated with equivalent rates of readmission within one year (13% versus 15%, P = 0.143), but higher readmissions within the first 30 days (7% versus 3%, P = 0.002) than Early Repair. Deferral patients had lower rates of orchiectomy (2% versus 5%, P = 0.001), wound infections (< 2% versus 2%, P = 0.020), and other infections (7% versus 15%, P < 0.001). The frequency of other complications including bowel resection, oophorectomy, testicular atrophy, sepsis, and pneumonia were equivalent between groups. Three percent of Deferrals had a diagnosis of incarceration on readmission. ConclusionsDeferral of incarcerated inguinal hernia repair at index admission is associated with higher rates of hospital readmissions within the first 30 days but equivalent readmission within the entire calendar year. These patients are at risk of repeat incarceration but have significantly lower rates of orchiectomy than their counterparts who undergo inguinal hernia repair at the index admission. We propose that prospective studies be performed to identify good candidates for Elective Deferral following manual reduction and overnight observation. Such studies must capture outpatient surgical outcomes.

Impact of Preexisting Depression and Anxiety on Hospital Readmission and Long-Term Survival After Cardiac Arrest.

While sudden cardiac arrest (CA) survivors are at risk for developing psychiatric disorders, little is known about the impact of preexisting mental health conditions on long-term survival or postacute healthcare utilization. We examined the prevalence of preexisting psychiatric conditions in CA patients who survived hospital discharge, characterized incidence and reason for inpatient psychiatry consultation during these patients' acute hospitalizations, and determined the association of pre-CA depression and anxiety with hospital readmission rates and long-term survival. We hypothesized that prior depression or anxiety would be associated with higher hospital readmission rates and lower long-term survival. We conducted a retrospective cohort study including patients resuscitated from in- and out-of-hospital CA who survived both admission and discharge from a single hospital between January 1, 2010, and December 31, 2017. We identified patients from our prospective registry, then performed a structured chart review to abstract past psychiatric history, prescription medications for psychiatric conditions, and identify inpatient psychiatric consultations. We used administrative data to identify readmissions within 1 year and vital status through December 31, 2020. We used multivariable Cox regressions controlling for patient demographics, medical comorbidities, discharge Cerebral Performance Category and disposition, depression, and anxiety history to predict long-term survival and hospital readmission. We included 684 subjects. Past depression or anxiety was noted in 24% (n = 162) and 19% (n = 129) of subjects. A minority of subjects (n = 139, 20%) received a psychiatry consultation during the index hospitalization. Overall, 262 (39%) subjects had at least 1 readmission within 1 year. Past depression was associated with an increased hazard of hospital readmission (hazard ratio 1.50, 95% CI 1.11-2.04), while past anxiety was not associated with readmission. Neither depression nor anxiety were independently associated with long-term survival. Depression is an independent risk factor for hospital readmission in CA survivors.

Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study.

SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. The study used a quasi-experimental pre-test-post-test design. The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.

339. OPAT Outcomes in Patients with Immunocompromise

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows patients to complete intravenous (IV) or high risk oral medications outside the acute inpatient setting. Data regarding OPAT in patients with immunocompromise (PWIC) are sparse. PWIC represent a vulnerable population due to underlying comorbidities. This study evaluated OPAT clinical outcomes in PWIC at an academic medical center. Methods This was a retrospective chart review of adult PWIC enrolled in our OPAT program between 1/2015-3/2023. Immunocompromising conditions included HIV/AIDS, stem cell or solid organ transplant, hematologic malignancy, solid tumor, or receipt of immunosuppressing medications. All patients were under the care of an immunocompromised ID specialist. Data collected included patient demographics, infection information, and OPAT outcomes including completion rates, readmission rates, OPAT failure, and death. OPAT failure was defined as death, 30-day infection-related readmission or 30-day OPAT-related complication. This study was exempt by the Institutional Review Board. Results 50 patients were included. Demographics are in Table 1. Most (68%) patients completed OPAT therapy in the home, with 82% of courses being IV-only. Most (72%) patients received 1 antimicrobial agent, but 20% received 2 and 8% received 3 agents. The most common agents were daptomycin, ertapenem, and vancomycin. Infection information is in Table 2. Bloodstream infections and osteomyelitis were the most common. Most (82%) patients had an organism identified: 51% were Gram positive, with Staphylococci the most prevalent. Cytomegalovirus was the reason for OPAT in 4 patients. OPAT outcomes are in Table 3. OPAT failure occurred in 9 patients, including 1 death and 8 OPAT-related readmissions. Most (68%) patients completed the OPAT course within the specified time. Hospital readmissions were common: 46% had at least 1 readmission, though most readmissions were unrelated to OPAT. Vascular device issues and adverse drug reactions occurred in 12% and 20%, respectively. Conclusion OPAT can be safely performed in PWIC with completion and complication rates comparable to non-immunocompromised cohorts. We observed high hospital readmission rates (46%) though a minority of readmissions were due to OPAT related issues. Disclosures Monica V. Mahoney, PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, BD Biosciences: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Grant/Research Support|Open Forum Infectious Diseases: Board Member|Open Forum Infectious Diseases: Associate Editor|Pfizer: Advisor/Consultant Carolyn D. Alonso, MD, Academy for Continued Healthcare Learning: Honoraria|AiCuris: Advisor/Consultant|American Society of Healthcare Pharmacists: Honoraria|Cidara Therapeutics: Advisor/Consultant|Clinical Care Options: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support

A 15-year review of characteristics and outcomes of patients leaving against medical advice

PurposeDischarging against medical advice can have significant, detrimental effects on burn patient outcomes as well as higher hospital readmission rates and healthcare expenditures. The goal of this study is to identify characteristics of patients who left against medical advice and suggest solutions to mitigate these factors. Data were collected at our American Burn Association verified Burn Unit over a 15-year period. ResultsBetween 2007 and 2022, 37 patients were identified as having left against medical advice from the burn unit. The average patient age was 37 years old with 64.9% being male, and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. The mechanism of injury was most commonly frostbite (43.2%). The majority sustained < 1% total body surface area injuries. Most (83.7%) had social work and/or case management involved during their admission, and all (100%) had their involvement if the length of admission was greater than one day. Over half (59.5%) returned to the ED within 2 weeks with complications. ConclusionsThis study found that patients discharging against medical advice from the burn unit suffered from smaller injuries, often due to cold related injuries. These patients had comorbid substance abuse or psychiatric histories, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care.

Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders.

Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms ofblood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include aprolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation ratesandhigher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties anddevelop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.

Comparing Machine Learning Classifiers for Predicting Hospital Readmission of Heart Failure Patients in Rwanda.

High rates of hospital readmission and the cost of treating heart failure (HF) are significant public health issues globally and in Rwanda. Using machine learning (ML) to predict which patients are at high risk for HF hospital readmission 20 days after their discharge has the potential to improve HF management by enabling early interventions and individualized treatment approaches. In this paper, we compared six different ML models for this task, including multi-layer perceptron (MLP), K-nearest neighbors (KNN), logistic regression (LR), decision trees (DT), random forests (RF), and support vector machines (SVM) with both linear and radial basis kernels. The outputs of the classifiers are compared using performance metrics including the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. We found that RF outperforms all the remaining models with an AUC of 94% while SVM, MLP, and KNN all yield 88% AUC. In contrast, DT performs poorly, with an AUC value of 57%. Hence, hospitals in Rwanda can benefit from using the RF classifier to determine which HF patients are at high risk of hospital readmission.

Comparison of 30-day readmission rates and 1-year mortality of cardiovascular disease between Australian- and overseas-born residents: a large cohort study of older Australian adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is prevalent, causing high hospital readmission rates and mortality. Social determinants of health such as ethnicity and cultural background are known to influence CVD outcomes. However, comparisons of CVD outcomes between Australian- and overseas-born residents for 30-day readmissions and mortality patterns in ischemic heart disease (IHD), heart failure (HF) and stroke, are not well understood. Purposes This study aimed to compare 30-day readmission after hospitalisation due to IHD, HF or stroke and 1-year CVD mortality across three country of birth groups (Australian-born, born in English-speaking countries and born in non-English-speaking countries). Methods The study group was drawn from the 45 and Up cohort, Australia’s largest ongoing study of health and ageing, consisted of participants free of IHD, HF and stroke at baseline who were admitted to hospital for a CVD-related diagnosis after baseline, linked with hospital admissions (mean follow-up time 11.2 years) and mortality data (mean follow-up time 9.9 years). Risk ratios for 30-day readmission and 1-year CVD mortality across three country of birth groups (Australia, English-speaking countries other than Australia, and non-English-speaking countries) were calculated using binary logistic regression, adjusting for age, sex, socioeconomic status, marital status, age at migration and education. Results A total of 39,458 participants were analysed with a mean age of 66.5, of which 54% were male, 13% and 10% were born in English-speaking countries other than Australia and non-English-speaking countries, respectively. The crude rates for 30-day readmission and 1-year CVD mortality of the overall sample were 32 per 100 and 2.6 per 100. Compared to Australian-born participants, those born in English-speaking countries had a 7 % lower risk of 30-day readmission (RR: 0.93, 95% CI: 0.87-0.99), and those born in non-English-speaking countries had a 16% lower risk (RR: 0.84, 95 CI: 0.78-0.91). No evidence of an association between country of birth and 1-year CVD mortality was found. Conclusion Overseas-born Australians regardless of English-language background have a lower risk of 30-day readmission compared to those who are Australian-born when sociodemographic characteristics are adjusted for. However, the 45 and Up Study questionnaire was available only in English. Residents born in non-English-speaking countries with limited English skills were thus less likely to be involved in this study. Further studies should consider other characteristics and potential explanations for this benefit.

Blood transfusion for children in sub-Saharan Africa: 200 years on

In 1818, James Blundell completed the first successful human blood transfusion. This life-saving medical intervention has revolutionised patient care globally in the past two centuries. Nevertheless, many challenges remain in implementing safe blood transfusion procedures, particularly in sub-Saharan Africa 1 Ala F Allain JP Bates I et al. External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection. PLoS Med. 2012; 9e1001309 Crossref PubMed Scopus (53) Google Scholar where demand predominantly centres on acute paediatric severe anaemia and haemorrhagic complications of pregnancy and trauma. Severe anaemia, when the haemoglobin concentration drops below 6 g/dL, is very common in children admitted to hospital in sub-Saharan Africa. Infectious diseases, nutritional deficiencies, and sickle cell anaemia are the major underlying causes of anaemia. Outcomes remain unsatisfactory, with high mortality and high hospital readmission rates within 6 months of initial admission. 2 Phiri KS Calis JC Faragher B et al. Long term outcome of severe anaemia in Malawian children. PLoS One. 2008; 3e2903 Crossref PubMed Scopus (75) Google Scholar World Blood Donor Day on June 14, 2023, calls for donors to “Give blood, give plasma, share life, share often”. Not only is this a day to celebrate the charitable contributions of blood donors, it is an important opportunity to raise awareness that every pint of blood donated results in critically important life-sustaining therapy, especially for children in sub-Saharan Africa.

101 A 15-Year Review of Risk Factors and Outcomes of Burn Patients Leaving Against Medical Advice

Abstract Introduction Discharging against medical advice (AMA) can have significant, detrimental effects on burn patient outcomes. Prior studies in non-burn injured patients have found that patients who leave AMA have a higher risk for adverse 30-day and 12-month outcomes, as well as higher hospital readmission rates and healthcare expenditures, in comparison to patients who are discharged to home in a conventional manner. The goal of this study is to identify risk factors for burn patients who left AMA and suggest solutions to mitigate these factors. Methods Data was collected at a Level 1 Trauma Center over a 15 year period (2007-2022). Patients who left AMA from the burn center were identified using discharge patient codes. Demographic information was collected, including: age, sex, past medical and substance use history, insurance status, and language barriers. Additional information was recorded, including: time to presentation, mechanism of injury, total body surface area (TBSA) burned, burn depth, number of ICU days, length of stay, treatment, consultant teams, readmission and/or known complications after leaving the hospital. Descriptive statistics were used to determine potential trends within this patient population. Results Over 2007-2022, 37 patients were identified as having left AMA from the burn unit. The average patient age was 37-years-old. Of those who left AMA, 64.9% were male and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. In regards to the type of injury, 43.2% presented due to a frostbite injury, with the majority of AMA patients sustaining a &amp;lt; 1% TBSA burn. Most (83.7%) had social work and/or case management involved during their admission and all (100%) had their involvement if the length of admission was greater than one day. Almost half (48.6%) returned to the ED within 2 weeks with complications relating to pain, need for dressing change, or infection. Conclusions Leaving AMA is associated with greater patient morbidity, including higher rates of hospital readmission and subsequently, higher healthcare expenditures. This study found that burn patients leaving AMA were more likely to suffer from small (&amp;lt; 1% TBSA) burns, often related to frostbite injuries. These patients were more likely to have substance abuse, a psychiatric history, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care. Applicability of Research to Practice Recruiting interdisciplinary team members to meet with patients at higher risk for leaving AMA, including those with small burns, substance use history, or psychiatric diagnoses may be useful to help lower the incidence of AMA discharges within the burn unit.

The Association of Hearing Loss with Hospitalization.

Individuals with hearing loss (HL) are at higher risk for hospitalizations, and may be for readmissions, compared with their hearing peers. The objective of this prospective study was to confirm retrospective studies suggesting that HL increases hospital readmissions, and, if confirmed, possible causes for it. A prospective cohort study of English-speaking patients >55 years old admitted to general medical and surgical floors at 2 large hospital systems in southeastern Michigan over a 2-year period was conducted. All patients underwent bedside audiometric testing. HL presence and severity were categorized using World Health Organization pure tone assessment parameters. Readmission rates, Charlson comorbidity index, socio-demographic and medical variables were obtained from Epic EMR databases. There were 1247 hospitalized patients enrolled. Of these, 76.8% had documented HL of which 50.5% (630) was mild HL and 26.3% (328) moderate or worse HL. Patients with any HL were older and more likely to be non-Hispanic, white, male, and had less education, lower health literacy, more comorbidities, and more difficulty communicating with their doctor. Readmission rates at 30 and 90-days were similar between HL and hearing groups, after adjusting for HL severity, Charlston index, and numerous potential confounders. Patients with HL do not seem to have higher rates of hospital readmissions. We did find high frequency of HL in hospitalized patients along with significant communication difficulties that patients had with their clinicians. These findings have implications for measures to improve patient-physician communication, potentially improving long-term health outcomes.

Passing the SNF Test: A Secondary Analysis of a Sepsis Transition Intervention Trial Among Patients Discharged to Post-Acute Care.

Sepsis survivors discharged to post-acute care facilities experience high rates of mortality and hospital readmission. This study compared the effects of a Sepsis Transition and Recovery (STAR) program vs usual care (UC) on 30-day mortality and hospital readmission among sepsis survivors discharged to post-acute care. Secondary analysis of a multisite pragmatic randomized clinical trial. Sepsis survivors discharged to post-acute care. We conducted a secondary analysis of patients from the IMPACTS (Improving Morbidity During Post-Acute Care Transitions for Sepsis) randomized clinical trial who were discharged to post-acute care. IMPACTS evaluated the effectiveness of STAR, a nurse-navigator-led program to deliver best practice post-sepsis care. Subjects were randomized to receive either STAR or UC. The primary outcome was 30-day readmission and mortality. We also evaluated hospital-free days alive as a secondary outcome. Of 691 patients enrolled in IMPACTS, 175 (25%) were discharged to post-acute care [143 (82%) to skilled nursing facilities, 12 (7%) to long-term acute care hospitals, and 20 (11%) to inpatient rehabilitation]. Of these, 87 received UC and 88 received the STAR intervention. The composite 30-day all-cause mortality and readmission endpoint occurred in 26 (29.9%) patients in the UC group vs 18 (20.5%) in the STAR group [risk difference-9.4% (95% CI-22.2 to 3.4); adjusted odds ratio 0.58 (95% CI 0.28 to 1.17)]. Separately, 30-day all-cause mortality was 8.1% in the UC group compared with 5.7% in the STAR group [risk difference-2.4% (95% CI-9.9 to 5.1)] and 30-day all-cause readmission was 26.4% in the UC group compared with 17.1% in the STAR program [risk difference-9.4% (95% CI-21.5 to 2.8)]. There are few proven interventions to reduce readmission among patients discharged to post-acute care facilities. These results suggest the STAR program may reduce 30-day mortality and readmission rates among sepsis survivors discharged to post-acute care facilities.

MP51-06 SAFETY AND EFFICACY OF GREENLIGHT PVP IN OCTOGENARIANS: EVALUATION OF THE GLOBAL GREENLIGHT GROUP DATABASE

MP51-06 SAFETY AND EFFICACY OF GREENLIGHT PVP IN OCTOGENARIANS: EVALUATION OF THE GLOBAL GREENLIGHT GROUP DATABASE

Risk of Complications in Patients Undergoing Complete Thyroidectomy. A Retrospective Study

Introduction: The main aim of this study was to determine the influence of surgery on postoperative complications in patients undergoing total thyroidectomy. Methods: Patients diagnosed with goiter and undergoing total thyroidectomy for more than ten years were retrospectively enrolled, and the main study outcomes were postoperative complications. Statistical analysis was done by chi-square and t-test with a p-value &lt;0.05 as significant. Results: A total of 116 patients with goiter were identified (mean age, 45.3 ± 8.75 years, with minimum and maximum age of 23 to 69). The most affected age with goiter resulted in 41-50 years old with 41.4% (95% CI, 37.4 to 45.8%). The majority of patients with goiter were women (85.3%), with a mean age of 47 years. After the thyroid surgery, male patients had significantly higher rates of hospital readmission than females with a risk ratio [RR] of 1.05; 95% CI [0.67–1.52], p-value = 0.02. Either hemorrhage/hematoma occurred in 4.7% and cardiopulmonary and thromboembolic events in 3.1% of the patients undergoing total thyroidectomy. In addition, either hypoparathyroidism was observed in 3.1% and temporary recurrent laryngeal nerve palsy (RLN) in 1.56%. Conclusion: The current study demonstrates that total thyroidectomy is associated with an increased rate of hemorrhagic complications. RLN palsies and hypoparathyroidism are less observed. Male patients undergoing thyroidectomy have higher rates of readmission and ICU admission. Furthermore, male patients revealed higher rates of hemorrhage and wound infection, while hypoparathyroidism or temporary recurrent laryngeal nerve palsy was more frequent among female patients.

Rapid triage and transition to telehealth for heart transplant patients in the COVID-19 pandemic setting.

In the setting of the COVID-19 pandemic, a rapid uptake of telehealth services was instituted with the aim of reducing the spread of disease to vulnerable patient populations including heart transplant recipients. Single-center, cohort study of all heart transplant patients seen by our institution's transplant program during the first 6 weeks of transition from in-person consultation to telehealth (23 March - 5 June 2020). Face-to-face consultation allocation strongly favored patients in the early post-operative period (34 vs. 242 weeks post-transplant; p < 0.001). Telehealth consultation dramatically reduced patient travel and wait times (80 min per visit saved in telehealth patients). No apparent excess re-hospitalization or mortality was seen in telehealth patients. With appropriate triage, telehealth was feasible in heart transplant recipients, with videoconferencing being the preferred modality. Patients seen face-to-face were those triaged to be higher acuity based on time since transplant and overall clinical status. These patients have the expected higher rates of hospital re-admission, and therefore should continue to be seen in person.

Structured handoff to improve communication from inpatient to outpatient dialysis units: A quality improvement project.

Patients with end-stage kidney disease requiring dialysis encounter high hospital readmission rates. One contributor is poor communication between hospitals and outpatient dialysis facilities. We hypothesized that improved communication may reduce 30-day hospital readmissions for patients on dialysis at an urban, safety net hospital. We created a standardized discharge handoff tool that is easy to use and provides concise data for dialysis centers. The handoff tool is a novel, electronic MACRO template (called a "dot-phrase") to be included in discharge documentation. Instructions for the dot-phrase and electronic facsimile (e-faxing) were sent to Internal Medicine residents immediately prior to their rotation on an inpatient Renal service. We then measured the intervention implementation rate and its impact on hospital readmission metrics. We compared 3 months of preintervention and 6months of postintervention data, identifying 82 and 135 index discharges in each respective study period. Patients were predominantly male (56.2%) and receiving hemodialysis (89.8%); a minority (9.2%) were undomiciled at the time of discharge. Mean age was 60.5 years (SD 14.0). Renal discharges followed by 30-day Renal readmission were not statistically lower in the postintervention group for the index discharge alone (26.8% vs. 20.0%, p=0.12), but were for overall discharges (51.2% vs. 25.7%, p < 0.0001). The dot-phrase was used in 95.4% of discharge summaries, and 74.7% of discharge summaries were e-faxed within 24 h of discharge. There was high uptake of a standardized discharge handoff tool among Internal Medicine residents on a Renal inpatient service. Using a handoff tool and e-faxing may improve communication with outpatient dialysis centers and may reduce readmissions among some patients but is likely insufficient to fully address high readmission rates. Subsequent intervention iterations would benefit from further collaboration with outpatient dialysis units for customization of the handoff tool to meet local communication needs.